COUNTRY REPORT GC Meeting Brussels 15-16 th November 2013 Stanhope Hotel 1. Responses were received from all except for Cyprus, Finland and Poland 2. Numbers of members This question was asked to ascertain various facts the sizes of the different national associations the number of students that are studying in each country (future members) the estimated total number of chiropractors in each country this can be used to identify the chiropractic market in each country Full Members Student Members Approximately how many members are there in your country Great Britain 1362 350 2692 Norway 650 100 700 France 381 0 700 Netherlands 253 44 371 Switzerland 237 65 270 Spain 234 22 280 Sweden 177 17 700 Italy 163 50 295 Ireland 107 1 130 Germany 100 55 130 Belgium 105 0 108 Greece 22 0 30 Iceland 9 0 12 Luxembourg 7 9 Hungary 6 0 6 Turkey 6 0 6 Liechtenstein 4 3 5 Total number of Chiropractors in ECU Countries 6444
3. List of other Chiropractic Associations in each country Country Name of Association Nos of Members Size compared to ECU NA GERMANY SWEDEN Deutsche Chiropraktoren-Gesellschaft e.v. (DCG) Kiropraktiska Föreningen i Sverige (KFS) 90? 280 +15% NETHERLANDS Dutch Chiropractic Federation (DCF) 75-50% NETHERLANDS Christelijke Chiropractoren Associatie 33-60% GREAT BRITAIN (2692) McTimoney Chiropractic Association (MCA) 565-30% GREAT BRITAIN GREAT BRITAIN Scottish Chiropractic Association (SCA) 215-43% United Chiropractic Association (UCA) 458-34%
4. Legislation Is there any legislation governing the chiropractic profession in your country Legislation specifically for Chiropractors Mandate of a code of Practice/Standard of Proficiency/Code of Ethics Protection of Title Appointment of a statutory regulator Great Britain Yes Yes Yes Yes Yes Yes Norway Yes Yes Yes Yes Yes Yes Sweden Yes Yes Yes Yes Yes Yes Switzerland Yes No Yes Yes Yes Yes Iceland Yes Yes Yes Yes No Yes Liechtenstein Yes Yes Yes Yes No Yes Italy Yes Yes Yes Yes No No France Yes Yes Yes No No No Belgium Yes No No No No No Germany Yes No No No No No Greece No No No No No No Hungary No No No No No No Ireland No No No No No No Luxembourg No No No No No No Netherlands No No No No No No Spain No No No No No No Turkey No No No No No No Legal sanctions
5. Scope of Practice Some countries have very limited rights however others have extensive rights. Scope of practice defined? Are Chiropractors legally able to take x-rays? Entitled to refer for laboratory tests Private medical insurers recognise Chiropractic? Prescribing rights? Fees state reimbursed? Belgium Yes No No No No No France Yes No Yes No No Yes Germany No No Yes Yes No Yes Great Britain No Yes Yes No No Yes Greece No No No No No No Hungary No No No No No No Iceland No Yes No No No No Ireland No Yes No No No Yes Italy No No No No No Yes Liechtenstein Yes Yes Yes Yes Yes Yes Luxembourg No No No No No Yes Netherlands Yes Yes No No No Yes Norway Yes Yes No No Yes Yes Spain No No No No No No Sweden No No No No Yes Yes Switzerland Yes Yes Yes Yes No Yes Turkey No No No No No No
6. EDUCATION The following graph identifies the countries which have Educational establishments it shows the number (No.) of ECCE full or candidates status institutions number of chiropractors who have PhD s the number of chiropractors who are currently doing a Phd whether they have plans to set up an educational establishment The Countries who have not got any of these criteria have not been shown in this table. No. ECCE full or candidate status institutions No. Chiropractic PhD's in membership No. PhD candidates Developing Chiropractic Education Belgium 1 France 2 4 4 Yes Germany 1 Great Britain 3 6?? Ireland 2 Yes Italy 1 Yes Netherlands 1 1 Yes Norway 2 6 Yes Spain 2 1 1 Sweden 2 2 Yes Switzerland 1 1 Turkey Yes TOTAL 8 20 16 7
7. National Patient Associations European Chiropractors Union The following countries have indicated that they intend to set up a National Patient Association by the end of 2013 Greece Luxembourg Spain The following do not have National Patient Associations and should be encouraged to set one up especially if legislation is one their priorities Belgium, France, Germany, Hungary, Iceland, Ireland, Liechtenstein, Norway, Sweden and Turkey.
8. FINANCIAL -The cost of Full National Association fees and cost of Professional indemnity fees. Full cost of membership fees Cost of Professional Indemnity insurance per member Is Professional Indemnity Mandatory? Switzerland 2840 No Netherlands 2300 75 Yes Italy 2020 325 Yes Norway 2000 500 Yes Sweden 2000 300 Yes Belgium 1700 311 Yes Spain 1200 130 Yes France 990 200 Yes Germany 900 160 No Ireland 730 1293 Yes Great Britain 713 904 Yes Greece 500 No Iceland 485 1200 Yes Liechtenstein 405 1000 Yes Hungary 400 No Luxembourg 400 3500 No Turkey 250 No
9. Value Added Tax (VAT) The following National Associations are charged VAT for Chiropractic Fees and the rates of VAT charged Greece 23% Spain 21% Netherlands 21% Luxembourg 15% but not many pay it! 10. Estimate of average treatments in Euros Initial Visit Follow Up Visit X-ray Belgium France Germany Great Britain Greece Hungary Iceland Key Ireland 101-120 Italy 81-100 Liechtenstein 61-80 Luxembourg 41-60 Netherlands 21-40 Norway 0-20 Spain Sweden Switzerland Turkey
11. Do you have any political connections to MEPs? No 76.5% Yes 23.5% Named contacts were:- Belgium Mr Said El Khadraoui: Socialist Party Greece Kriton Arsenis 12. Do you have a formal research programme or research organisation? Percentage of countries have set up research programmes which have in the past been funded by monies from the ECU Yes have an established research programme 58.8% Collaboration with: 5.9% No do not have an established research programme 35.3% Norway ELIB (NCA Research Foundation) Great Britain Chiropractic Research Council France SOFEC Société Franco Européenne de Chiropraxie (Research society) Spain collaboration with Fundación Jiménez Díaz and Juan Pablo CEU.
