Sweden
(ref 1)
Summary
In Sweden anybody is allowed to treat but law restricts the scope of their activities. Chiropractics and naprapathy are regulated.
Professionals and non-professionals
Legally regulated personnel
The Health and Medical Service Act of 1982 regulates the requirements for practising medicine and the regulation and authorisation of health personnel (ref 2) . Practitioners of chiropractics were authorised in 1989 and naprapaths in 1994 (ref 3) . Homeopathy and other forms of CAM are not recognised as "responsible professional conduct" and may therefore not be provided by health professionals. Acupuncture of western style may be provided (ref 4) . The authorities supervise all authorised health personnel (ref 5).
Anybody may treat-
But some treatments are restricted to authorised health personnel
CAM providers are allowed to practise medicine regardless of their training and without previous authorisation. They are, however, not recognised as official health care personnel, their titles are not protected, they are not integrated into the national health care system, and they are not under the supervision of the authorities.
According to the Quackery Act, that has been included in The Health and Medical Services (Professional Activity) Act, only authorised health personnel are allowed to perform the following specific medical procedures and give the following treatment of certain diseases:
- practise general or local anaesthesia
- provide care with radiological methods
- practise in a itinerant way
- treat specific contagious diseases
- treat cancer, diabetes, epilepsy or pathological conditions associated with pregnancy or childbirth
- treat a child who is less then eight years old
- issue written recommendations or instructions for the treatment of patients who were not personally examined by them
- provide acupuncture
- test or supply contact lenses (ref 6)
Violations of the limited monopoly of performing medical procedures and treating certain diseases are an offence. However, CAM providers may only be prosecuted for exposing patients to a probable danger, or causing them serious deterioration or death. Providers found guilty of this charge may be judged by the penal law and may be prohibited from working in the health field (ref 7).
Voluntary registration of CAM providers (ref 8)
On 10 December 2004, the Swedish government sent an inquiry report referred for consideration to establish a voluntary official register for CAM providers who are not medical physicians. The objective of the register is to contribute to the security for the users who seek and receives CAM.
To be registered, the providers must have membership in a practitioners’ organisation approved by the government, have documented knowledge of basic medicine and hold current insurance. According to the current draft, the authorities will take on the necessary tasks for registration, but will closely cooperate with participating organisations. The register will be voluntary and providers will be self-regulated through their member associations. The government offices are working with the legislative proposal.
The Quackery Act safeguards all patients from being treated by unauthorised providers in cases of some restricted medical procedures and diseases. The draft on a CAM register does not include any official supervision of CAM providers or their used methods.
Reimbursement
In general, public reimbursement is not available for the use of alternative medicine. However, some reimbursement for acupuncture treatment is made when provided by physicians (ref 9) . International Health Insurance, Denmark AS, distributes private insurance in Sweden and several others European countries.
1. Ministry of Health and Social Affairs, Sweden 11.10.05
2. Lag om hälso- och sjukvården (1982:763, HSL)
3. Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review, (document WHO/EDM/TRM/2001.2). Geneva: World Health Organization, 2001.
4. Ministry of Health and Social Affairs, Sweden 05.10.05
5. Lag om yrkesverksamhet på hälso- och sjukvärdens område, 6 kap, (1998:531, LYHS)
6. Lag om yrkesverksamhet på hälso- och sjukvärdens område, 4 kap, (1998:531LYHS) The Quackery Act, (on the prohibition of specific practises in the field of health and medical care)
7. Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review, (document WHO/EDM/TRM/2001.2). Geneva: World Health Organization, 2001.
8. SOU 2004:123; Ett nationellt register över yrkesutövere av alternativ- eller komplementärmedicin. http://www.regeringen.se/sb/d/108/a/35339
9. Maddalena S. The legal status of complementary medicines in Europe. Berne: Universitè de Neuchâtel, Stæmpfli Publisher Ltd. 1999.
