[Omeo33] Art 0766 - J Compl Int Med, 2007, 4 (1), art 5

[Gino Santini]

How Do Private CAM Therapies Affect Integrative Health Care Settings  
in a Publicly Funded Health Care System?
Daniel Hollenber

“Integrative health care” (IHC), combining various aspects of Western  
biomedicine and complementary/alternative medicine (CAM), is a  
relatively new development in health care systems. IHC is recognized  
internationally, yet the occurrence of private CAM therapies and their  
various effects on IHC settings has not extensively been analyzed.  
This paper presents findings from a larger study of three IHC settings  
in Canada conducted between 2002 and 2003. The main research question  
addressed here is: How have private CAM therapies affected IHC  
settings combining CAM and biomedicine in a publicly funded health  
care system? Drawing on ethnography, 38 in-depth interviews are drawn  
upon, including those with 15 biomedical and eight CAM practitioners,  
13 patients and two health care managers. Ethnographic observation and  
document analysis was conducted at each site. Findings illustrated  
that patients could not consistently afford unfunded CAM treatments,  
resulting in the premature termination of an integrative care plan.  
CAM practitioners from the private sector could not uniformly attend  
group rounds, resulting in disrupted care co-ordination. Certain  
biomedical institutions viewed CAM as a commodity from which to  
generate revenue and lower budgetary deficits. This study argues that  
the unfunded nature of CAM therapies in public health systems,  
although CAM has therapeutic value, does not contribute to an  
equitable partnership when attempting to integrate biomedicine and  
CAM. Future analyses of IHC need to take into account the complexities  
of health system context that continues to shape IHC.

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