The Netherlands
Summary (ref 1)
In The Netherlands anybody may treat but law restricts the scope of their activities. CAM is not regulated.
Professionals and non-professionals
Legally regulated personnel
The Individual Health care Professionals Act (the BIG Act 1993) (ref 2) regulates the health personnel, focusing on the quality of professional practise and patient protection. The law has been implemented in stages. The purpose of the act is to foster and monitor high standards of professional practise and to protect the patients against professional carelessness and incompetence. The act contains provisions relating to the protection of titles, registration, reserved procedures and medical disciplines. According to the act professionals can be regulated in two ways. Section 3 lies down rules governing eight professions (medical doctor, dentist, pharmaceutical chemist, health care psychologist, psychotherapists, midwife and nurse). Section 34 regulates the paramedical professions (e.g. speech therapist, dental hygienist and dietician). Reserved procedures may be carried out only by to groups of medical practitioners; those with direct authorisation (doctors, dentists and midwives) and those who may perform the procedures under the instruction of the former (and thereby authorised).
The Individual Health Care Professionals Act lays down disciplinary norms that apply to professionals registered under section 3. The professionals may use CAM treatment, following "due care" and "proper practise", and that the therapies are not restricted by the reserved procedures. The disciplinary norms and the civil law (penal code) can be used in conjunction with one another.
Supervising regulated personnel
The authorities supervise health personnel regulated in section 3. CAM therapies provided by these professions are restricted by the reserved procedures and the disciplinary code in the act. The authorities can withdraw the authorisation of health personnel if the law is violated. If the violation is serious, the authority of health may also ask the police to investigate the matter.
Anybody may treat-
But some treatments are restricted to authorised health personnel
Since 1997, according to the Health care Professionals Act, CAM providers are allowed to treat. They are not, however, 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 direct supervision of the authorities.
According to the law, specific medical procedures and treatment of certain diseases are restricted to authorised health personnel, except when under the order of a medical professional with direct authorisation. Authorised health personnel only may practise the following:
- surgical procedures
- obstetric procedures
- catheterisations and endoscopies
- punctures and injections
- general anaesthetic
- procedures involving the use of radioactive substances and ionising radiation
- cardioversion
- defibrillation, electroconvulsive therapy
- lithotripsy
- artificial insemination
The list of the reserved medical acts is not exhaustive and additions are possible.
Violations of the limited monopoly can result in an offence.
The government is not legally regulating any CAM or licensing any providers. The restriction of some procedures and the penal code is protecting the patient while attending the provider. The penal code has rules about abuse and neglect. That means that a person in whom a patient has trust must not mislead the patient, thus making it possible for the patient to be harmed. CAM therapies are commonly in use as preventive medicine and as self-cure. The Individual Healthcare Professionals Act guarantees the patients’ complete freedom of choice of providers and, at the same time, includes preventive measures to avoid any potential risk to harm patients’ health.
Reimbursement
There are no public reimbursements of CAM. Private insurance offers a package covering for the most used forms of complementary medicine when provided by a medical doctor.
References
1 .Referee for the chapter where nothing else is stated:Ministry of Health, Welfare and Sports and Public health Supervisory Service of the Netherlands, The Inspectorate of Health Care region South East, The Hague, meeting 26.04.05.
2. More information about the BIG Act: http://www.bigregister.nl or http://www.verwijspunt.nl
