National Health Programs

BACKGROUND: The demand for complementary and alternative medicine (CAM) treatment in the European Union (EU) has led to an increase in the various CAM interventions available to the public. Our aim was to describe the CAM services available from both registered medical practitioners and registered non-medical practitioners.

There is an increased interest amongst women in seeking alternatives for hormone replacement therapy because of their fear of side-effects. It is claimed that acupuncture is effective for curing menopausal symptoms, and to be a safe treatment in the hands of well-trained and qualified practitioners. About one million acupuncture treatments are given in the National Health Service and two million privately each year in England for various indications.

In October 2000 the German Federal Committee of Physicians and Health Insurers recommended that special Model Projects on Acupuncture ("Modellvorhaben Akupunktur") be developed in order to determine the evidence-based role of acupuncture in the treatment of certain illnesses. This paper presents a summary of the main randomised controlled trials performed as part of these projects, and the associated economic analyses.

There is an increased interest amongst women in seeking alternatives for hormone replacement therapy because of their fear of side-effects. It is claimed that acupuncture is effective for curing menopausal symptoms, and to be a safe treatment in the hands of well-trained and qualified practitioners. About one million acupuncture treatments are given in the National Health Service and two million privately each year in England for various indications.

In October 2000 the German Federal Committee of Physicians and Health Insurers recommended that special Model Projects on Acupuncture ("Modellvorhaben Akupunktur") be developed in order to determine the evidence-based role of acupuncture in the treatment of certain illnesses. This paper presents a summary of the main randomised controlled trials performed as part of these projects, and the associated economic analyses.

GOALS OF WORK: Therapeutic touch (TT) is a complementary and alternative medicine (CAM) treatment modeled on the ancient practice of "laying on of hands" that has been developed into a contemporary supportive care intervention. Evidence-based support for TT is emerging with increasingly more sophisticated studies; however, flaws in early research contributed to a perception that TT is poor science. Yet TT is a safe CAM treatment that is highly valued by patients and can be integrated into conventional settings.

The following paper describes a model project (currently in the trial phase at one clinic) focussing on empathetic communication within the family as an essential part of the treatment of mothers suffering from breast cancer and their children in order to activate the mother's self-healing powers and at the same time to prevent the children being traumatised as a consequence of the mother's illness.

The BEACH (Bettering the Evaluation and Care of Health) program, a continuous national study of general practice, began in April 1998 and is now in its eighth year. More than 7500 GPs have participated to date (about one-third of the total workforce) and data are available for about 750,000 encounters. The following overview is designed to disseminate key findings from BEACH, to publicize the annual report, and as a public expression of gratitude to the GP participants without whose generous contribution this study would not be possible.

In this paper we argue that the usual framework for evaluating health services may need modification in the context of a National Health Scheme (NHS). Some costs and benefits may need to be ignored or discounted, others included at face value, and some transfer payments included in the decision algorithm. In contrast with the standard framework, we argue that economic evaluation in the context of an NHS should focus on 'social transfers' between taxpayers and beneficiaries, and that the nature and scope of these transfers is determined by the level of social generosity.

National paid sick day and paid sick leave policies are compared in 22 countries ranked highly in terms of economic and human development. The authors calculate the financial support available to workers facing two different kinds of health problems: a case of the flu that requires missing 5 days of work, and a cancer treatment that requires 50 days of absence. Only 3 countries--the United States, Canada, and Japan--have no national policy requiring employers to provide paid sick days for workers who need to miss 5 days of work to recover from the flu.