Use and expenditure on complementary medicine in England: a population based survey

Objectives: Many claims are made that complementary medicine use is a subst antial and growing part of health-care behaviour. Estimates of practitioner visits in the USA and Australia indicate high levels of use and expenditur e. No reliable population-based estimates of practitioner use are available for the UK. Methods: In 1998, a previously piloted postal questionnaire wa s sent to a geographically stratified, random sample of 5010 adults in Engl and. The questionnaire focuses on practitioner contacts, but also asked abo ut the purchase of over-the-counter remedies. Additional information was re quested on socio-demographic characteristics, perceived health, and recent NHS resource use. Information on use included reason for encounter, expendi ture, insurance, and location of visit. Main outcome measures: Population e stimates (by age group and sex) of lifetime use and use in the past 12 mont hs for acupuncture, chiropractic, homoeopathy, hypnotherapy, medical herbal ism, osteopathy. Estimates for two additional therapies (reflexology and ar omatherapy), and homoeopathic or herbal remedies purchased over-the-counter . Estimates of annual out-of-pocket expenditure on practitioner visits in 1 998. Results: A crude response rate of 60% was achieved (adjusted response rate 59%). Responders were order and more likely to be female than non-resp onders. Usable responses (n = 2669) were weighted using the age/sex profile of the sample frame. From these adjusted data we estimate that 10.6% (95% CI 9.4 to 11.7) of the adult population of England had visited at least one therapist providing any one of the six more established therapies in the p ast 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 < 0,0 I for all compariso ns). An estimated 22 million visits were made to practitioners of one of th e six established therapies in 1998. The NHS provided an estimated 10% of t hese contacts. The majority of non-NHS visits were financed through direct out-of-pocket expenditure. Annual out-of-pocket expenditure on any of the s ix more established therapies was estimated at <pound>450 million (95% CI 3 57 to 543). Conclusion: This survey has demonstrated substantial use of pra ctitioner-provided complementary therapies in England in 1998. The findings suggest that CAM is making a measurable contribution to first-contact prim ary care. However, we have shown that 90% of this provision is purchased pr ivately. Further research into the cost-effectiveness of different CAM ther apies for particular patient groups is now urgently needed to facilitate eq ual and appropriate access via the NHS. (C) 2001 Harcourt Publishers Ltd.