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European Chiropractors’ Union

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COUNTRY REPORT

GC Meeting Brussels 15-16th 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

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European Chiropractors’ Union

3. List of other Chiropractic Associations in each country

Country Name of Association Nos of Members Size compared to ECU NA GERMANY Deutsche Chiropraktoren-Gesellschaft

e.V. (DCG)

90 ?

SWEDEN Kiropraktiska Föreningen i Sverige (KFS)

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

Scottish Chiropractic Association (SCA) 215 -43%

GREAT BRITAIN

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European Chiropractors’ Union

th 4. Legislation Is there any legislation governing the chiropractic profession in your country Legislation specifically for Chiropractors Protection of Title Appointment of a statutory regulator Mandate of a code of Practice/Standard of Proficiency/Code

of Ethics Legal sanctions

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

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European Chiropractors’ Union

European Chiropractors’ Union

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 Prescribing rights? Fees state reimbursed? Private medical insurers recognise Chiropractic? 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

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European Chiropractors’ Union

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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

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European Chiropractors’ Union

7. National Patient Associations

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.

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European Chiropractors’ Union

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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

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European Chiropractors’ Union

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

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European Chiropractors’ Union

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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)

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European Chiropractors’ Union

13.

Comments

Ireland 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 Italy Members are encouraged to join EAC. There have been problems in signing up to EAC

Liechtenstein One half of the members are in the EAC Spain Members can join individually

Great Britain In UK, Chiropractors join Royal College of Chiropractic by choice France They do as they want by themselves

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European Chiropractors’ Union

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European Chiropractors’ Union

15. Continuous Professional Development

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European Chiropractors’ Union

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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 Yes required by Government No Comments Belgium x x France x x Germany x Great Britain x x Greece x x Hungary x x

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

1 year supervised practice inc. 3 months hospital consultation is mandatory. As well as examination on Swedish health care laws

Switzerland x x Turkey x x

Non Turkish citizens aren't allowed to practice in medical fields however Chiropractic isn't regulated

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European Chiropractors’ Union

17. Public Health Initiatives

Belgium Week of Back pain May-14 France World Spine Day for 2013. 2014 Paediatric and World Spine Day October Germany

Great Britain Working with NHS England to develop guidelines for backpain and sciatica Greece Volunteer team of HCA participating in Ultramarathon 250km race Spartathlon Hungary Members aiming to speak at public events Iceland

Ireland

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

Italy

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 Meeting 16th October with College Medical Netherlands Norway Collaboration with Den Norske Tursitforening

Spain

Sweden

Switzerland

National Health Politics 2020; various medical professions working together in networks, group practices, etc. chiropractors to be part as first contact fir musculoskeletal disorders

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European Chiropractors’ Union

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18. Please list the three most important issues facing your national association at this time.

Belgium

1 - Pending legislation

2 - Possibility of fees becoming subject to VAT 3 - Media attention

France

1 - Communication on the profession

2 - Homogenization of texts and supports(media) professional for all 3 - End of identity

Germany

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

Great Britain

1 - Revalidation of the profession

2 - Limited prescribing rights for chiropractors

3 - Competition for membership with other associations

Greece

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

Hungary

1 - Compiling the documentation needed 2 - Approaching MP

3 - Need 10 members to maintain official association status by law

Iceland

1 - Structure intern year

2 - Get all ECCE accredited chiropractors into the association

Ireland

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

Italy

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

Liechtenstein

1 - Cost Containment

2 - Negotiations that will limit the number of chiropractors that may bill over the obligatory health insurance

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European Chiropractors’ Union

Luxembourg

1 - Acquiring legislation 2 - Instituting GEP and CPD

3 - Consensus on where and what we want to be with in the health system

Netherlands

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.

Norway

1 - Establishing University Undergraduate Programme

2 - Recruiting more PhD-candidates

3 - Increase level of state reimbursement

Spain

1 - Legislation

2 - All of our issues are related to a lack of legislation

Sweden

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.

Switzerland

1 - Workshop on Image of the Chiropractic Profession 2 - Recruiting chiropractic students

3 - Pending request for prescription rights for medication

Turkey

1 – Regulation 2 – Education

References

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