Patients of complementary/alternative medicine who are ill report that they use complementary/alternative medicine because the therapies do not involve treatment with drugs or chemicals, there are no side effects, and allopathic medicine was unsuccessful in treating their illness. Patients of complementary/alternative medicine who are not ill report that they use complementary/alternative medicine to improve their well-being and to keep from falling ill.
A 1992-1993 study showed that the use of complementary/alternative medicine within the previous 12 months was closely related to whether or not a patient had complementary/alternative health insurance:
• Of those surveyed who had insurance covering complementary/alternative medicine, 20.7% did not use complementary/alternative medicine; 18.9% used one form of complementary/alternative medicine; 21.5%, two forms; and 39.0%, three or more forms.
• Those without insurance covering complementary/alternative medicine reported the following: 56.4% did not use complementary/alternative medicine; 20.5% used one form of complementary/alternative medicine; 13.4%, two forms; and 9.7%, three or more forms.
Persons living in the German-speaking and French-speaking parts of the country used complementary/alternative medicine more extensively than those living in the Italian-speaking region. Women and persons with higher levels of formal education were more likely to consult a complementary/alternative medical practitioner than were men and persons with lower levels of formal education. The most commonly consulted forms of complementary/alternative medicine are shown in the chart below.
Type of Complementary/Alternative Medicine Consulted
63%-Patients with insurance coverage
26%-Patients without insurance coverage
Alternative massage therapies
41%-Patients with insurance coverage
19%-Patients without insurance coverage
27%-Patients with insurance coverage
14%-Patients without insurance coverage
22%-Patients with insurance coverage
9%-Patients without insurance coverage
18%-Patients with insurance coverage
4%-Patients without insurance coverage
13%-Patients with insurance coverage
3%-Patients without insurance coverage
8%-Patients with insurance coverage
3%-Patients without insurance coverage
a The percentages are the proportion of respondents who consulted a complementary/alternative practitioner, not the total number of people surveyed.
There are approximately 180 chiropractors practicing in Switzerland. Complementary/alternative therapies are provided by allopathic physicians, natural doctors, non-allopathic practitioners, pharmacists, and patients themselves. There are many organizations linked to complementary/alternative medicine in the country.
In Switzerland, cantons (similar to states or provinces) make their own public health regulations, including the regulation of local medical practice. Nonetheless, some degree programs and professions, such as allopathic physicians or chiropractors, are recognized throughout the country, and the titles of some professions, including “Medical Doctor” and “Chiropractor”, are protected. The cantons allowing only allopathic physicians to practice medicine are Appenzell internal Rhodes, Jura, Nidwalden, Uri, and, with the provisions noted, the following:
• Aargau: a licence is not required to provide care to healthy persons (when treating nervousness, stress, sleeplessness, or phobias, for example).
• Basel Stadt: authorized physiotherapists and masseurs are permitted to use reflexology.
• Bern: the practice of acupuncture by non-allopathic practitioners is tolerated when provided under the orders of an allopathic physician.
• Fribourg: the Department of Health may issue licences to practice complementary/alternative medicine on condition that practitioners do not use methods and techniques restricted to authorized health care professionals.
• Geneva: recently, the authorities have been relatively tolerant of non-allopathic practitioners.
• Glarus: reflexology, acupressure, and other similar forms of massage may be freely provided.
• Schwyz: non-physicians may obtain a licence to practice acupuncture.
• Solthurn: a draft law would enable the practice of complementary/alternative medicine as a self-employed profession.
• Vaud: recently, the authorities have been relatively tolerant of non-allopathic practitioners.
• Zug: under the supervision of the health authority, reflexology, sport massage, acupressure, and health advising may be freely provided. Acupuncture may be provided by persons who have completed three years of training, including comprehensive theoretical and practical courses, and who have passed a cantonal exam.
• Zurich: magnetism is not considered a form of medicine and, therefore, its practice does not require official authorization.
Although the law in these cantons is typically monopolistic, the authorities are relatively tolerant with regard to non-allopathic practitioners.
In order to be allowed to practice in German-speaking cantons (Appenzell external Rhodes, Basel Landschaft, Graubünden, Luzern, Obwalden, St. Gallen, Shaffhausen, and Thurgau), non-allopathic providers must pass the State exam and obtain a licence from State authorities. In most German-speaking cantons, there are specific medical acts that are reserved for physicians.
In non-German-speaking cantons, the situation is slightly different. In the canton of Neuchâtel, since the introduction of a 1995 law, non-allopathic practitioners are permitted to provide non-dangerous complementary/alternative therapies. While a licence to practice is not required, complementary/alternative medical providers may not advertise their services. In Valais, the same restrictions apply, with two additional requirements: complementary/alternative providers must clearly inform their patients that they do not have any allopathic education and they must have a licence from the health department. In the canton of Ticino, non-allopathic practitioners may practice medicine without a licence; however, they must clearly inform their patients that they do not have an allopathic education. And, they are not permitted to advertise; use optical, mechanical, electrical, or ionizing equipment; or prescribe medications or drugs.
