Norway

Alban Europe

Norway

Background Information

Although some authorized allopathic doctors and other health personnel in Norway have integrated acupuncture and/or homeopathy into their practice, most usually do not use complementary/alternative therapies. Some persons with authorization to practice as health personnel, such as nurses, have complementary/alternative medicine practices.

Statistics

A 1994 poll reported that 23% of men and 30% of women had used complementary/alternative medicine at least once. Most respondents in this group were middle-aged persons living in towns. The most popular therapies are acupuncture, accounting for 35% of consultations for complementary/alternative treatments; homeopathy, accounting for 33%; reflexology, 29%; natural medicine, 29%; chiropractic, 16%; kinesiology, 7%; natural healing, 3%; and iridology, 3%.

The Norwegian Association of Chiropractors has about 100 members.

Regulatory Situation

In principle, everyone in Norway is allowed to treat patients, regardless of training or profession. However, only allopathic physicians, and to some extent dentists and persons assisting physicians and under the guidance of a physician, are allowed to use the title “Doctor of Medicine”, use a title indicating a specialty in a specific illness, or advertise – although anyone can place an announcement in the press that contains only a name, address, consultation hours, and general information on services provided. Specific medical acts are similarly restricted. These include the use of controlled medications in treatment, surgical procedures, injections, general or local anaesthesia, diagnostic or therapeutic methods restricted to physicians, treatment of cancer, diabetes, dangerous anaemia, struma/goitre with sticky forms, and some contagious/infectious diseases mentioned in Act 55 of 5 August 1994 on contagious/infectious diseases (such as venereal diseases, tuberculosis, infectious hepatitis, HIV, poliomyelitis, and infectious meningitis), as well as practicing in an itinerant way. To receive authorization to practice as an allopathic medical doctor, a candidate must possess a medical degree from a Norwegian or other recognized university and have undergone an 18-month internship.

Norway has the oldest regulations in Europe on the practice of medicine by non-allopathic physicians. The first legislation of this kind in Norway dates back to 1619. A new law was adopted in 1871. The Act of 1871 was to some extent less restrictive than the current Act 9 of 19 June 1936 on the limitations of the right of persons who are not allopathic physicians or dentists to undertake treatment of ill persons. Act 9 was used as a model for legislation in Sweden and Denmark.

Aside from allopathic physicians or dentists, anyone who wants to practice complementary/alternative medicine is subject to Act 9 of 19 June 1936. Under the law, non-physicians and non-dentists who treat patients are subject to a jail sentence of up to three months if the patient’s life or health is exposed to serious danger either by the treatment or because the patient did not seek a health care provider who could have prevented the danger. Anyone sentenced to prison for such violations can no longer practice medicine. Except in the most serious cases, criminal sanctions are rarely used.

Allopathic practitioners are restricted from using complementary/alternative therapies unless the therapies are considered to be responsible practice within the practitioner’s profession, the patient is informed about the method and its status, and the patient agrees to the treatment.

The insertion of acupuncture needles is considered a surgical intervention and can only be performed by allopathic physicians, dentists, or persons delegated by physicians.

Since 1990, chiropractors have been officially recognized as health care professionals. Only licensed chiropractors are permitted to use the title of “Chiropractor”. To be licensed, a candidate must have completed a training program and passed examinations at an approved institution; undertaken additional training in Norwegian health law and chiropractic disciplines; completed one year of practical training; and not be in a position that would lead to withdrawal of the authorization – for instance, the candidate must not be found unsuitable for practicing chiropractic due to old age, illness, alcohol/drug abuse, or other circumstances. To become a member of the Norwegian Association of Chiropractors, chiropractors must have completed a course approved by the American Council on Chiropractic Education and undergone three months of clinical training.

With some exceptions, homeopathic medicines may only be sold from pharmacies. A licence is necessary to market homeopathic products when the degree of dilution is less than one million.

In June 1995, the Storting (parliament) examined the place of complementary/alternative medicine in the Norwegian health service. Among other things, the Storting decided to consider introducing certification of the various types of training and education available for complementary/alternative medical professions. In 1997, with the intention of revising the 1936 law, the Ministry of Health appointed a committee to write a report on complementary/alternative medicine. The report was delivered to the Ministry in December 1998. It describes the situation of complementary/alternative medicine in Norway and includes a discussion of the clinical effects of treatments, possible legal measures, and means of communicating research results and other information to the public. The Government has not yet decided how to follow up on the report.

In Beijing on 6 April 1999, the Ministers of Health of Norway and China signed a memorandum of understanding on Chinese/Norwegian cooperation in the field of health to increase the knowledge and understanding of traditional Chinese medicine among Norwegian health personnel.

Education and Training

The 1990 chiropractic law regulates the training of chiropractors; however, there are no recognized schools of chiropractic in the country. There are two schools of homeopathy in Norway. One offers courses to all persons with some education in allopathic medicine. Beginning with the basics, it is a five-year program with classes taught one weekend each month. The other school only offers courses to persons who have the minimum qualifications to practice allopathic nursing.

Insurance Coverage

Public reimbursement is not available for what is regarded in Norway as complementary/alternative medicine. Coverage for homeopathic treatments, for example, is not included under the official health care system. However, by the regulations governing the national insurance scheme, partial reimbursement is available for chiropractic treatment provided the chiropractor is authorized as a health care professional (although not necessarily a member of the Norwegian Association on Chiropractic) and the patient was referred to the chiropractor by an allopathic physician. This coverage is limited to a maximum of between 10 and 14 consultations per year.

In Norway, Norsk Helseforsikring, which is connected to International Health Insurance Denmark AS, is the only private insurance company offering partial reimbursement for complementary/alternative medicine. The insurance covers chiropractic and, when performed by a licensed allopathic physician as part of medical treatment, acupuncture.