Heilpraktiker

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Heilpraktiker ("healing practitioner") is a naturopathic profession in Germany. It is recognized as an alternative and complementary health care profession by German law.[1] A heilpraktiker, also called alternative practitioner, natural practitioner or non-medical practitioner, does not need to have any formal education or training but must do an exam at the health authorities. This exam used to be somewhat basic until the 1980s, at which time it was made to become much more demanding. A candidate needs to have good knowledge of medical sciences, such as anatomy, physiology and pathology and psychiatry; a good knowledge of law regulations is also needed.[2] Healing practitioners often specialize in a complementary and alternative field of healthcare that could be anything from homeopathy, phytotherapy, Chinese medicine, Ayurvedic medicine, to reflexology or acupuncture. A healing practitioner is a person who is allowed to practice as a non-medical practitioner using any unconventional therapy. About 47000 heilpraktiker are accredited in Germany.[3] Within Germany, Heilpraktikers belong to the free professions and according to the Fiscal Code of Germany are legally obliged to pay taxes on their income.[4]

Organisation[edit]

Most Heilpraktikers are organized in Germany-wide associations, which represent their interests. Since 2011, the "Dachverband Deutscher Heilpraktikererverbände" (DDH) has been one of the largest associations and supports its members in questions of professional, medical and professional policy. Many Heilpraktiker associations run their own schools where new Heilpraktikers are trained up to the state's permission to heal and can obtain additional qualifications.

Permission to heal[edit]

The treatment methods practised by Heilpraktikers are dependent on the healing permission granted to them. The legal situation differentiates between Heilpraktikers with full permission and Heilpraktikers with sectoral permission. They are colloquially divided into "big" and "small" Heilpraktikers.

Full healing permission[edit]

In Germany, heilpraktiker with a full healing permission do not need a licence to practise medicine such as a doctor or psychotherapist. Nevertheless, the full healing permission is subject to a number of requirements. Only those who have successfully passed an extensive examination before the responsible health authority receive the state granted permission. A great deal of knowledge from all medical fields is required for this. With full permission, a Heilpraktiker may independently diagnose and treat both physical and mental sufferings.

Sectoral permission[edit]

Since a law change in the year 1993 there are also Heilpraktiker with sectoral healing permission only.[5] In contrast to full permission, sectoral healing permission does not require comprehensive knowledge of anatomy, physiology, pathology and pharmacology. Instead, the contents of the examination are limited to the future field of work in the particular special field.

A distinction is made between the so-called "Heilpraktiker beschränkt auf das Gebiet der Psychotherapie", which was introduced in 1993, and the "Heilpraktiker beschränkt auf das Gebiet der Physiologie", which was added as a further healing profession in 2009. Since both subgroups are limited to their special fields, treatment methods that go beyond that are reserved only for Heilpraktikers with full healing permission.

Distinctions from doctors and psychotherapists[edit]

Both sectoral Heilpraktikers and Heilpraktikers with full healing permission, unlike doctors and psychological psychotherapists, are subject to certain legal restrictions. For example, they are not allowed to administer drugs only available by prescription, hospital admissions or sociotherapy. They may not call themselves a doctor or psychotherapist without the required medical license. Nevertheless, "Heilpraktiker beschränkt auf das Gebiet der Psychologie" are also listed in the occupational group of people who may work psychotherapeutically in Germany.[6]

Another difference in comparison to doctors and psychological psychotherapists lies in the billing of the treatments provided by alternative practitioners. The statutory health insurance funds of the German health care system do not cover the costs of treatment by a Heilpraktiker.

Legal bases[edit]

Heilpraktikergesetz[edit]

The law called "Gesetz über die berufsmäßige Ausübung der Heilkunde ohne Bestallung " (Heilpratikergesetz, also: HeilprG) of 1939 regulates all legal bases for the practice of the healing profession to this day. This law is unique worldwide in its form, even though there are 11 other states within the EU outside Germany that have general CAM legislation.[7][8]

Though Article 45 of the "Treaty on European Union and the Treaty on the Functioning of the European Union" grants EU citizens the freedom to practise their profession in all EU countries without restrictions, the profession of the German Heilpraktiker is still not officially recognised in other European countries.[9] In nearby Austria, for example, the practice of alternative medicine is reserved exclusively for licensed doctors.[10]

The German Heilpraktikergesetz (law on non-medical practitioners) dates back to the time of Nazi Germany under Adolf Hitler. After the chairman of the then Chamber of Physicians, "Reichsärzteführer" Gerhard Wagner, criticized that non-medical practitioners were also allowed to practice in the medical field without a real license, the National Socialists decided to ban further training for non-medical practitioners and to close all non-medical practitioner schools.

