Key points:
- The CAM Act ("Lov om alternativ behandling av sykdom mv"), identifies and defines CAM therapies and –treatment as "health-related services" which are provided more often outside than inside the official health care system; mostly provided by non-authorized personnel.
- Practising CAM does not require any form of registration, authorization or license from Norwegian authorities. Neither does it require any medical education nor demonstration of medical competence.
- Medically trained and qualified professionals may also provide CAM, as long as it is considered in line with the Act regulating Healthcare professionals (Helsepersonelloven); especially the concepts of soundness, properness and professionalism expected in official patient care described in section 4 of the act.
What does “health-related treatment” mean?
The terms Alternative/ Health-related treatment cover a wide range of services, modalities and therapies that have in common that they aim to identify/ diagnoze, prevent, cure or alleviate illness, ailments and disorders, as well as to strengthen the immune system or the body's self-healing capabilities.
The wide range is intentional, for the sake of contributing optimally to patient safety outside the official health care system.
Hence, the CAM Act and its definition regulates both treatment of both physical, psycho-somatical as well as mental health problems. Also, giving dietary and/ or life style advice for health purposes fall under the definition and Act.
When is a service considered CAM?
In addition to the Act's term that a service must be considered mostly provided outside the official health care system, the other mandatory factor is if its main intention is mainly health-related, in the meaning that it aims to affect a diagnoze, prevent or improve a health problem. Whether the service actually can be said to affect health as intended, is of less relevance.
Thus, research findings and the level of documentation of a health-related service is not a defining factor. In addition, payment is generally not a mandatory factor for identifying a service as CAM or not, but strengthens the perception of a patient-provider relationship and the general understanding of the service as health-related.
When is a service not considered CAM?
Services that are mainly aimed at and promoted for increasing physical and mental well-being (relaxation, etc) in general; beauty care and the like are not considered CAM - and thus not regulated by the CAM Act.
Also common religious activities, as well as services that lack clear health ambitions but mainly aim at personal self-development or to improve one’s normal abilities, in principle fall outside the CAM definition and regulation.
Though, the CAM Act may still apply if such a service is further considered, and found to give an impression of improving patients' state of health in an extended sense (E.g the provision of individual and paid-for religious prayer, or teaching self-help techniques; both aimed at improving specific health problems)
Governmental supervision of CAM
- Medically trained and qualified professionals are always supervised under the Norwegian Supervision Act (Helsetilsynsloven) by the Norwegian Board of Health Supervision (Helsetilsynet) - independent of if they provide conventional medicine or CAM; inside or outside the official health care system.
- CAM treatment provided by non-medically trained/ qualified personnel generally falls within the jurisdiction of the Criminal Act (Straffeloven), though the CAM Act itself provides specific penal provisions, especially regarding its sections 5, 6, 7 and 9.
What is not allowed?
- The CAM Act reserves any treatment aiming to cure serious disease and disorders (E.g cancer, MS, HiV/ AIDS etc); all treatment of serious communicable diseases; plus any medical procedures considered as possibly hazardous to the patient’s health, to only be practised by medically trained qualified healthcare professionals. Non-qualified providers who break these sections, are subject to punishment.
- In addition, non-qualified who break the Act by willfully or through gross negligence placing a person’s life or health in serious danger, may be punished - either because of the treatment itself or because the patient as a result of the treatment omits to seek expert help. Misunderstanding the danger or the nature of the disease does not exempt providers of CAM from responsibility and punishment.
Further regulation and supervision of the CAM field
Complementing the CAM Act, Norway has two national regulations that both relate to the provision of CAM:
- FOR 2003-12-11 nr 1501: Regulation related to the marketing of CAM (Forskrift om markedsføring av alternativ behandling av sykdom)
This regulation details CAM providers’ marketing and their use of professional titles. It is meant to ensure patient’s safety by keeping marketing of CAM services and providers unbiased and fact-oriented. Further, the regulation takes on a clear consumer perspective by stating that all marketing of CAM will be assessed based on the immediate impression the marketing creates for the average patient. Thus,the regulation aims to help ensure that the patient does not get unrealistic perceptions of what help can be expected.
- Professional titles in the field of CAM are generally not protected. Anyone may use titles such as "acupuncturist", "homeopath", "herbalist" etc.
- Non-medically trained/ qualified providers cannot use titles that give the impression they have such qualifications, or that they represent the official health care system.
- CAM providers’ marketing of their services is not allowed to give the impression that they are effective for specific health problems.
- CAM providers cannot market treatment directed at patients/ conditions regulated by Sections 5,6 and 7 in the CAM Act.
The marketing and promotion of CAM and non-medically qualified health providers’ use of titles is supervised by the Norway's official Consumer Authority.
