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The Regulation of Complementary and Alternative Medical Practitioners in the Uk

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The Regulation of Complementary and Alternative Medical Practitioners in the Uk MOVING IN FROM THE FRINGES: THE REGULATION OF COMPLEMENTARY AND ALTERNATIVE MEDICAL PRACTITIONERS IN THE UK ANNA LOUISE DIXON LONDON SCHOOL OF ECONOMICS AND POLITICAL SCIENCE PHD UMI Number: U2B0791 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U230791 Published by ProQuest LLC 2014. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 DECLARATION I declare that the work presented in this thesis is my own. Signed Date (a) The copyright of this thesis rests with the author. Quotation from it is permitted, provided that full acknowledgement is made. This thesis may not be reproduced without prior written consent of the author. (b) I warrant that this authorization does not, to the best of my belief, infringe the rights of any third party. (c) I understand that in the event of my thesis not being approved by the examiners, this declaration will become void. British ibrary O 'Polifim pfl Economy bwfri'u ABSTRACT Taking the cases of five complementary therapies in the United Kingdom, the study seeks to explain why some complementary medical practitioners are statutorily regulated while others remain unregulated. It also asks why regulation has taken the form that it has. The analytical framework used draws on sociology, economics and political science. The study examines whether statutory regulation is best explained as the result of the mobilisation of complementary medical practitioner groups, actions by the state, or interactions between individual policy actors. It tests the explanatory value of demand theories of professionalisation, supply theories of professionalisation, and personal policy network analysis. It also examines the role of ideas in shaping policy. While practitioner groups in all five therapies were professionalised not all actively pursued statutory regulation. In the cases of osteopaths and chiropractors mobilisation by practitioner groups appears to explain their success in gaining statutory regulation. The state’s concern to regulate risk appears to have been crucial in the decision to introduce statutory regulation for acupuncturists and herbalists. In all cases, individual policy entrepreneurs and policy advocates, including HRH the Prince of Wales, played a crucial role in shaping the policy process. The medical model of professional self-regulation dominated policy ideas. Alternative regulatory models were seldom debated. The study discusses the implications of the findings for the future of professional regulation of CAM practitioners and healthcare professionals generally. It concludes by suggesting that despite its limitations personal policy network analysis might usefully be applied in other contexts. TABLE OF CONTENTS Acknowledgements.........................................................................................................11 1 INTRODUCTION ............................................................................................... 16 1.1 Background......................................................................................................... 16 1.2 Research questions.............................................................................................. 17 1.3 Outline of the study............................................................................................. 18 1.4 Why is the regulation of CAM practitioners an important issue?................... 20 1.5 Aims and objectives............................................................................................21 2 THEMARKETFOR COMPLEMENTARY AND ALTERNATIVE M EDICINE....................................................................................................................23 2.1 Introduction........................................................................................................ 23 2.2 Who uses CAM? ...................................................................................................23 2.2.1 Systematic reviews............................................................................................................... 24 2.2.2 Other population surveys....................................................................................................25 2.2.3 Sub-population surveys....................................................................................................... 26 2.2.4 Discussion .............................................................................................................................. 27 2.3 How are CAM services financed? ...................................................................... 27 2.3.1 Public financing ....................................................................................................................28 2.3.2 Private financing...................................................................................................................29 2.3.3 Discussion .............................................................................................................................. 30 2.4 Who provides CAM services?.............................................................................31 2.4.1 Statutorily registered health care professionals............................................................ 32 2.4.2 Registered CAM practitioners ...........................................................................................33 2.4.3 Discussion .............................................................................................................................. 36 2.5 Discussion.............................................................................................................36 3 MODELS OF REGULA TION ............................................................................ 38 3.1 Introduction........................................................................................................ 38 3.2 International experience .....................................................................................39 3.2.1 Germany.................................................................................................................................. 39 3.2.2 Norway.................................................................................................................................... 41 3.3 Regulatory strategies........................................................................................... 42 3.4 Command and control........................................................................................ 43 3.4.1 Protection of title ..................................................................................................................45 3.4.2 Reserved procedures............................................................................................................46 3.4.3 Licensure ................................................................................................................................47 3.4.4 Disciplinary procedures ...................................................................................................... 48 4 3.5 Self-regulation.....................................................................................................48 3.6 Incentives............................................................................................................ 50 3.7 Market harnessing controls................................................................................50 3.7.1 Competition laws ...................................................................................................................51 3.7.2 Regulation by contract......................................................................................................... 51 3.8 Disclosure............................................................................................................ 52 3.9 Direct action....................................................................................................... 53 3.10 Rights and liabilities laws ................................................................................. 54 3.11 Public compensation...........................................................................................54 3.12 Discussion.............................................................................................................55 4 THE HISTORY OF HEALTH CARE PROFESSIONAL REGULATION.. 56 4.1 Introduction........................................................................................................ 56 4.2 History of medical regulation............................................................................ 57 4.2.1 The Royal Colleges...............................................................................................................57 4.2.2 The Medical Act 1858............................................................................................................58 4.3 Statutory regulation of other health care professionals.....................................60 4.3.1 Midwives..................................................................................................................................60
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