Homeopathy is among the most frequently practiced complementary/alternative therapies in Switzerland. All persons legally providing health care may apply homeopathy according to the standards of good medical practice. In some cantons, those not medically qualified may practice homeopathy as well. In 1998, the National Medical Association recognized homeopathy as a medical sub-specialty.
Chiropractic is considered an independent medical profession that is federally regulated and recognized throughout the country. There are several requirements that must be met to be allowed to practice as a chiropractor, including limited competence in medical diagnosis and treatment. To practice chiropractic, a person must have Swiss citizenship, hold a diploma giving access to a university, have studied at least four years in a chiropractic college recognized by the American Council on Chiropractic Education, have passed the American commission exam, have passed the Swiss intercantonal exam, have passed the Swiss federal exam to be allowed to X-ray, and have completed at least a one-year internship with a Swiss-authorized chiropractor.
Education and Training
The universities of Zurich and Bern include an introductory course on complementary/alternative medicine in the standard curriculum for allopathic physicians. In Bern there are also more extensive courses on homeopathy, neuraltherapy, traditional Chinese medicine, phytotherapy, anthroposophic medicine, hydrotherapy, and bio-resonanc.
The Swiss Medical Association has been aware of the need to establish complementary/alternative medical specialties. In 1999 and 2000, it set up a new training program for allopathic physicians. Homeopathy, Chinese medicine, acupuncture, anthroposophic medicine, and neural therapy are now granted specialty titles for allopathic physicians. Training for these techniques, as with allopathic specialties such as cardiology or rheumatology, lasts between eight and 10 years.
Students who are not allopathic practitioners may study at any one of several private institutions offering training programs in complementary/alternative medicine, including the following:
• Swiss Association of Natural Doctors: the program, which lasts six semesters and is provided on weekends, includes introductions to anatomy, physiology, and biochemistry; seminars in physiology and pathology; and seminars on diagnostic and treatment techniques.
• School for Natural Medicine in Zurich: two training options are available, both include basic courses in anatomy, physiology, and pathology. Students then specialize either in homeopathy and traditional Chinese medicine or in several forms of complementary/alternative massage. The program lasts four years.
• Academy for Natural Medicine in Basel: the school offers a basic common course in anatomy, physiology, pathology, psychiatry, neurology, and physical diagnosis. After completing this common course, students choose from among three specializations: homeopathy, phytotherapy and natural medicine; traditional Chinese medicine; or acupuncture. The program lasts four years plus a required four-month internship.
• Swiss School for Osteopathy of Belmont/Lausanne: this school is working to obtain official recognition equivalent to a university faculty. It offers a five-year diploma and a six-year doctorate program.
Although chiropractic is a recognized profession in Switzerland, there are no recognized chiropractic schools in the country. Practitioners must train abroad.
Some cantons – Appenzell external Rhodes, Basel Landschaft, Graubünden, Obwalden, St. Gallen, Shaffhausen, and Thurgau – have specific rules concerning the exam that candidates must pass to be allowed to practice complementary/alternative medicine.
There are several levels of health care protection in Switzerland. Insured persons are free to choose between minimum basic coverage and extensive coverage provided through policies that provide coverage for complementary/alternative health care and medications.
Since July 1999, five commonly used complementary/alternative therapies – homeopathy, Chinese medicine, anthroposophic medicine, neural therapy, and phytotherapy – have been reimbursed by compulsory social insurance when they are provided by an allopathic physician with a postgraduate education recognized by the Swiss Medical Association. Treatments provided by non-allopathic physicians are not reimbursed. Except for acupuncture, in order for these therapies to continue to be reimbursable after 2005, their efficacy and cost-effectiveness have to be proven by that year.
The complementary/alternative medicine policies of private insurance companies influenced the Swiss Government’s decision to cover the most commonly used therapies. Private insurance companies, such as Caisse Vaudoise, generally offer complementary/alternative health care policies covering acupuncture, acupressure, Alexander technique, anthroposophy (when provided by a physician), audiopsycho-phonology, auriculotherapy, lymphatic drainage, etiopathy, curative eurythmy, eutony, homeopathy, postural integration, iridology, colonic irrigation, Kneipp therapy, kinesiology, anthroposophic medicine, mesotherapy, naturopathy, osteopathy, polarity, energetic balancing, reflexology, relaxation, breathing techniques, shiatsu, sophrology, and sympathicotherapy. The supplementary fee for complementary/alternative policies varies between 10 and 20 Swiss francs per month. Reimbursement varies between 30 and 100 Swiss francs per consultation; three to 10 consultations are covered per year.