[Criteria for assessing benefit with complementary medical methods].

Abstract

UNLABELLED: Criteria for Assessing Benefit with Complementary Medical Methods BACKGROUND: The paper was produced by the author at the request of the Swiss Federal Social Insurance Department in a broad-based consensus process involving the principal parties in the health system, discussed with international experts at a public workshop, and finally approved in the form it is presented here by the Services Commission of the Federal Home Office on March 12, 1998. It provides a basis for assessing the efficacy, suitability and financial viability of complementary medical methods in the context of Swiss health insurance legislation. CONTENTS: Evidence-based complementary medicine cannot rest entirely on experimental trials but needs all available methods of obtaining evidence to arrive at a fair assessment, from the empirical judgement of individual medical practitioners to randomized double blind trials. In addition to experimental trials, special emphasis lies on test methods involving no experimental change in the medical intervention and the conditions pertaining to it. In so far as the experimental design on which randomized double blind trials are based takes no account of factors that are integral to holistic and individualized complementary medical treatment (e.g., the individual aspect of the doctor-patient relationship, and motivation), other evaluation concepts are needed that will do justice to these methods, such as evaluation of the overall clinical situation.The same applies when it is a matter not only of the efficacy of a method within the closely defined framework of experimental trials but also of its effectiveness in a wider context in practice and the context-related situation in the target population for the social security system (real world effectiveness). It is important for evaluation to be not primarily design-orientated but problem-orientated, with the design developed accordingly.