On 24 January 1957, the German Federal Administrative Court decided to revoke the ban on training imposed by law[11]. The court stated that the prohibition was not compatible with the applicable Basic Law. A further prohibition from the Nazi era was also abolished, prohibiting foreigners from obtaining a Heilpraktiker permission. Apart from a few minor adjustments, the Heilpraktikergesetz has barely been changed to this day, which is criticised by many sides in Germany.[12]

Heilpraktiker are not bound to the legal obligation of secrecy, as are psychotherapists, professional psychologists or doctors in Germany according to § 203 StGB.[13]

Admission requirements[edit]

According to the Heilpraktikergesetz, only those who meet the conditions set out in §1 HeilprG may work as a Heilpraktiker.[14] These include an examination with a written and an oral part. For the execution of the oral examination the state commissions the health department. Both examinations must be passed successfully. The final healing permit is granted by the competent state authority, which in turn must follow the regulations of the respective federal state.

Further admission requirements are a minimum age of 25, a lower secondary school leaving certificate, German citizenship or Union citizenship as well as proven suitability for the job. A police clearance certificate must be submitted along with a medical clearance certificate [15].

Heilpraktiker examination[edit]

The Heilpraktiker examination is essentially based on anatomical, physiological and pathophysiological findings.[16] The identification and differentiation of common diseases is also part of the examination. This includes cardiovascular and metabolic disorders as well as communicable and degenerative diseases. Also contents from the pathology and psychopathology of humans are part of the Heilpraktiker examination apart from general hygiene topics.

From a legal point of view, no training is required before taking the examination. However, many prospective alternative practitioners voluntarily undergo training at a private institution in order to acquire the required knowledge. The average training period is one to three years.

Psychologists with a master's or diploma degree who have already obtained admission only have to undergo a simplified procedure in order to obtain permission to work as a sectoral Heilpraktiker, thanks to an exception in the admission procedure.

Health Services and Products Advertising Act[edit]

The German Health Services and Products Advertising Act (Heilmittelwerbegesetz) is one of the most important laws that alternative practitioners must comply with.[17] The main purpose of this law is to protect consumers. The German Health Services and Products Advertising Act provides explicit regulations for the advertising of medical products, treatments and medicines.

Many CAM treatments are not scientifically recognized, so the German Health Services and Products Advertising Act applies by prohibiting claims that individual treatments work without proof. This makes it more difficult for Heilpraktiker to advertise their services.

Economy[edit]

The importance of alternative practitioners in the German health care system is reflected in the total turnover of the industry: every year, around one billion euros are turned over by Heilpraktikers in Germany. The share of self-paying patients is 53.2% or 531.51 million euros in annual sales. The private health insurance companies are responsible for 173.86 million euros in sales, while a further 294.63 million euros are being sold across the industry via supplementary insurance and state aid.[3]

Fees of Heilpraktikers[edit]

Heilpraktiker determine their fee according to § 630a Bürgerliches Gesetzbuch (BGB) themselves.[18] They conclude a treatment contract with the patient. Often the Heilpraktiker orient themselves with the determination of their hourly rates at the fee order for physicians.

Cost absorption by health insurance funds[edit]

The statutory health insurance funds do not cover the costs of treatment by a non-medical practitioner. The patient pays for the services himself. A Heilpraktiker may not write prescriptions for prescription drugs. The patient must therefore also pay for prescribed medicines such as homeopathic remedies and herbal therapy.

Since 2005, however, many of the statutory health insurance funds in Germany have been offering voluntary supplementary insurance, which also covers the costs of treatment by a non-medical practitioner.[19]

Methods of treatment[edit]

Heilpraktiker offer various alternative medical treatments. Heilpraktiker with a full permission treat both mental and physical illness. Sectoral Heilpraktikers must limit themselves to their particular field of expertise and therefore practice either exclusively within the framework of physiology or psychology.

Due to the so-called "freedom of therapy", practitioners can offer and apply all the treatment methods they have mastered. If appropriately qualified, this can also include conventional medical procedures. But holistic and naturopathic methods are more common. The following techniques are the most popular methods of treatment:

· Aromatherapy

· Breathwork

· Autogenic training

· Bioenergetics

· Chiropractic treamtment techniques

· Energy medicine

· Homeopathy

· Hypnosis

· NLP

· Osteopathy

· Physical therapy

· Herbal medicine

· Traditionelle Chinesische Medizin (TCM)

· Yager-Code

Criticism[edit]

Even though the German government has created a comparatively favourable framework for complementary and alternative medicine (CAM), neither universities nor the state have shown any further interest in CAM, which is why most studies on alternative medical procedures still have to be financed from third-party funds. This, in turn, is criticised by many because potentially effective methods remain largely unexplored and are equated with parascientific methods.[20]

It is criticised that many alternative treatment methods are questionable, especially in the treatment of serious diseases. Misinterpretations by Heilpraktikers can have far-reaching consequences due to a lack of scientific knowledge and the uncertain chances of cure. If no successful treatment is achieved or the patient's state of health deteriorates, failure to refer the patient to a doctor can be life-threatening.

