Complementary and Alternative Medicine in the UK and Germany – Research and Evidence on Supply and Demand - 2003

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Anna Dixon^{1, 3}, Annette Riesberg^{2, 3}, Susanne Weinbrenner², Omer Saka¹, Julian Le Grand¹, Reinhard Busse^{2, 3}

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 / Deutsch-Britische Stiftung für das Studium der Industriegesellschaft

Contents

Executive summary

PART I - Complementary and alternative medicine in the UK and Germany

I.1 Introduction

I.1.1 Rationale

I.1.2 Aims

I.1.3 Research methods

I.2 Definitions and classifications

I.2.1 Defining complementary and alternative medicine and conventional medicine

I.2.2 Classifications and concepts within complementary and alternative medicine

I.2.3 Who are considered to be CAM Providers?

I.2.4 What are considered to be CAM therapies?

I.2.5 Dictionary of CAM therapies

I.2.6 Summary

I.3 Supply and demand in the United Kingdom and Germany: comparison and trends

I.3.1 Summary: country report United Kingdom

I.3.2 Summary: country report Germany

I.3.3 Discussion

I.4 Methodological challenges

I.4.1 Scope of CAM

I.4.2 Time period specification

I.4.3 Training and registration

I.4.4 Expenditure and income data

I.5 Relevance for policy and future research

I.5.1 Policy issues

I.5.2 Scope for future research

I.6 Conclusions

References and bibliography

PART II - Supply of and demand for complementary and alternative medicine in the United Kingdom: Country report

II.1 Methodology

II.1.1 Demand for CAM

II.1.2 Supply of CAM

II.2 Demand for and utilisation of CAM

II.2.1 Surveys on utilisation of CAM therapies/services

II.2.2 Surveys of CAM products

II.2.3 Demographics

II.2.4 Presenting problem/diagnosis

II.2.5 Reason for use

II.2.6 Reported out-of-pocket expenditure

II.2.7 Providers

II.3 CAM Providers

II.3.1 Physicians

II.3.2 Other health care Professionals

II.3.3 Registered CAM practitioners

II.3.4 Non-registered CAM Providers (private market)

II.3.5 Employment and working conditions

II.4 CAM Services

II.4.1. Health authorities

II.4.2 General practice fundholding

II.4.3 Primary care groups/primary care trusts

II.4.4 Inpatient Services

II.5 CAM products

II.5.1 Over-the-counter medication

II.5.2 CAM products paid for by the NHS

II.5.3 Retailers

II.6 Service-provider-finance matrix

References

PART III - Supply of and demand for complementary and alternative medicine in Germany: a country report

III.1 Methodology

III.2 Demand for and utilisation of CAM

III.2.1 Utilisation of CAM Providers and Services

III.2.2 Utilisation of CAM products

III.2.3 Reasons for use

III.2.4 Reported out-of-pocket expenditure

III.3 CAM Providers

IIl.3.1 Physicians

III.3.2 Other health care Professionals

III.3.3 State-registered CAM practitioners - Heilpraktiker

III.3.4 Non-registered CAM Providers

III.4 CAM Services

IIl.4.1 Ambulatory statutory health insurance benefits

IIl.4.2 Ambulatory Services financed by statutory health insurance under certain conditions

IIl.4.3 Services financed by private health insurance or out of pocket

IIl.4.4 Inpatient Services

III.5 CAM products

III.5.1 CAM medicines funded by statutory health insurance

III.5.2 Over-the-counter medication

III.5.3 Retailers

III.6 Service-provider-finance matrix

References and bibliography

APPENDICES

Appendix 1: Authors

Appendix 2: Commonly used alternative terms for conventional medicine and CAM in English and German

Appendix 3: English-German/German-English dictionary of CAM therapies

3.1 English-German

3.2 German-English

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)

Figure III.2.2 Lifetime prevalence for selected therapies in Germany, 2000

Figure III.2.3 Influence of socio-demographic factors on lifetime prevalence of reported usage of natural remedies, 1970-2002

List of tables

Table I.2.1 Classification of CAM Providers in the UK and Germany

Table II.1.1 Utilisation studies of the general population: key methodological aspects

Table II.1.2 Utilisation studies of subpopulations in the UK: key methodological aspects

Table II.1.3 Utilisation studies of the general population in the UK: key findings

Table II.1.4 Utilisation studies of subpopulations in the UK: key findings

Table II.2.1 Treatment costs of therapies in the UK (£), 2000

Table II.5.1 UK CAM market 1996-2000 value (£ million) and percentage change

Table II.6.1 Combination of funding source and provider of CAM therapy in the UK

Table III.2.1 Lifetime prevalence of utilisation of CAM or CAM practitioners

Table III.2.2 Trends in prevalence of 'natural remedies' use in West Germany, 1970-2002

Table III.2.3 Prevalence of 'natural remedies' use in East and West Germany

Table III.3.1 Qualifications in CAM and physical medicine among active physicians, 2001

Table III.3.2 Trends in CAM and physical medicine qualifications among active physicians, 1993-2001

Table III.3.3 Gender distribution of active physicians qualified in CAM or physical medicine, 2001

Table III.3.4 CAM users with reimbursable CAM prescriptions by provider, 2002

Table III.3.5 Qualifications in CAM and physical medicine among physicians working in different settings, 1995 and 2001

Table III.3.6 Other health professions likely to provide complementary and/or physical therapies, 2000

Table III.3.7 Trends in the number of Heilpraktiker, 1993-2000

Table III.4.1 Surveys of reimbursement for unconventional methods and projected one-year case prevalence, 1999-2002

Table III.4.2 Reimbursement and extrapolated expenditure for unconventional methods, 1999-2000

Table III.5.1 Trends in prescriptions of herbal medicines for selected indications funded by statutory health insurance, 1992-2000

Table III.5.2 Over-the-counter sales of herbal medicines and total drugs by indication, 1997-2000

Table III.5.3 Number of retailers of pharmaceuticals, 2000