The Swiss have backed plans to promote alternative medicine but supporters are now squaring up to more hurdles before a key goal of insurance coverage is secured.
The most politicised issue of the proposals – supported by two-thirds of voters on Sunday – called for therapies to be included on the constitutional list of paid health services.
The interior ministry had struck complementary therapies off the list in 2005 amid rising national health costs, arguing they failed to meet the criteria of efficacy, cost-effectiveness and suitability.
Supporters then collected enough signatures to force a nationwide vote on the re-introduction of five treatments – homeopathy, holistic, herbal and neural therapies and traditional Chinese medicine – but later withdrew their initiative after parliament agreed on a modified version.
The law states that the therapies should be "scientifically proven" to be effective, reasonably priced and appropriate for inclusion on the list of paid health services. Supporters are now trying to ensure that this is the case.
But a federal court ruling says double-blind clinical studies are not necessary to confirm the scientific value of these treatments.
Organisations representing each therapy must also submit a dossier to support their case by October. An ad hoc commission will then give its recommendations for action to the interior ministry.
"I think it will be not only a scientific process, but also a political one," Gianfranco Dominighetti, a health economist at Lausanne and Lugano universities, told swissinfo.ch.
A parliamentary group, made up of 30 Swiss parliamentarians from all major parties and representatives of alternative therapies, has been created to follow up on the vote outcome.
Most political parties, apart from the rightwing Swiss People's Party, had backed the plan to include the therapies in basic insurance cover.
Opponents have argued that covering these types of treatment would put more financial strain on the health system. The committee campaigning for a no vote said it was not surprised by Sunday's outcome, but expressed concern at what it says is a measure that will lead to a new rise in health costs and "fierce" differences of opinion among experts.
People's Party parliamentarian Toni Bortoluzzi warned that the new constitutional basis for the therapies would create as many problems as potential solutions.
There are no signs of the interior ministry warming to the therapies either. Interior Minister Pascal Couchepin acknowledged the vote outcome, but said that his main concern was "not to accelerate the explosion in health costs" by introducing new benefits in the basic insurance cover.
Pro-campaigners argue that before complementary medicines were struck off the insurance list, spending on such therapies equalled SFr25milion ($22.4 million) a year – only 0.1 per cent of basic insurance costs.
"The process of evaluating alternative medicine has clearly showed that the costs are lower, that treatment with alternative medicine costs less than traditional medicine", Walter Stüdeli, of the campaign group, told swissinfo.ch.
"If people thought it was going to cost more, they would not have said yes. Obviously they were not afraid that the costs would go up; they understood our argument that the costs would be less."
Simonetta Sommaruga, a parliamentarian from the centre-left Social Democratic Party who heads both the pro-campaign group and the Swiss consumer protection foundation, said that by approving cover for certain alternative therapies the public had shown a desire for traditional and complementary medicine to "cohabit". But there remained much work to do, she added.
The newly formed parliamentary group also intends to follow up on other aspects of the people's initiative, in particular an undertaking by cabinet to establish national diplomas for non-medical practitioners of alternative medicine.
Action will also be taken to call for the creation of university professor posts in complementary therapies, more collaboration between alternative and classical medicine, and more research.
The vote result will benefit the public, added Jean-François Steiert, vice-president of the Swiss federation of patients.
"A collaboration between traditional medicine and complementary medicine, long wished for by patients, is finally becoming possible.
"I hope that the [interior] minister, Pascal Couchepin, will finally get the message and do the necessary so that patients can exercise their rights as soon as possible."
Jessica Dacey, swissinfo.ch
In 1999 the interior ministry ruled that five therapies – homeopathy, herbal medicine, neural therapy, traditional Chinese medicine and anthroposophic medicine – should be provisionally covered by basic health insurance. But this decision was reversed in 2005 amid rising national health care costs.
A national vote was held on May 17 to decide whether complementary medicine should be accommodated once again in the constitution.
Specifically the five treatments would be included on a list of paid health services. Diplomas for non-medical practitioners of alternative medicine would be recognised, there would be more collaboration between alternative and classical medicine and more research.
67% of people – 1.28 million – voted yes
33% - 632,000 – voted no
In 2005, Switzerland spent SFr52.9 billion ($52.11 billion) or 11.6% of GDP on healthcare.
The average for OECD countries is 8.8%.
The US spends 15.3%, Germany 10.9% and France 10.5% on health.
From 2001, health costs rose on average 4.1% a year in Switzerland.