13. Comments Ireland Italy Liechtenstein Spain Great Britain France Switzerland We encourage membership to join. Again I would ask that the EAC provide information leaflets that we can include in new membership packs and conference packs Members are encouraged to join EAC. There have been problems in signing up to EAC One half of the members are in the EAC Members can join individually In UK, Chiropractors join Royal College of Chiropractic by choice They do as they want by themselves No
14 Graduate Education Programmes Number of GEP events each year and whether they have a formal graduate programme.
15. Continuous Professional Development CPD Events Hosted by each association European Chiropractors Union
16. Entry requirements for Chiropractors arriving from another Country. Is there formal examination requirement from overseas wishing to practice Are there formal requirements for Chiropractors to practice legally Yes advised Yes required by Government No Yes advised Belgium x x France x x Germany x Great Britain x x Greece x x Hungary x x Yes required by Government No Comments Iceland x x Licensing body may require language skills Ireland x x Italy x x AIC GEP has a final exam Liechtenstein x x Luxembourg x x Netherlands x x Norway x x Spain x x Sweden x x Switzerland x x Turkey x x 1 year supervised practice inc. 3 months hospital consultation is mandatory. As well as examination on Swedish health care laws Non Turkish citizens aren't allowed to practice in medical fields however Chiropractic isn't regulated
17. Public Health Initiatives European Chiropractors Union Belgium Week of Back pain May-14 France World Spine Day for 2013. 2014 Paediatric and World Spine Day October Germany Great Britain Greece Hungary Iceland Working with NHS England to develop guidelines for backpain and sciatica Volunteer team of HCA participating in Ultramarathon 250km race Spartathlon Members aiming to speak at public events Ireland Italy Straighten UP Ireland, always run over the week to include World Spine Day on 16th October. Chiropractic awareness Week in April 2014 October 2013/ April 2014 Various World Health Days are promoted to members and the public through the year. Chiropractic Week includes a spinal check-up. Spinal Column "Prevention" month planned Oct-Nov 2013 Oct-Nov 2013 Liechtenstein Children s Spine Day on November 9 Nov-13 Luxembourg Netherlands Norway Spain Sweden Meeting 16th October with College Medical Collaboration with Den Norske Tursitforening Switzerland Turkey National Health Politics 2020; various medical professions working together in networks, group practices, etc. chiropractors to be part as first contact fir musculoskeletal disorders
18. Please list the three most important issues facing your national association at this time. Belgium France Germany Great Britain Greece Hungary Iceland Ireland Italy Liechtenstein 1 - Pending legislation 2 - Possibility of fees becoming subject to VAT 3 - Media attention 1 - Communication on the profession 2 - Homogenization of texts and supports(media) professional for all 3 - End of identity 1 - BSc/MSc programme taught by non-chiropractors 2 - Inability to provide new graduates with principals to do GEP programme 3 - Not clear if the DCG will be able to define what Chiropractic/Chiropractors are 1 - Revalidation of the profession 2 - Limited prescribing rights for chiropractors 3 - Competition for membership with other associations 1 In negotiations with Ministry for legislation 2 In negotiations with private insurers for treatment reimbursement 3 In negotiations with private insurers for malpractice insurance 1 - Compiling the documentation needed 2 - Approaching MP 3 - Need 10 members to maintain official association status by law 1 - Structure intern year 2 - Get all ECCE accredited chiropractors into the association 1 - Lack of specific legislation or mandatory regulation: resulting in limited access for specialist testing, ie: MRI/XRAY, no inter-professional relationships etc 2 - Developing an undergraduate education program 3 - Lack of cohesion within the membership 1 - Getting the ECCE or similar education standard adopted by the Italian Government 2 - Opening of the chiropractic Register 3 - Opening of an ECCE chiropractic college in Italy 1 - Cost Containment 2 - Negotiations that will limit the number of chiropractors that may bill over the obligatory health insurance 3 - Improved interdisciplinary relations.
Luxembourg Netherlands Norway Spain Sweden Switzerland Turkey 1 - Acquiring legislation 2 - Instituting GEP and CPD 3 - Consensus on where and what we want to be with in the health system 1 - Challenging the governmental decision to apply VAT to chiropractic services by court case and political lobby. 2 - Discussions with the Ministry of Health regarding a proposed ban of upper cervical manipulation. 3 - Agreeing with our membership on our common ground, implementation of a corporate identity of the NCA chiropractor. 1 - Establishing University Undergraduate Programme 2 - Recruiting more PhD-candidates 3 - Increase level of state reimbursement 1 - Legislation 2 - All of our issues are related to a lack of legislation 1 - Chiropractic degree not being established as master program for physiotherapists but as a separate degree with international standards. 2 - Low number of students. Small increase in number of new members. 3 - Two associations (one for not ECCE accredited) makes political work more challenging. 1 - Workshop on Image of the Chiropractic Profession 2 - Recruiting chiropractic students 3 - Pending request for prescription rights for medication 1 Regulation 2 Education 3 Increase in numbers