Switzerland is to fund complementary therapies for six years while effectiveness is evaluated

Complementary medicine in Switzerland will be covered by public health insurance from 2012 until the end of 2017 as part of a temporary scientific evaluation plan to determine whether state coverage should be made permanent.

The plan, outlined in January by the Swiss Department of Home Affairs and which will include oversight from an “internationally recognised institution,” comes after two thirds of Swiss voters in 2009 approved a referendum in support of state reimbursement of complementary medicine.

The five therapies included in the plan are anthroposophical medicine (which focuses on the body, life force, soul, and spirit and can include natural substances as well as conventional drugs), homoeopathy, neural therapy (in which local anaesthetic is injected near nerve centres), phytotherapy (or herbal medicine, which uses extracts from natural sources), and traditional Chinese medicine.

Under Swiss law only medical services that meet three requirements—effectiveness, cost effectiveness, and suitability—can be added to the list of treatments reimbursed by public insurance schemes. In December 2010 the federal commission responsible for reviewing which medical services to add to the list ruled that the effectiveness of complementary medicine had not been confirmed scientifically and recommended that the Home Affairs Department, whose portfolio includes health, leave it off the list.

Confronted with a legally binding referendum the home affairs minister, Didier Burkhalter, announced provisional public health insurance coverage combined with a scientific evaluation. A department press release said that the plan would help clarify “controversial aspects” of complementary medicine.

Jacques de Haller, president of the Swiss Medical Association, described Mr Burkhalter’s plan as a “superb decision.” Dr de Haller told the BMJ that the association had not taken an official stand on the issue, because opinion among its 35 000 members is divided. He estimated that 3000 to 4000 or about 20% of the 15 000 to 17 000 association members in private practice practise some form of complementary medicine.

Dr Haller said that when he was previously in private practice he had seen patients “feel better” after complementary treatment. On the other hand, he said, it is difficult to prove scientifically the effectiveness of complementary medicine. He said that he encourages “bilateral respect” on the issue.

Switzerland first allowed temporary coverage by public health insurance of the same five therapies in 1999 while it conducted a programme to determine whether coverage should be made permanent, but that evaluation was inconclusive, and coverage of the five therapies stopped in 2005, setting the stage for the 2009 referendum.

By the end of 2015 the five medical associations representing the five therapies must submit to the Home Affairs Department concepts and evaluations to support claims that their therapies meet the insurance coverage criteria.

Effectiveness must be reviewed by the “internationally recognised institution,” which will then submit health technology assessments to the Home Affairs Department, after which the department will decide whether to extend insurance coverage beyond 2017.

Hansueli Albonic, president of the Union of Associations of Swiss Physicians for Complementary Medicine, called the plan “a politically wise ruling and a necessary corrective to onerous administrative procedures,” adding that Mr Burkhalter “takes the wishes of patients seriously.”

Dr Albonic, head of the department of complementary medicine at Emmental Regional Hospital, said that his union represents “highly qualified medical doctors” who have been trained in traditional medicine as well as in complementary medicine. He believes that the federal commission’s negative recommendation in 2010 “was based on legally questionable procedures.”

He added, “The union has always accepted that effectiveness, cost effectiveness, and suitability must be demonstrated. But we insist on fair review and assessment procedures and, above all, on adherence to reliable evaluation criteria.”