Chiropractic in Norway
By Kyrre Myhrvold, President of Norwegian Chiropractors' AssociationThe Norwegian Chiropractors' Association (NCA) has 125 members, including interns, and 15 associated members around the world. Ninety-eight percent of Norwegian chiropractors are members of the NCA. At the present time there are 52 Norwegian chiropractic students in Europe and the United States.
NCA is a member of the European Chiropractors' Union (ECU), World Federation (WFC), and the Federation Internationale de Chiropratique Sportive (FICS).
Past and Present
The NCA was founded in 1935; its members have a long tradition of unity and solidarity in the fight for chiropractic in Norway. The struggle for recognition and acceptance has culminated in a law passed by our parliament, the Storting, ratified by King Olav V, and put into effect July 1, 1990. The law gives protection of the title kiropraktor, and in some interpretations, of chiropractic procedures. The law confirms the chiropractor's role as a primary health provider.
Through legislative endeavors, chiropractic has received recognition in Norway since 1975. Today, partial reimbursement for chiropractic services is paid by Trygdekassen, the national health insurance plan. There are two drawbacks to this system: first, the partial reimbursement for chiropractic treatment is a lowly 10 percent; second, the patient is reimbursed only upon receiving a medical referral. This being the case, many patients who seek chiropractic care elect not to visit the MD and go through the time consuming referral process, and the medical resistance they encounter.
MDs refer their patients to chiropractors only about 10 percent of the time. Politicians are investigating the matter and looking for a better solution. This is a time of actions and reactions. We believe the end result will be reimbursement of chiropractic services regardless of referral. It is the Norwegian Chiropractors' Association's hope that this will further enhance the position of chiropractic as a positive and valuable asset to the Norwegian health system.
The NCA is presently financing a statistical evaluation of referral procedures and the effect of these in regard to the relationship between patients, MDs, and DCs. The study is done by an officially recognized and unbiased research group. Thus far the answers and the results are in favor of removing the principle of medical referral in order for the patients to receive direct federal reimbursement for chiropractic treatment.
We have known for a long time that the system of referral is expensive, unnecessary, and time and treatment delaying, in addition to being looked upon as geographically unfair -- due to distances and a small population of chiropractors.
The results of this study are to be published. But to give you a few examples, this study shows that 44.4 percent of the patients referred for chiropractic treatment have been given a diagnosis without any clinical examination, and to top that, 18 percent of the patients given a referral without any examination had clinical findings put on the referral form.
Under the law of February 1988, chiropractors in Norway have reinforced and secured their rights to own and use their own x-ray facilities. In addition, chiropractors can refer to hospitals and private roentgen institutes for further studies if needed. Most chiropractors have their own equipment; those who do not, in general, have developed a very good working relationship with existing private institutes. The economic consequences for the chiropractors under this new law still have not been settled. Negotiations will take place in the near future. Needless to say, these will be exciting times for the chiropractors of Norway.
NCA frequently receives requests concerning possibilities for foreign chiropractors to practice in Norway. This is a problem with regards to chiropractors from other Nordic countries where there are no language barriers. The parliament still requires Norwegian citizenship, or at least 10 years residency. This issue was recently debated in the parliament. The minister of health promised that the chiropractors, as is the case for the other three primary health care providers (MDs, DDSs, and psychologists), will be exempt from the "law on quackery." This will open the door and allow foreign DCs to practice in Norway. It's another step toward the recognition of chiropractic as an independent health profession.
The NCA Office
NCA decided at their general assembly to form a secretariat, the Norwegian Chiropractors' Office for Service and Information. The office is situated in Oslo and is currently staffed by two chiropractors and a secretary, all on a part-time basis. This office is publishing pertinent information and brochures to both the chiropractors of Norway and to the public. It is also a center for information and public relations between legislative and health regulatory bodies of Norway. The office is centrally located one block from the Storting. This proximity to our national legislative body will certainly be convenient when it comes to lobbying activities.
The office is open three days per week, but is easily accessible at all times by fax.
Norwegian Chiropractors' Office for Service and Information
The NCA Structure
The infrastructure of the NCA is very strong and today about 40 persons of the total membership is engaged in subcommittees and various activities of the NCA. We also take steps to involve the recently graduated DC, not only through our mandatory 12-month intern period, but also by involving them in the operation of the NCA. This participation secures the unity and the recruitment of officers to the future running of NCA.
The 12-month internship period has been an integral part and a requirement for individual membership of NCA for the last four years. Under the law of authorization of chiropractors, this also has become a requirement of the authorities. The NCA has been given the responsibility of running this program on behalf of the "Helsedirektorat" Health Directorat -- the supreme health regulatory body in Norway.
Education and Acceptance in Europe
I would like to bring to your attention a constantly recurring problem that we face in Scandinavia: chiropractors, especially from the United States, that teach courses in manipulation and sometimes chiropractic procedures to unqualified people. People that should know better, and are officers of international chiropractic organizations, are endorsing this. This is really challenging the principles of solidarity within the chiropractic profession.
We also have a standard of etiquette when it comes to giving chiropractic seminars in Scandinavia and Europe, and that is for the responsible party to contact the national chiropractic organizations. I would like you to firmly take a stand on this question of not interfering and jeopardizing national chiropractic endeavors towards legislation and acceptance on behalf of shortsighted monetary interests, whether it be from individuals or institutions.
At last I have a request to the different national representatives. As you all know, the Winter Olympics in 1996 are at Lillehammer, Norway. The Norwegian Chiropractors' Association has already written a formal address to the National Olympic Committee volunteering staff and assistance in supplying equipment for a chiropractic office in the Olympic village. This has been done in conjunction with a request from FICS.
To further strengthen and encourage this effort, any DCs having connections with their national Olympic committee can petition their committee to make a formal request to the Norwegian Olympic Committee to establish chiropractic facilities for their athletes at the winter games of 1996.