Please wait a minute...
1Traditional Medicine Research  2020, Vol. 5 Issue (3): 125-135    DOI: 10.12032/TMR20190718125
Special Issue on Infectious Diseases and Public Health     
Complementary and alternative medicine in European countries - legislative framework
Jovana Milenkovic1,*(), Sergey Bolevich2, Gvozden Rosic3
1Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
2Department of Human Pathology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia
3Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia.
Download: HTML     PDF(755KB)
Export: BibTeX | EndNote (RIS)      


The present article reviews the available data regarding the use of the complementary and alternative medicine and the legislation behind it in European countries.


Complementary and alternative medicine has been used for centuries. Since ancient times to date, these methods have been improved in line with the progress of Western medicine. Today, these methods have been applied in many countries around the world.


Complementary and alternative medicine (CAM) is a set of different diagnostic and therapeutic procedures, as well as the use of natural products for the treatment of patients, derived from previously known traditional methods and enriched with modern scientific knowledge. The present article reviews the available data regarding the use of CAM and the legislation behind it in European countries. The use of CAM is recorded in Europe as a whole and varies between 10-70% of the population of individual European countries. At least 300,000 registered CAM providers have been identified in the European Union (EU), of which slightly more than half includes non-medical practitioners. The most practiced discipline is acupuncture, followed by homeopathy. CAM regulation and legislation in Europe is not precisely defined and is constantly striving to find a common approach. Since legal frameworks for CAM are not defined, each European country has its own regulations and legislation. In order to define universal legislation for CAM, the EU created the CAMbrella project, a project of the EU designed to find a unique system that would include the treatment of CAM in Europe. According to the data from CAMbrella, from 39 countries in the EU, 17 have general CAM legislations. The status of CAM in Europe is characterized by enormous heterogeneity in all aspects, including terminology, methods, prevalence and ultimately, legal status, regulations and legislation.

Key wordsComplementary and alternative medicine      European countries      Methods of therapy      Legal status      Regulation      Legislation     
Published: 13 April 2020
Corresponding Authors: Jovana Milenkovic   
Cite this article:

Jovana Milenkovic, Sergey Bolevich, Gvozden Rosic. Complementary and alternative medicine in European countries - legislative framework. 1Traditional Medicine Research, 2020, 5(3): 125-135. doi: 10.12032/TMR20190718125