There is also criticism that there is no regulated training as a non-medical practitioner. Since only a multiple-choice test decides on admission, licensed physicians and psychologists repeatedly emphasize that the admission requirements must be tightened and a more comprehensive examination has to be made necessary. In addition, a stricter control of the work of Heilpraktiker for quality assurance is demanded. A binding professional code of ethics is being discussed as a solution.

Discussed abolition of the Heilpraktiker[edit]

In 2017, the interdisciplinary expert group "Münsteraner Kreis" was founded in Germany by the licensed medical ethicist Bettina Schöne-Seifert, who made the abolition of alternative medicine a nationwide topic. In a white paper, the "Münsteraner Memorandum Heilpraktiker", the Council of Experts, which consists of doctors and scientists, presents concrete solutions for the new regulation of the alternative practitioner profession.[21]

The white paper proposes two solutions, one of which provides for the complete abolition of the profession of the Heilpratiker. Alternatively, according to the "Münsteraner Kreis", it would at least be necessary to reserve the profession exclusively to persons from existing health professions who are allowed to exercise it by acquiring an additional qualification.

References[edit]

  1. ^ Gesetz über die berufsmäßige Ausübung der Heilkunde ohne Bestallung (Heilpraktikergesetz), 17.02.1939.
  2. ^ Erste Durchführungsverordnung zum Gesetz über die berufsmäßige Ausübung der Heilkunde ohne Bestallung (Heilpraktikergesetz), 18.02.1939.
  3. ^ a b "Repräsentative Umfrage: Jeden Tag gehen in Deutschland 128.000 Patienten zum Heilpraktiker (Statistics about the profession Heilpraktiker)" (in German). Retrieved 2019-11-02.
  4. ^ "The Fiscal Code of Germany (Law)". www.gesetze-im-internet.de. Retrieved 2019-11-19.
  5. ^ "Gerichtsurteile (Archived court decision in German)". web.archive.org. 2008-06-25. Retrieved 2019-11-19.
  6. ^ "Recognition of Professional Qualifications". www.bdp-verband.de. Retrieved 2019-11-19.
  7. ^ "Naturopaths: Why are they only available in Germany?". medizindoc.de (in German). Medizindoc n.e.V. Retrieved 2019-11-19.
  8. ^ "Legal status and regulation of CAM in Europe". cambrella. 2012.
  9. ^ "Consolidated version of the Treaty on the Functioning of the European Union". eur-lex.europa.eu. 26.10.2012. Retrieved 2019-11-19. Check date values in: |date= (help)
  10. ^ David A. O. Edward; Robert Lane (1 January 2013). Edward and Lane on European Union Law. p. 577: Edward Elgar Publishing. ISBN 978-0-85793-105-4.
  11. ^ "DFR - BVerfGE 78, 179 - Heilpraktikergesetz". www.servat.unibe.ch. Retrieved 2019-11-19.
  12. ^ https://www.lto.de/recht/feuilleton/f/heilpraktikergesetz-heilkunde-kurierfreiheit-nationalsozialismus-anforderungen-qualifikation/
  13. ^ "§ 203 StGB - Einzelnorm (German law)". www.gesetze-im-internet.de. Retrieved 2019-11-19.
  14. ^ "§ 1 HeilprG - Einzelnorm (German law)". www.gesetze-im-internet.de. Retrieved 2019-11-19.
  15. ^ "Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review: Europe: Germany". apps.who.int. Retrieved 2019-11-19.
  16. ^ "Complementary and Alternative Medicine in the UK and Germany – Research and Evidence on Supply and Demand" (PDF). Anglo-German Foundation for the Study of Industrial Society. p. 10.
  17. ^ "Act on Advertising in the Field of Health (Heilmittelwerbegesetz – HWG)" (PDF). German Federal Ministry of Food and Agriculture. 2014.
  18. ^ https://www.gesetze-im-internet.de/englisch_bgb/englisch_bgb.html#p2645 English translation of the BGB (German Civil Code), p. 2645
  19. ^ Joos, Stefanie; Musselmann, Berthold; Miksch, Antje; Rosemann, Thomas; Szecsenyi, Joachim (2008-06-12). "The role of complementary and alternative medicine (CAM) in Germany – A focus group study of GPs". BMC Health Services Research. 8: 127. doi:10.1186/1472-6963-8-127. ISSN 1472-6963. PMC 2442431. PMID 18549476.
  20. ^ Albrecht, Henning (2013). "[The situation of complementary medicine in Germany]". Forschende Komplementarmedizin (2006). 20 (1): 73–77. doi:10.1159/000347149. ISSN 1661-4127. PMID 23727765.
  21. ^ White paper "Münsteraner Memoradum Heilpraktiker" by interdisciplinary expert group Münsterraner Kreis