Economic aspects of nursing in inpatient naturopathy: vidence from Germany.

The costs of nursing in Germany are defined in terms of "nursing-relevant secondary diagnoses." However, the further development of the German-DRG system reveals nursing diagnoses play a constantly declining role with regard to increasing severity and revenue assurance. In particular, additional therapeutic nursing services performed, for example, by specially trained, certified nurses in acute hospitals focusing on naturopathy are not adequately defined. In this study, researchers analyzed naturopathic care, especially the nursing costs for inpatient care of multi-morbid cardiac patients, with a particular focus on a holistic, comprehensive treatment. Results indicated the nursing costs in an inpatient acute hospital with a naturopathic focus are significantly higher than nursing costs in hospitals operating exclusively according to conventional medicine. Questions about adequate determination of the costs of DRGs for professional groups such as the nursing service need to be addressed.

[Comparison of treatment expenses of naturopathic and orthopedic in-patient treatment]. / Kostenvergleichsuntersuchung zur naturheilkundlichen und konventionellen orthopädischen stationären Behandlung.

BACKGROUND: In health services research comparative studies between orthopaedics and naturopathy are necessary. They allow evidence based decisions between individual therapeutical alternatives as well as decisions on health politics, e.g. concerning allocation of resources. PATIENTS AND METHODS: A controlled prospective cohort study is presented. Conservatively treated patients were recruited for the study, if they needed in-patient treatment because of chronic back pain. The conservative orthopaedic treatment including Minimal invasive Therapy (MIT) was compared to in-patient naturopathic "complex"-treatment. The real costs to the public health insurance system are unknown--relating to both the individual patient and the physician. Hence an approximation was attempted on the basis of the billing of the concerned hospitals, the analysis of extensive patient interviews, randomly selected evaluation of in- and out-patient records, validated by an expert panel. RESULTS: Costs for medication decreased in the post stationary phase after orthopedic and naturopathic treatment. Rehabilitation measures and treatments at a health resort increased after orthopedic treatment, whereas the frequency of specialist consultation decreased in both cohorts indicating the efficacy of the in-patient treatment. Incidence of psychotherapy was highest in the naturopathic group before admission to hospital and decreased afterwards. The gathered data point to a reduction of the total outpatient treatment costs in both cohorts. There were treatment-specific differences when regarding single components. CONCLUSION: Naturopathic complex in-patient treatment is a cost-efficient complement of the conventional orthopedic treatment options.

Cost-effectiveness of naturopathic care for chronic low back pain.

OBJECTIVE: To determine the cost-effectiveness of naturopathic care (acupuncture, relaxation exercises, exercise and dietary advice, and a back care booklet) compared to standardized physiotherapy education and a back care booklet (control treatment) for low back pain in a sample (N = 70) of warehouse workers. DESIGN: Economic evaluation based upon the results of a pragmatic randomized controlled trial to determine the cost-effectiveness of naturopathic care to society as a whole, to the employer, and to participants. RESULTS: Naturopathic care (as compared to the control treatment) significantly improved quality-adjusted life-years over the 6-month study period (3-month intervention period and 3-month follow-up period) by 0.0256 (95% CI: 0.0075, 0.0437)--roughly equivalent to 9.4 "perfect health" days. Naturopathic care also significantly reduced societal costs by $1212 per participant. From the perspective of the employer, the intervention cost $154 per absentee day avoided (compared to employer costs of lost productivity of $172 per day) and had a return on investment of 7.9% under the healthcare coverage limits set by this employer and assuming the employer paid the full cost of naturopathic care. Participants experienced savings in adjunctive care of $1096 per participant. CONCLUSIONS: This economic evaluation alongside a pragmatic randomized control trial shows naturopathic care to be more cost-effective than a standardized physiotherapy education regimen in the treatment of chronic low back pain. Further studies of the economic impact of naturopathic medicine are warranted.

Breast Cancer Integrative Oncology Care and Its Costs.