Country Prevalence rate (%)
United Kingdom 6-71
Germany 4.6-62
Turkey 48-86
Switzerland 5-57
Sweden 5-64
Norway 9-53
Denmark 45-59
Italy 16-84
Israel 5-43
Finland 11-43
Spain 5-47
France 21
Ireland 15
Netherlands 17.2
Poland 14.4
Portugal 43.7
Slovenia 6.6
Table 1 Percentage of CAM usage in different European countries
Country Who is implementing CAM? Insurance Additional education
Austria There are no legal regulations that confirm that use is allowed, but allopathic doctors are allowed to use it. The Health Insurance Fund does not cover services. Some private companies cover CAM. Upgrading 3-4 years
Belgium There is a specific law, CAM is administered only by doctors licensed for this practice. It is not covered by the health insurance fund. Private companies partially compensate for acupuncture and chiropractic. There is an education in the form of training and courses.
Denmark Non-allopathic doctors are not recognized as official providers of health care. The exception is chiropractors. The insurance fund covers partial costs (1/3). ?
Finland Only allopathic doctors and registered chiropractors, naprapathy and osteopaths can practice CAM. Covered by the fund if administered by allopathic doctors. There is no private insurance. Upgrading 3-4 years
France Allopathic doctors provide CAM, while they are not allopathic criminally prosecuted. Chiropractic is legal in France. There is only CAM provided by allopathic doctors. There is education in the form of training and courses.
Germany All licensed doctors can implement CAM practice. It covers some forms of CAM practice. There is also private insurance. There is education in the form of training and courses.
Hungary There is a specific law. Not allopathic doctors are allowed to use CAM if they pass the exam. ? There is education in the form of training and courses.
Ireland Only allopathic doctors can do CAM. It is covered when CAM services are provided by allopathic doctors. Courses and trainings do not exist.
Italy Only registered allopathic doctors can administer CAM. Every Italian region is regulated differently. There is additional education in the form of courses but not legally recognized.
Latvia Local laws regulate CAM. Allopathic doctors may apply it. CAM is not covered by compulsory health insurance. ?
Liechtenstein No specific law. CAM practice in allopathic doctors is not regulated. It is not covered by compulsory health insurance. Training in foreign countries
Luxembourg Only allopathic doctors can do CAM. Only homeopathy is covered by insurance, other disciplines are not covered. There is no officially recognized education.
Malta Only allopathic doctors can do CAM, while they are not allopathic. There is a partial coverage of CAM costs. ?
Netherlands In addition to allopathic doctors, they can also be practiced by qualified practitioners. NO YES
Table 2 Who can use CAM?
Country Acupuncture Chiropractic Homeopathy
1 2 3 4 1 2 3 4 1 2 3 4
Albania + + +
Austria + + +
Belgium + + +
BiH + + +
Bulgaria + + +
Croatia + + +
Cyprus + + +
Czech Republic + + +
Denmark + + +
Estonia + + +
Finland + + +
France + + +
Germany + + +
Greece + + +
Hungary + + +
Iceland + + +
Ireland + + +
Israel + + +
Italy + + +
Latvia + + +
Liechteistein + + +
Lithuania + + +
Luxemburg + + +
Macedonia + + +
Malta + + +
Montenegro + + +
Netherlands + + +
Norway + + +
Poland + + +
Portugal + + +
Romania + + +
Serbia + + +
Slovakia + + +
Slovenia + + +
Spain + + +
Sweeden + + +
Switzerland + + +
Turkey + + +
UK + + +
Table 3 The status of acupuncture, homeopathy and chiropractic in different European countries.
With CAM law With general CAM legislation in health laws Without general CAM legislation
Belgium Switzerland Austria
Denmark Malta Croatia
Germany Bulgaria Cyprus
Portugal Macedonia Czech Republic
Iceland Albania Estonia
Liechtenstein Bosnia & Herzegovina Finland
Norway France
Hungary Greece
Slovenia Ireland
Romania Israel
Serbia Italy
Turkey (since 2015) Latvia
Table 4 CAM legislation in different countries
1.   Abbott RB, Hui K-K, Hays RD, et al. Medical Student Attitudes toward Complementary, Alternative and Integrative Medicine. Evid Based Complement Alternat Med 2011, 2011: 985243.
2.   Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report 2008, 12: 1-23.
3.   Cassileth BR, Schraub S, Robinson E, et al. Alternative medicine use worldwide: the International Union Against Cancer survey. Cancer 2001, 91: 1390-1393.
4.   de Nijs MJ. Complementary and Alternative Medicine: The History, Current Prevalence, and Future Projections. Liberty University 2013.
5.   Malicević Z. Alternative and complementary medicine. Vojnosanit Pregl 2006, 1: 55-64.
6.   Chen CYC. TCM Database@Taiwan: the world’s largest traditional Chinese medicine database for drug screening in silico. PLoS One 2011, 6: e15939.
7.   Epler DC. Bloodletting in early Chinese medicine and its relation to the origin of acupuncture. Bull Hist Med 1980, 54: 337-367.
8.   Zou P. Traditional Chinese Medicine, Food Therapy, Hypertension Control: A Narrative Review of Chinese Literature. Am J Chin Med 2016, 44: 1579-1594.
9.   Jaiswal YS, Williams LL. A glimpse of Ayurveda - The forgotten history and principles of Indian traditional medicine. J Tradit Complement Med 2017, 7: 503.
10.   Hardy ML. Research in Ayurveda: where do we go from here? Altern Ther Health Med 2001, 7: 34-35.
