Anglo-German Foundation for the Study of Industrial Society/ Deutsch-Britische Stiftung für das Studium der Industriegesellschaft 2003 Complementary and Alternative Medicine in the UK and Germany – Research and Evidence on Supply and Demand Anna Dixon, Annette Riesberg, Susanne Weinbrenner, Omer Saka, Julian Le Grand, Reinhard Busse Complementary and Alternative Medicine in the UK and Germany Research and Evidence on Supply and Demand 1,3 2,3 2 Anna Dixon , Annette Riesberg , Susanne Weinbrenner , 1 1 2,3 Omer Saka , Julian Le Grand , Reinhard Busse 1 LSE Health and Social Care, Department of Social Policy, London School of Economics and Political Science, London, United Kingdom 2 Department of Health Care Management, Institute of Health Sciences, Technische Universität, Berlin, Germany 3 European Observatory on Health Care Systems and Policies Anglo-German Foundation for the Study of Industrial Society © Anglo-German Foundation for the Study of Industrial Society COMPLEMENTARY AND ALTERNATIVE MEDICINE IN THE UK AND GERMANY Through its work in Germany and in the United Kingdom, the Anglo-German Foundation seeks to foster dialogue and co-operation between the two countries. It supports research projects, seminars and conferences promoting the exchange of experience and ideas in the social, political and economic areas. Die Deutsch-Britische Stiftung möchte mittels ihrer Tätigkeit in Deutschland und Grossbritannien den Dialog und die Zusammenarbeit der beiden Staaten fördern. Sie unterstützt gemeinsame Forschungsprojekte, Seminare und Konferenzen und setzt sich dabei besonders für den Erfahrungs- und Ideenaustausch im sozialen, politischen und wirtschaftlichen Bereich ein. © 2003 Anglo-German Foundation Anglo-German Foundation for the Study of Industrial Society/ Deutsch-Britische Stiftung für das Studium der Industriegesellschaft 34 Belgrave Square, London SW1X 8DZ Tel: +44 (0)20 7823 1123 Fax: + 44 (0)20 7823 2324 Website: www.agf.org.uk COMPLEMENTARY AND ALTERNATIVE MEDICINE IN THE UK AND GERMANY Contents List of figures iv List of tables iv Acknowledgements vi Executive summary viii PART I Complementary and alternative medicine in the UK and Germany 1 I.1 Introduction 3 I.1.1 Rationale 3 I.1.2 Aims 4 I.1.3 Research methods 5 I.2 Definitions and classifications 6 I.2.1 Defining complementary and alternative medicine and conventional medicine 6 I.2.2 Classifications and concepts within complementary and alternative medicine 8 I.2.3 Who are considered to be CAM providers? 9 I.2.4 What are considered to be CAM therapies? 11 I.2.5 Dictionary of CAM therapies 12 I.2.6 Sumary 13 I.3 Supply and demand in the United Kingdom and Germany: comparison and trends 14 I.3.1 Summary: country report United Kingdom 14 I.3.2 Summary: country report Germany 15 I.3.3 Discusion 16 i © Anglo-German Foundation for the Study of Industrial Society COMPLEMENTARY AND ALTERNATIVE MEDICINE IN THE UK AND GERMANY I.4 Methodological challenges 20 I.4.1 Scope of CAM 20 I.4.2 Time period specification 20 I.4.3 Training and registration 21 I.4.4 Expenditure and income data 21 I.5 Relevance for policy and future research 22 I.5.1 Policy issues 22 I.5.2 Scope for future research 23 I.6 Conclusions 26 References and bibliography 27 PART II Supply of and demand for complementary and alternative medicine in the United Kingdom: Country report 31 I.1 Methodology 3 II.1.1 Demand for CAM 33 II.1.2 Supply of CAM 37 II.2 Demand for and utilisation of CAM 44 II.2.1 Surveys on utilisation of CAM therapies/services 44 II.2.2 Surveys of CAM products 44 I.2.3 Demographics 45 II.2.4 Presenting problem/diagnosis 45 II.2.5 Reason for use 46 II.2.6 Reported out-of-pocket expenditure 46 I.2.7 Providers 47 II.3 CAM providers 48 I.3.1 Physicians 48 II.3.2 Other health care professionals 48 II.3.3 Registered CAM practitioners 49 II.3.4 Non-registered CAM providers (private market) 49 II.3.5 Employment and working conditions 50 ii © Anglo-German Foundation for the Study of Industrial Society COMPLEMENTARY AND ALTERNATIVE MEDICINE IN THE UK AND GERMANY II.4 CAM services 51 II.4.1. Health authorities 51 II.4.2 General practice fundholding 52 II.4.3 Primary care groups/primary care trusts 53 II.4.4 Inpatient services 53 II.5 CAM products 54 II.5.1 Over-the-counter