BACKGROUND: Naturopathic oncology in conjunction with conventional treatment is commonly referred to as integrative oncology (IO). Clinics directed by oncology board certified NDs (Fellows of the American Board of Naturopathic Oncology or FABNOs) provide high-quality data for describing IO therapies, their costs and measuring clinical outcomes. PURPOSE: To describe the types of IO therapies prescribed to breast cancer patients by ND FABNO physicians. Study participants (n = 324). Women who sought care at 1 of 6 naturopathic oncology clinics in Washington State were asked to enroll in a prospective 5 year observational outcomes study. METHODS: Medical records were abstracted to collect treatment recommendations and cost data. RESULTS: More than 72 oral or topical, nutritional, botanical, fungal and bacterial-based medicines were prescribed to the cohort during their first year of IO care. Trametes versicolor was prescribed to 63% of the women. Mind-body therapy was recommended to 45% of patients, and 49% received acupuncture. Also, 26% were prescribed injectable therapy, including mistletoe, vitamin B complex (12%), IV ascorbate (12%), IV artesunate (7%), and IV nutrition and hydration (4%). Costs ranged from $1594/year for early-stage breast cancer to $6200/year for stage 4 breast cancer patients. Of the total amount billed for IO care for 1 year for breast cancer patients, 21% was out-of-pocket. CONCLUSIONS: IO care for women with breast cancer consists of botanical and mushroom oral therapies, parenteral botanical and nutrient therapy, mind-body medicine and acupuncture. IO clinic visits and acupuncture are partially paid for by medical insurance companies.

Utilization, patient satisfaction, and cost implications of acupuncture, massage, and naturopathic medicine offered as covered health benefits: a comparison of two delivery models.

CONTEXT: Increasing numbers of health plans in the United States offer complementary and alternative medicine (CAM) benefits despite limited information. OBJECTIVE: To determine the utilization rates and costs associated with providing CAM services in 2 benefit designs, and to determine the satisfaction of patients in both plans. DESIGN: Two health plans were identified: a traditional indemnity plan offered through a defined preferred provider organization (PPO) of CAM providers and a health maintenance organization (HMO). Costs and utilization rates for CAM services were compared during a 1-year period of coverage beginning November 1, 1996. SETTING AND PARTICIPANTS: 1091 patients in both plans who used CAM services during the month of May 1997 in Washington state. RESULTS: Only 1% of all patients covered for CAM accessed these services during the study period. A significantly higher percentage of patients in the PPO plan (1.2%) used CAM services compared to the HMO plan (0.6%) (P < .001). However, the average total cost of annual CAM services (plan benefit + user contribution) was similar ($347 in the HMO and $376 in the PPO), and the price per member per month was nearly identical ($0.20 in the HMO and $0.19 in the PPO). Most users perceived these services as helpful. CONCLUSIONS: Utilization of CAM services and per member per month costs were lower than expected given the high interest in CAM services reported in consumer surveys. The high level of satisfaction with CAM services and self-reported decrease in the use of pain medications suggests the need for prospective studies examining the effect of CAM treatments.

[Naturopathy in rehabilitation--a logical option in the German health system]. / Naturheilkunde in der Rehabilitation--eine sinnvolle Option im deutschen Gesundheitswesen.

The present restructuring of the German health system is a reaction to the changing demands resulting from demographic and financial developments. In this context, an increase in patients autonomy is urgently needed which is only possible in cooperation with this group. The rehabilitative sector of the health system with its biopsychosocial model of diseases offers still heavily overlooked solutions, in particular because of its extensive use of complementary medicine, which has a high degree of acceptance among patients and the general population.

A naturopathic approach to the prevention of cardiovascular disease: cost-effectiveness analysis of a pragmatic multi-worksite randomized clinical trial.

OBJECTIVE: To determine the cost-effectiveness of a worksite-based naturopathic (individualized lifestyle counseling and nutritional medicine) approach to primary prevention of cardiovascular disease (CVD). METHODS: Economic evaluation alongside a pragmatic, multi-worksite, randomized controlled trial comparing enhanced usual care (EUC; usual care plus biometric screening) to the addition of a naturopathic approach to CVD prevention (NC+EUC). RESULTS: After 1 year, NC+EUC resulted in a net decrease of 3.3 (confidence interval: 1.7 to 4.8) percentage points in 10-year CVD event risk (number needed to treat = 30). These risk reductions came with average net study-year savings of $1138 in societal costs and $1187 in employer costs. There was no change in quality-adjusted life years across the study year. CONCLUSIONS: A naturopathic approach to CVD primary prevention significantly reduced CVD risk over usual care plus biometric screening and reduced costs to society and employers in this multi-worksite-based study. Trial Registration clinicaltrials.gov Identifier: NCT00718796.

