Integration of Acupuncture into Healthcare Systems: Regulatory and Cost-Effectiveness Aspects
In times of economic crisis and spending review, funding of many medical practices has increasingly been questioned.
In order to cut unjustified public healthcare costs, advice has been given to GPs and specialists to prescribe only therapies proven to be effective in randomized controlled trials according to studies with sound methodology.
However, the increasing evidence available from recent studies yields reliable information about the efficacy and advantages of Acupuncture in terms of lower costs, reduced drug use and almost total lack of side effects; that’s why in western countries increasing attention has been focused on this therapy which has proven to be effective in the treatment of many chronic diseases and conditions. That's the case of some Italian regions, such as Emilia Romagna, which has secured public funding to provide Acupuncture for the treatment of low back pain, with or without sciatica, chronic migraine and tension-type headaches.
The EU has also shown its interest in Acupuncture by financing the CHETCH project (China and Europe taking care of Healthcare Solutions), a 4-year programme to promote exchanges between European and Chinese researchers in order to study how to integrate the best diagnostic tools and practices of TCM – as Acupuncture - in the European national health care systems.
One of the reasons leading to conceive this project and highlighting the need for regulation in this field, was the patients’ increasing request to choose their own therapy, either acupuncture alone or associated with conventional treatment provided by public healthcare, in other words the so-called "Right to Health Care".
Is integration really possible? Which obstacles, if any, to the proliferation of this medical practice in the Western healthcare? What would be the pros and cons for the patients, as well as for the healthcare systems? What is the current state of knowledge according to the literature review?
Economic evaluations being always used to assess healthcare, they have become an accepted aspect of health policy and planning.
Cost-effectiveness analysis (CEA) is a tool used to aid decisions about which medical care should be offered. It is a method of comparing the cost and effectiveness of two or more alternatives. Such comparisons are useful when one of the alternatives being considered is standard care and when resources are scarce. The goal of cost-effectiveness analysis is to determine if the value of an intervention justifies its cost.
Over the past two decades, an increasing number of patients have turned to acupuncture, for they perceive it to be a cost-effective treatment. At the same time, more and more scientific knowledge on the efficacy of complementary medicine has been acquired: its mechanisms of action are better understood, quality is ensured and standards set in terms of materials and products.
Acupuncture is one of the most visible and fastest growing forms of health care in many countries. This explosion is due to the recognition by patients and regulators of the safety, effectiveness and low cost of this form of health care. Spiralling healthcare costs in limited resource environments have fuelled demand for clinically applicable research assessing treatment effectiveness.
Will acupuncture clinical research be able to face the need for RCTs to answer questions about the effectiveness of acupuncture and find evidence based answers? At the same time, will acupuncturists be able to test its effectiveness in routine clinical practice?
The debate is open.