medication 54 II.5.2 CAM products paid for by the NHS 54 I.5.3 Retailers 56 II.6 Service-provider-finance matrix 57 References 58 PART III Supply of and demand for complementary and alternative medicine in Germany: a country report 63 I.1 Methodology 65 III.2 Demand for and utilisation of CAM 67 III.2.1 Utilisation of CAM providers and services 67 III.2.2 Utilisation of CAM products 70 III.2.3 Reasons for use 72 III.2.4 Reported out-of-pocket expenditure 72 III.3 CAM providers 73 I.3.1 Physicians 73 III.3.2 Other health care professionals 79 III.3.3 State-registered CAM practitioners – Heilpraktiker 80 III.3.4 Non-registered CAM providers 81 III.4 CAM services 83 III.4.1 Ambulatory statutory health insurance benefits 83 III.4.2 Ambulatory services financed by statutory health insurance under certain conditions 85 III.4.3 Services financed by private health insurance or out of pocket 90 III.4.4 Inpatient services 92 iii © Anglo-German Foundation for the Study of Industrial Society COMPLEMENTARY AND ALTERNATIVE MEDICINE IN THE UK AND GERMANY III.5 CAM products 95 III.5.1 CAM medicines funded by statutory health insurance 96 III.5.2 Over-the-counter medication 97 I.5.3 Retailers 98 III.6 Service-provider-finance matrix 99 References and bibliography 101 APPENDICES Appendix 1: Authors 107 Appendix 2: Commonly used alternative terms for conventional medicine and CAM in English and German 108 Appendix 3: English–German/German–English dictionary of CAM therapies 109 3.1 English–German 109 3.2 German–English 1 List of figures Figure III.2.1 One-year prevalence (%) of utilisation of CAM specialists and physicians (x) in correlation to satisfaction with providers (y) 67 Figure III.2.2 Lifetime prevalence for selected therapies in Germany, 2000 69 Figure III.2.3 Influence of socio-demographic factors on lifetime prevalence of reported usage of natural remedies, 1970–2002 71 List of tables Table I.2.1 Classification of CAM providers in the UK and Germany 10 Table II.1.1 Utilisation studies of the general population: key methodological aspects 34 Table II.1.2 Utilisation studies of subpopulations in the UK: key methodological aspects 35 iv © Anglo-German Foundation for the Study of Industrial Society COMPLEMENTARY AND ALTERNATIVE MEDICINE IN THE UK AND GERMANY Table II.1.2 Utilisation studies of subpopulations in the UK: key methodological aspects (continued) 36 Table II.1.3 Utilisation studies of the general population in the UK: key findings 38 Table II.1.4 Utilisation studies of subpopulations in the UK: key findings 41 Table II.2.1 Treatment costs of therapies in the UK (£), 2000 47 Table II.5.1 UK CAM market 1996–2000 value (£ million) and percentage change 55 Table II.6.1 Combination of funding source and provider of CAM therapy in the UK 57 Table III.2.1 Lifetime prevalence of utilisation of CAM or CAM practitioners 68 Table III.2.2 Trends in prevalence of ‘natural remedies’ use in West Germany, 1970–202 70 Table III.2.3 Prevalence of ‘natural remedies’ use in East and West Germany 70 Table III.3.1 Qualifications in CAM and physical medicine among active physicians, 201 74 Table III.3.2 Trends in CAM and physical medicine qualifications among active physicians, 193–201 74 Table III.3.3 Gender distribution of active physicians qualified in CAM or physical medicine, 2001 75 Table III.3.4 CAM users with reimbursable CAM prescriptions by provider, 2002 76 Table III.3.5 Qualifications in CAM and physical medicine among physicians working in different settings, 1995 and 2001 78 Table III.3.6 Other health professions likely to provide complementary and/or physical therapies, 2000 79 Table I.3.7 Trends in the number of Heilpraktiker, 1993–2000 80 Table III.4.1 Surveys of reimbursement for unconventional methods and projected one-year case prevalence, 1999–2002 87 Table III.4.2 Reimbursement and extrapolated expenditure for unconventional methods, 19–20 87 Table III.5.1 Trends in prescriptions of herbal medicines for selected indications funded by statutory health insurance, 1992–2000 96 Table III.5.2 Over-the-counter sales of herbal medicines and total drugs by indication, 197–20 97 Table III.5.3 Number of retailers of pharmaceuticals, 2000 98 v © Anglo-German Foundation for the Study of Industrial Society