Power structures and their implications

1
Power structures and their implications for the
use and provision of CAM in Tuscany and Denmark.
Helle Johannessen Associate Professor,
mag.scient., PhD Institute of Public
Health University of Southern Denmark
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In 1999 an official political process of
integration of CAM in the regional public health
care system of Toscana began
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1999 Discussions are initiated in the regional
council of Toscany - advocates of CAM are invited
speakers 2000 Funding is provided for many
different projects aimed at development of CAM -
a wide variety of CAM-practices are
included 2003 New funding is distributed - this
time only to public health care
institutions 2005 Four kinds of CAM are
included in the regional health care
reimbursement system - if they are provided by
medical doctors 2007 A regional law is passed
which states that three kinds of CAM (homeopathy,
acupuncture, phytotherapy) are included as basic
provisions of the public health care system - if
provided by medical doctors, dentists,
veterinarians or pharmacists. Regulation of
education is institutionalised
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CAM has been legalised and integrated - but
truncated Maybe that was necessary to ensure
wide provision and good quality?
5
In Denmark CAM is not part of the public health
care system and no reimbursement is possible
(neither by the state nor by private insurance
companies) - although acupuncture is partly
covered when provided by GPs
Since 2005 a voluntary system of registration has
been officially recognized as a quality branding
administrated by associations of
CAM-practitioners. No official authorization or
sanctioning is attached to this registration.
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Preliminary conclusion CAM must be more widely
used, as well as better, safer, more recognized
and with better results in Toscany than in Denmark
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Use of CAM Sources ISTAT SIF Damkier
Johannessen et al
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Patients espectations and evaluation of CAM for
cancer Tuscany To be treated by MDs in order
to counteract physical symptoms and
sideeffects Denmark To be treated beyond the
competence of MDs in order to counteract physical
symptoms and sideeffect. AND to get more energy
and peace of mind, to relax, and to learn from
the disease (new lifestyle, stress patterns,
emotional distress)
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• An observation from a
• MDs practice in Tuscany
• Use of Bachs flower remedies
• Number of remedies12
• Prescriptive/diagnostic procedures
• were physical (reactions to the remedies on the
  skin)
• Symptoms and goals of treatment focused on were
  physical

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• An observation from a CAM practice in Denmark
• Use of Bachs flower remedies
• Number of remedies 38
• Prescriptive/diagnostic procedures were
  intuitive (talk, kinesiological test of muscle
  strength, use of pendulum, etc.)
• Symptoms and goals of treatment focused on were
  emotional

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Questions to reflect upon
Is the Tuscan model an inclusion of CAM or an
extensions of biomedicine? Is CAM reduced to
technicalities when it is included in public
health care and administred by MDs? Where can
patients go for holistic care if CAM is reduced
to technical interventions? Do we need
regulation and quality control in CAM? How can
we balance of the need for regulation and
quality control without reducing CAM to
technicalities?
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Thank you...