[The situation of complementary medicine in Germany]. / Zur lage der komplementärmedizin in Deutschland.

With the amendment of the German Medicinal Products Act in 1976 and the inclusion of naturopathy and homeopathy into the German Medical Licensure Act from 1988, the German government set up a comparatively favorable framework for Complementary and Alternative Medicine (CAM). But no comprehensive integration into the academic operating systems followed, because the universities as well as the legislative body seemed to have no further interest in CAM. Therefore, research projects in the field and suitable professorships had and still have to be financed by third-party funds. Notwithstanding the success of several CAM-projects, no sustainable development could be established: When the third-party funding runs off and the protagonists retire the institutional structures are supposed to vanish as well. Although the public demand for CAM is high in Germany, the administration detached homeopathy as a compulsory subject from the German Medical Licensure Act in 2002 and restricted severely the refunding of naturopathic medicines by the statutory health insurance in 2004. Moreover, the trend for CAM bashing takes root in the media. Unfortunately the CAM scene does not close ranks and is incapable to implement fundamental data collection processes into daily clinical routine: A wide range of data could justify further efforts to the government as well as to the scientific community. To say something positive, it must be mentioned that the scientific standard of CAM research is high for the most part and that third-party funded projects deliver remarkable results ever and on.

A review of tensions and risks in naturopathic education and training in Australia: a need for regulation.

OBJECTIVES: In line with increasing complementary medicine (CAM) use, the Australian government has committed considerable resources to the training of CAM practitioners. However, it has generally failed to complement this support with regulation or accountability measures. This is particularly true in Australia's largest CAM profession (naturopaths), which remains entirely unregulated but attracts approximately AUD$40 million each year in government funding for its education sector. This article explores the consequences of such unfettered support on professional outcomes. DESIGN: Data on Australian government funding for naturopathic student places were collated and compared with various outcome measures including research and professional outcomes. RESULTS: Lack of accountability measures attached to government support has enabled the proliferation of commercial education providers in the sector. This is often at the expense of the university sector, which is financially disadvantaged in naturopathic education delivery through extra academic and research obligations not shared by private for-profit providers. The major beneficiaries of government funding have facilitated few formal contributions to naturopathic research or professional development, whereas those with the highest research, professional, and academic output attracted the least government funding. Course content has declined in the previous 5 years, and government funding is still directed to courses that do not meet the minimum education levels for the prescribed government definition of naturopath. Unfettered support has also resulted in a significant increase in student numbers growth, which significantly outstrips growth in utilization, potentially affecting the profession's sustainability. CONCLUSIONS: Lack of regulation in naturopathic education has resulted in significant risks to patients (through reduced standards) as well as the naturopathic profession itself. Although CAM advocates often focus on pushing for government support for the development CAM, support without the development of appropriate regulatory and accountability measures can ultimately be detrimental to the development of CAM.

A study of costs and length of stay of inpatient naturopathy--evidence from Germany.

BACKGROUND: Classical naturopathy in an acute, inpatient, internal medicine setting is rare in Germany. Procedure 8-975 regulates the structures and processes for providing naturopathic complex therapy in German hospitals. An interdisciplinary team is required to provide therapy from at least five therapeutic areas of classical naturopathy, all applied within a narrow time-frame. The entry criteria for being entitled to receive naturopathy in an acute hospital depend upon the degree of chronicity, the intensity of the symptoms and the complexity of the disease. METHODS: In the present study, a total of 918 patients who received naturopathic complex therapy were investigated regarding their clinical picture and the length of their stay in hospital. RESULTS: The results showed that the duration of hospitalization was significantly greater than that of the comparison group of patients (cases from 263 German hospitals) receiving purely internal medical treatment in hospitals at national level.

[Naturopathy as a contribution to cost control. Attempt at a cost analysis]. / Naturheilkunde als Beitrag zur Kostendämpfung. Versuch einer Kostenanalyse.

OBJECTIVE: A data analysis has been performed to investigate to what extent naturopathy may contribute to reducing costs of medical care. METHODS: The study included anonymous data from the second quarter of 1988 obtained from the North-Württemberg Kassenärztlichen Vereinigung (insurance company). Physicians practicing in this area at that time were compared to a similarly large collective of those designated additionally as naturopaths and/or homeopaths. RESULTS: Differences between the two groups were significant with respect to drug costs and disability certificates however not with respect to physician fees.