- FOR-2003-12-11-1500 Regulation of a voluntary registration system for CAM (Forskrift om frivillig registerordning for utøvere av alternativ behandling)
This regulation details procedures for listing in the voluntary, official ALTBAS Registry, which is meant to improve patient’s safety by setting a minimum standard of professionalism among CAM practitioners.
Listing here does not imply official recognition of the provider or his/ her therapies; but ensures patients that the provider has a company listed in the Register of Business Enterprises (Enhetsregisteret); holds a membership in a government-approved providers' association with the possibility to make complaints; and that the provider holds a valid liability insurance for potential claims for injuries sustained in their CAM practise.
Per 2023, ALTBAS lists about 2.500 providers in total, belonging to some 40 approved providers' associations. The formal approval of CAM providers' associations to the ALTBAS registry is supervised by the Directorate of Health.
Providers opting to register in ALTBAS, must first and hold a membership in an approved providers' association. The various associations' minimum requirements to new members are not standardized and varies substantially, both when it comes to education, training and experience.
There is also a number of other, non-governmental-approved CAM providers' associations. Holding a membership in one of these will not qualify for listing in ALTBAS. For an overview of all known CAM providers' associations in Norway, visit this page.
The reimbursement status of CAM practices and CAM products
Expenses for healthcare given inside/ by the official healthcare, from medically trained/ qualified professionals are generally reimbursed substantially by the National Insurance Scheme (Folketrygden).
CAM treatment provided by non-medically trained/ qualified providers is not reimbursed. Yet private health insurance is not widely used in Norway, some companies offers insurance which reimburse the expense of specific CAM treatments, regardless whether the provider is medically qualified or not.
When CAM is provided by medically trained/ qualified healthcare professionals expenses may be reimbursed; if the treatment is considered "adequately integrated with conventional treatment" and given inside the official healthcare system.
Examples of such may be when acupuncture is provided in hospitals by a midwife for relieving pain during labour; or the use of needles from a physiotherapist as a part of conventional physiotherapy treatment.
Expenses for over-the-counter (OTC) health products (such as dietary supplements, homeopathic/ antroposophic remedies and non-prescription plant-based or pharmaceutical drugs) are not reimbursed. Prescription plant-based drugs are reimbursed on the same level as prescription pharmaceutical drugs. To ensure patient safety, homeopathic/ anthroposophic remedies are regulated as drugs but without the demands for scientific evidence for efficacy.
Responsibilities and claims for compensation after injures
The government does not take responsibility for claims for compensation after injuries sustained by treatment from non-medically trained/ qualified providers.
If the provider is medically qualified and the CAM treatment is considered adequately integrated into the standard treatment offered by the official health care services, the Act on Patient Injury Compensation (Pasientskadeloven) may apply and such compensation can be granted.
- For example, claims following an injury sustained during acupuncture from a licensed physiotherapist may be covered, depending on if it is considered an integral part of the physiotherapy treatment which is usually given inside the official health care system.
- However, if a medically qualified professional mainly offers CAM treatment outside the official health services, such claims will not be covered. This would be especially true if the person's status as an medically qualified health professional was used in the promotion of CAM treatment.
The governmental agency Norwegian System of Patient Injury Compensation (NPE) offers specific assessments about such topics to medically trained/ qualified professionals who include or consider to include CAM in their treatment of patients.
Further official engagement in CAM
Along with the passing of the CAM Act and the two regulations, Norwegian health authorities contribute to patient safety via funding solid research and research-based, unbiased public information about CAM. For this purpose, NAFKAM was founded in 2000 and located inside the Faculty of Health Sciences at UiT the Arctic University of Norway.
In addition to doing research and running web-based information sources, NAFKAM offers a Q&A service to patients, health providers and the media. NAFKAM is also frequently consulted by professional organizations, official bodies and political entities. NAFKAM is also appointed a WHO Collaboration Center.
For a while, Norwegian authorities also gave financial support to the CAM providers' own umbrella association SABORG, aiming to stimulate further professionalism through collaboration, alignment and development across the various providers' associations. Today, SABORG is supported by less than 1/4 of known CAM providers' associations.
Practising medical healthcare and health-related services (CAM) and in Norway as a foreigner
Medically trained/ qualified professionals from abroad who want to practise medical healthcare inside or outside Norway's official health care system, must be registered and hold a license or authorisation. Further information on this and instructions on how to apply, is found at the Norwegian Directorate of Health, plus at the official Altinn Business Information website, under the heading "occupational therapist".
Though no documented medical knowledge, education or training; as well as no registration, medical licence or authorization is needed to offer and practice CAM in Norway, one should be aware of the general national rules for starting up and running a business in Norway. Information about this may be found at Altinn. There, it is also provided a help line for those who seek further answers. Information about rules for taxation and VAT can be found at the Norwegian Tax Administration (Skatteetaten).
If you are considering coming to Norway and practising CAM as an employee, ie. in someone else's Clinique, you may find useful information about working in Norway at the official Work in Norway web site.
