Germany
Summary (ref 1)
In Germany treatment is restricted to legally regulated personnel (health personnel and Heilpraktikers). The law restricts the scope of Heilpraktikers` activities.
Professionals and non-professionals
Legally regulated personnel
Only medically qualified personnel and licensed Heilpraktikers may practise medicine (heilkunde). The Individual Health Care Professions Act and the Social Code Bood V regulate the requirements for practising medicine and the regulation and authorisation of health personnel.
When authorised health personnel practise alternative treatment within the scope of the health service, the alternative treatment has to be considered as responsible professional conduct and be given by duly qualified medical personnel. The authority supervises health personnel and ensures fulfilment of laws and regulations. The authority can withdraw the authorisation of health personnel if the law is violated, and if the violation is serious, the health authority may also ask the police to investigate the matter.
The law on Heilpraktiker introduced in 1939, licenses practitioners who are not members of a recognised health professions to practise (ref 2). The main intension of the law is to secure that the treatment of Heilpraktikers does not negatively affect the public health. The Lander (provincial government) is administering the system. To obtain a Heilpraktiker license the candidate must pass an examination in basic medical knowledge, be at least 25 years old, have a German or EU citizenship, have completed primary school, have a good reputation, and have a medical certificate. The law restricts specific medical procedures and treatment of certain diseases to authorised health personnel. Heilpraktikers are not allowed:
- to practise dentistry
- to treat sexual diseases
- to treat communicable and epidemic diseases
- to deliver certain medications (drugs)
- to give or provide anaesthetics and narcotics
- to practise obstetrics and gynaecology
- to X-ray
- to practise autopsies and to deliver death certificates
Regarding ethical rules, the Heilpraktikers’ organisations issue a professional Code of Practise. The code of practise provides that Heilpraktikers are conscious of the limit of their knowledge and skills, that they have concern of professional secrecy, give the patients clear explanations concerning their illness and the treatment they provide as well as the length and the dangers of the treatment, and that they have an obligation to refer the patients to a specialist when practitioners do not have sufficient knowledge to treat them. However, this code of practise cannot be compared with the professional public regulation regarding allopathic medical professionals (physicians). This code of practise does not incorporate rules with regard to knowledge and skills necessary to practise responsible professional conduct.
If Heilpraktikers violate the legal rules, the authority or patients can ask the police to investigate the matter. Violations of the limited monopoly of performing medical procedures and treating certain diseases result in an offence.
If patients attend a Heilpraktiker, the Code of Practise will not safeguard the patient in the same way as the legal regulation of authorised health personnel does. However, the legal code will protect the patient in serious matters.
Not anybody may treat
The practise of medicine without a legal qualification is an offence. According to the Penal Code, unskilled persons practising medicine or activities reserved for authorised and licensed personnel, risk imprisonment or a fine.
Reimbursement
Public and private reimbursement is only available for CAM given by authorised health personnel. However, some private insurance companies also reimburse treatment not scientifically recognised if they are provided by Heilpraktikers and if their effectiveness is not completely rejected (ref 3).
References
1. Reference for the chapter where nothing else is noted: Maddalena S. The legal status of complementary medicines in Europe. Berne: Universitè de Neuchâtel, Stæmpfli Publisher Ltd. 1999. and Bundesministerium für Gesundheit, Germany 07.06.05
2. Heilpraktikergesetz: http://www/med-con.de/html/hpg01.html
3. Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review, (document WHO/EDM/TRM/2001.2). Geneva: World Health Organization, 2001.