11.   Frenkel M, Slater R, Sapire K, et al. Complementary and Integrative Medicine in Lung Cancer: Questions and Challenges. J Altern Complement Med 2018, 24: 862-871.
12.   Ooi SL, McLean L, Pak SC. Naturopathy in Australia: Where are we now? Where are we heading? Complement Ther Clin Pract 2018, 33: 27-35.
13.   Şenel E. Evolution of homeopathy: A scientometric analysis of global homeopathy literature between 1975 and 2017. Complement Ther Clin Pract 2019, 34: 165-173.
14.   Zhuang Y, Xing J, Li J, et al. History of acupuncture research. Int Rev Neurobiol 2013, 111: 1-23.
15.   Xing J, Zeng BY, Li J, et al. Acupuncture point specificity. Int Rev Neurobiol 2013, 111: 49-65.
16.   Zhang Y, Zhang H, Nierhaus T, et al. Default Mode Network as a Neural Substrate of Acupuncture: Evidence, Challenges and Strategy. Front Neurosci 2019, 13: 100.
17.   Berman BM, Lao L, Langenberg P, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med 2004, 141: 901-910.
18.   Grace S, Barnes L, Reilly W, et al. An integrative review of dietetic and naturopathic approaches to functional bowel disorders. Complement Ther Med 2018, 41: 67-80.
19.   Smith MJ, Logan AC. Naturopathy. Med Clin North Am 2002, 86: 173-84.
20.   Smith CA, Levett KM, Collins CT, et al. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database Syst Rev 2012: CD009290.
21.   Embong NH, Soh YC, Ming LC, et al. Revisiting reflexology: Concept, evidence, current practice, and practitioner training. J Tradit Complement Med 2015, 5: 197-206.
22.   Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA 1998, 280: 1569-1575.
23.   Ashraf M, Saeed H, Saleem Z, et al. A cross-sectional assessment of knowledge, attitudes and self-perceived effectiveness of complementary and alternative medicine among pharmacy and non-pharmacy university students. BMC Complement Altern Med 2019, 19: 95.
24.   World Health Organization. Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review. World Heal Organ 2001: 1-199.
25.   Clarke TC, Black LI, Stussman BJ, et al. Trends in the use of complementary health approaches among adults: United States, 2002-2012. Natl Health Stat Report 2015: 1-16.
26.   von Ammon K, Frei-Erb M, Cardini F, et al. Complementary and alternative medicine provision in Europe-first results approaching reality in an unclear field of practices. Forsch Komplementmed 2012, 19 Suppl 2: 37-43.
27.   Eardley S, Bishop FL, Prescott P, et al. A systematic literature review of complementary and alternative medicine prevalence in EU. Forsch Komplementmed 2012, 19 Suppl 2: 18-28.
28.   Astin JA. Why patients use alternative medicine: results of a national study. JAMA 1998, 279: 1548-1553.
29.   Wiesener S, Falkenberg T, Hegyi G, et al. Legal status and regulation of complementary and alternative medicine in Europe. Forsch Komplementmed 2012, 19 Suppl 2: 29-36.
30.   Trebilcock MJ, Ghimire KM. Regulating Alternative Medicines: Disorder in the Borderlands. CD Howe Institute Commentary 2019, 541.
31   CAMbrella. [Internet]. The Roadmap for European CAM Research. An Explanation of the CAMbrella Project and its Key Findings. [cited 2019 May 18]. Available from:
32.   Wiesener S, Falkenberg T, Hegyi G, et al. Legal status and regulation of CAM in Europe. Complement Med Res 2012, 19: 29-36.
33.   Lewith GT, Breen A, Filshie J, et al. Complementary medicine: evidence base, competence to practice and regulation. Clin Med 2003, 3: 235-240.
34.   Jakovljevic MB, Djordjevic V, Markovic V, et al. Cross-sectional survey on complementary and alternative medicine awareness among health care professionals and students using CHBQ questionnaire in a Balkan country. Chin J Integr Med 2013, 19: 650-655.
35.   Jakovljevic MB, Milovanovic O. Growing burden of non-communicable diseases in the emerging health markets: the case of BRICS. Front Public Health 2015, 3: 1-5.
36.   Sunjka ML, Pejcic A, Jakovljevic M. Utilization patterns of complementary and alternative medicine in Australia, Canada and the United States: popularity of dietary supplements, mind-body and manipulative therapies. Farmeconomia Heal Econ Ther pathways 2017, 18: 15-20.
37.   Jakovljevic M, Jakab M, Gerdtham U, et al. Comparative financing analysis and political economy of noncommunicable diseases. J Med Econ 2019, 27: 1-6.
38.   Jakovljevic M, Potapchik E, Popovich L, et al. Evolving Health Expenditure Landscape of the BRICS Nations and Projections to 2025. Health Econ 2017, 26: 844-852.
39   CAM Regulation. [Internet]. Norway’s National Research Center in Complementary and Alternative Medicine. [cited 2019 May 18]. Available from:
40   CAMbrella. [Internet]. Final Report Summary - CAMBRELLA [A pan-European research network for complementary and alternative medicine(CAM)].[cited 2019 May 18]. Available from:
41.   The Norwegian Physiotherapist Association: Personal Communication, the leader of the central board. Oslo 2012.
[1] Milena Jurisevic, Sergey Bolevich. Complementary and alternative medicine applications in cancer medicine[J]. 1Traditional Medicine Research, 2020, 5(1): 7-21.
[2] Editor Group of TMR. Complementary and alternative medicine for cancer treatment: magic or fraud?[J]. 1Traditional Medicine Research, 2019, 4(2): 54-55.
[3] V. Pejcic Ana, Jakovljevic Mihajlo B. Economic impact of traditional medicine practice worldwide[J]. 1Traditional Medicine Research, 2017, 2(2): 60-74.