German doctors and politicians disagree on reimbursement for homoeopathyBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3902 (Published 20 July 2010) Cite this as: BMJ 2010;341:c3902
A recent spate of demands in the United Kingdom that homoeopathic treatments no longer be provided on the NHS has prompted a debate in Germany about the place of homoeopathy in its health service.
Despite the fact that some German pharmacology experts would like to see public health insurers cease paying for it, the German Medical Association (Bundesärztekammer) has come out in favour of keeping its reimbursement.
The association’s president, Jörg-Dietrich Hoppe, has defended homoeopathic treatment in an official statement. He said that despite the lack of scientific evidence for its effectiveness homoeopathy was an important part of medicine. It was especially effective in treating travel sickness and general malaise but also in preventing disease, he said.
He was backed by the federal health minister, Philipp Rösler, who wants to keep the status quo in Germany, where homoeopathy is a treatment reimbursed by the public health insurance companies.
Professor Hoppe’s and Dr Rösler’s statements come amid a public debate after last week’s publication in the magazine Der Spiegel of a lead article questioning the value of homoeopathic treatment (www.spiegel.de/wirtschaft/soziales/0,1518,706336,00.html). It referred to the current debate in the UK, where doctors and the parliamentary health select committee have called on the NHS to stop paying for homoeopathy (BMJ 2010;340:c3513, doi:10.1136/bmj.c3513; 2010;340:c1091, doi:10.1136/bmj.c1091).
This view is supported by German medical experts and a few politicians who claim that in cases where homoeopathy seems to work it is as a result of a placebo effect. They want to see it withdrawn from the funding budget of the public health insurance companies, which together are currently spending an estimated €100m (£85m; $130m) on homoeopathic preparations.
Germany is the home country of homoeopathy, where it was first expounded by the physician Samuel Hahnemann in the late 18th century. A recent study by the Allensbach Institute, a public opinion research firm in southern Germany, stated that use of homoeopathy is on the rise. In 1970 only one in four West Germans had ever used homoeopathic remedies, a figure that has since risen to 57%.
Karl Lauterbach, chairman of the German parliamentary health committee, has called for health insurance companies to stop funding homoeopathic remedies. In an interview with Der Spiegel he said that many patients believe that insurance only covers treatments that have proved to help and therefore it is in the public interest to stop the practice. “Health insurers are dignifying homoeopaths through their actions,” he said.
Kay Brune, professor in experimental and clinical pharmacology and toxicology at Friedrich-Alexander University of Erlangen-Nuremberg, said, in an interview with the broadcaster Deutsche Welle: “The founder, Hahnemann, was a brilliant physician. But at that time doing nothing was helpful to the patient. In 200 years the pseudoscience has not taken any steps forward” (www.dw-world.de/dw/article/0,,5789488,00.html). He also added that Nazi medical officials explored it as a “non-Jewish medicine,” and even they gave up on it.
Jürgen Windeler, the incoming head of the Institute for Quality and Efficiency in Health Care, Germany’s equivalent of the UK’s National Institute for Health and Clinical Excellence, said that homoeopathy is a refuted concept. “And there isn’t any need for any further research,” he said. “The issue is settled.”
But public insurance companies such as the Techniker Krankenkasse insist that offering alternative treatments such as homoeopathy allows companies to attract higher earning customers, whom they need to ensure that Germany’s healthcare system, which is based on the principle of solidarity, functions properly.
“Around one fifth of our 42 500 insured customers earn enough money that they could switch to a private insurance company if they wanted,” Hermann Bärenfänger, a spokesman for Techniker Krankenkasse, said. “If we want to keep these people in the public health insurance system and not change to private insurance companies we have to offer them something.”
Cite this as: BMJ 2010;341:c3902