Abstract
The paper explores the patterns of coexistence of alternative/complementary health care (CAM) and conventional medicine in Israel in the cultural, political, and social contexts of the society. The data are drawn from over ten years of sociological research on CAM in Israel, which included observation, survey research, and over one hundred in-depth interviews with a variety of CAM practitioners - many with bio-medical credentials - and with policy makers in the major medical institutions. The analysis considers the reasons for CAM use, number of practitioners, the frequency of CAM use and some of its correlates, and how CAM is regulated. The structure of the relationship between the conventional health care system and CAM is discussed in the public sector, which provides two-thirds of CAM services, and in the private sector, which provides about one-third. The history of the development of these structures and some of the dilemmas of their operation are discussed. A number of policy issues are considered against this background: regulation and licensing, CAM in primary care, reimbursement for CAM treatment, and the inclusion of CAM in education and training for the health professions.
Highlights
Despite the vast achievements and dramatic successes of conventional bio-medicine, remarkable numbers of people in Western societies seek complementary or alternative health care (CAM)
It would seem that these social processes in the field of health care are not ephemeral but are likely to continue in one form or another
The Israel findings may be useful to health policy planners in other countries in which CAM provides increasing segments of health care
Summary
Despite the vast achievements and dramatic successes of conventional bio-medicine, remarkable numbers of people in Western societies seek complementary or alternative health care (CAM). Hollenberg [65] highlights the difficulties inherent in integrative practice in an analysis of the relations between physicians and CAM practitioners in such settings He points to the complexities of working together since bio-medical doctors often continue to perpetuate patterns of medical dominance by maintaining control of overall patient care and using bio-medical language as the primary form of communication. Unlike the senior physician in the CAM clinics in Israel (rofe memayen), the “gatekeeper” in the Swedish primary care clinic is a bio-medical-CAM practitioner who is responsible for the full clinical management of the patient including recommendations for both biomedical and CAM treatment These recommendations are considered by a “consensus case conference” with the full provider team. Curriculum committees, which determine course content and requirements in the medical schools and in the schools for other health care professionals, should explore the inclusion of CAM in their respective required curriculum
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