Use and expenditure an complementary medicine in England: a Population based survey

Author(s): Nicholl, J., Coleman, P.

Abstract: Objectives: Many claims are made that complementary medicine use is a substantial and growing part of health-care behaviour. Estimates of practitioner visits in the USA and Australia indicate high levels of use and expenditure. No reliable Population-based estimates of practitioner use are available for the UK. Methods: In I 998, a previously piloted postal questionnaire was sent to a geographically stratified, random sample of 5010 adults in England.The questionnaire focuses an practitioner contacts, but also asked about the purchase of over6the-counter remedies.Additional information was requested an socio-demographic characteristics, perceived health, and recent NHS resource use. Information an use included reason for encounter, expenditure, insurance, and location of visit. Main outcome measures: Population estimates (by age group and sex) of lifetime use and use in the past 12 months for acupuncture, chiropractic, homoeopathy, hypnotherapy, medical herbalism, osteopathy. Estimates for two additional therapies (reflexology and aromatherapy), and homoeopathic or herbal remedies purchased over-the-counter. Estimates of annual out-of-pocket expenditure an practitioner visits in 1998. Results: A crude response rate of 60% was achieved (adjusted response rate 59%). Responders were older and more likely to be female than non-responders. Usable responses (n = 2669) were weighted using the agelsex profile of the sample frame. From these adjusted data we estimate that 10.6% (95% CI 9.4 to 1 1.7) of the adult population of England had visited at least one therapist providing any one of the six more established therapies in the past 12 months (13.6% for use of any of the eight named therapies, 95% CI 12.3 to 14.9). If all eight therapies, and self-care using remedies purchased over the counter are included, the estimated proportion rises to 28.3% (95% CI 26.6 to 30.0) for use in the past 12 months, and 46.6% (95% CI 44.6 to 48.5) for lifetime use.All types of use declined in older age groups, and were more commonly reported by women than men (P < 0.01 for all comparisons).An estimated 22 million visits were made to practitioners of one of the six established therapies in 1998.The NHS provided an estimated 10% of these contacts.The majority of non-NHS visits were financed through direct out-of-pocket expenditure.Annual out-of-pocket expenditure an any of the six more established therapies was estimated at E450 million (95% CI 357 to 543). Conclusion:This survey has demonstrated substantial use of practitioner-provided complementary therapies in England in 1998.The findings suggest that CAM is making a measurable contribution to First-contact primary care. However, we have shown that 90% of this provision is purchased privately. Further research into the cost-effectiveness of different CAM therapies for particular patient groups is now urgently needed to facilitate equal and appropriate access via the NHS.

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