Sundhedsudvalget 2022-23 (2. samling)
SUU Alm.del Bilag 211
Offentligt
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Regulation of the Osteopathic Profession in Europe
An Overview
Second Edition
SEPTEMBER 2022
 SUU, Alm.del - 2022-23 (2. samling) - Bilag 211: Henvendelse fra Danske Osteopater vedr. foretræde om status på osteopatien fem år efter autorisation af professionen
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Contents
Introduction and aims of the EFFO
Policy Committee statement
Definition of the term regulation
Type I and Type II Osteopathy training programmes
Benefits of regulating osteopaths
Osteopathy and brief history
Osteopathic standards
Osteopathic Education Committee statement
Population and regulation overview
Education overview
Osteopathic practice overview
Regulation in detail
Regulation in Cyprus
Regulation in Denmark
Regulation in Finland
Regulation in France
Regulation in Iceland
Regulation in Italy
Regulation in Luxembourg
Regulation in Malta
Regulation in Norway
Regulation in Portugal
Regulation in Switzerland
Regulation in the United Kingdom
Appendices
Appendix 1: Danish law on regulation
Appendix 2: French law on regulation
Appendix 3: Portuguese law on regulation
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Page 46
Hanna Tómasdóttir
President
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Introduction
The European Federation & Forum for Osteopathy (EFFO) is an organisation of
organisations, and represents the professional associations of osteopaths from 22
countries in Europe, as well as from Brazil, Canada and Israel. The EFFO aims to establish
standards, regulation and recognition for all osteopaths in Europe. Our mission is to
advance the awareness and recognition of the role that the osteopathic profession
contributes to the health and wellbeing of the public, and ensure high standards of
osteopathic care as well as patient safety.
The EFFO came about as a merger between the European Federation of Osteopaths
(EFO), and the Forum for Osteopathic Regulation in Europe (FORE) in March 2018. One of
the successes of the two organisations is the establishment of the European CEN (Centre
Européen de Normalisation) Standard for Osteopathic Healthcare Provision in 2015. The
EFFO itself are members of the OIA which is a global osteopathic organisation of over
60 professional associations, regulators, universities and research groups, representing
osteopaths and osteopathic physicians as two streams of the same profession.
The following regulation overview of the osteopathic profession is based on information
collected by the Policy Committee within the EFFO, with contributions from all our
membership, in 2021 and updated in September 2022. The content in this document has
been approved by the EFFO Board, the respective national organisations, and the Policy
Committee. The document will be updated regularly, and the last updated version can be
found, and downloaded, as a pdf on the EFFO website:
www.effo.eu.
We would be very pleased to provide further information if needed.
With kind regards,
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The European Federation & Forum for Osteopathy (EFFO) is an organisation of
organisations, and represents the professional associations of osteopaths from
22 countries in Europe, as well as from Brazil, Canada and Israel. The aim of the
EFFO is to establish standards, regulation and recognition for all osteopaths
in Europe. Our mission is to advance the awareness and recognition of the role
that osteopaths play in the health and wellbeing of the public, and ensure high
standards of osteopathic care as well as patient safety.
Maurice Cheng
Chief Executive
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Regulation of the Profession
The EFFO strongly urge all governments across Europe to recognise and regulate
osteopathy as an independent, primary healthcare profession.
We recommend that the title ‘osteopath’ is protected by law, and that osteopaths and
osteopathic physicians can only use the titles if they meet certain statutory conditions
in terms of competencies and registration and/or licensure. This would normally
require statutory registration, set out in national or state/provincial law, as the health
professional must comply with set standards of practice that protect the patients they
treat.
Patients should be able to consult an osteopath, confident in the knowledge that the
practitioner is able to practise efficiently, effectively and safely. Countries which have
properly trained and regulated osteopaths see the benefits of high patient satisfaction,
safe practise and good patient outcomes.
The profession has well established internationally recognised education and practice
standards, and has achieved statutory regulation and licensing in 12 countries in Europe
as of 2022. Those countries are Cyprus, Denmark, Finland, France, Iceland, Liechtenstein,
Luxembourg, Norway, Malta, Portugal, Switzerland, and the United Kingdom.
Norway is the most recent country to achieve full statutory regulation, with legislation in
place as a primary healthcare profession and a protection of the title, from 1 May 2022.
Italy have recognised the status of osteopaths as an independent healthcare profession,
and are working towards regulation.
In countries where there is, yet, no statutory regulation of the osteopathic profession,
we strongly advise all relevant stakeholders, national organisations, healthcare and
governmental bodies, to use and comply with the European CEN standard EN 16686 on
Osteopathic Healthcare Provision, published in 2015.
On behalf of the EFFO Policy Committee
What does the term
‘regulation’ mean?
“Regulated by law normally means that
the title ‘osteopath’ is protected by law,
and that osteopaths and/or osteopathic
physicians can only use the titles if they
meet certain statutory conditions in terms
of competencies and registration and/
or licensure. This would normally require
statutory registration, as the health
professional must comply with set standards
of practice that protect the patients they
treat; statutory regulation is set out in
national or state/provincial law.”
(Adapted from the Osteopathic International
Alliance statutes 3.1)
Training
programmes
According to the CEN standard and the WHO
Benchmarks for Training in Osteopathy,
there are two types of osteopathy training
programmes:
•
Type I training programmes are
aimed at those with little or no prior
healthcare training, but who have
completed high school education or
equivalent; and
Type II training programmes are
aimed at those with prior training as
healthcare professionals.
•
Hanna Tómasdóttir, (Denmark/EFFO)
Chair of the EFFO Policy Committee
President of the European Federation & Forum for Osteopathy
Members:
•
•
•
•
•
•
•
•
Evangelos Evangelou, (Cyprus)
Jean Bofferding (Luxembourg)
Lluís M. Horta, (Spain/EFFO)
Maurice Cheng (UK/EFFO)
Michel Van Espen (Luxembourg)
Nancy Spence (Canada)
Nejc Mikič (Slovenia)
Nina Köck-Mittendorfer (Austria)
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Benefits of regulating
Osteopaths:
•
Regulation of the osteopathic profession leads to standardised, appropriate
and recognised education standards, which improves patient safety
Protection of the title ‘osteopath’ means that citizens can be reassured that the
osteopathic practitioner have the skills and competences to convey safe and
effective osteopathic treatment
The
Comité Européen de Normalisation,
CEN, issued a European Standard
on Osteopathic Healthcare Provision in 2015, (EN 16686), developed in
partnership with the two former European osteopathy organisations:
European Federation of Osteopaths (EFO) and the Forum for Osteopathic
Regulation in Europe (FORE), now merged as the EFFO. The CEN standard sets
a benchmark for high quality clinical practice, education, safety and ethics for
Osteopathy in Europe and has been published in 33 European countries, and
has served as a key reference for the legislative work related to regulation.
Read more about the CEN standard here:
https://www.cencenelec.eu
As primary contact healthcare practitioners, osteopaths can relieve waiting lists
for medical attention, as well as forming an integral part of multidisciplinary
team working. The profession across Europe numbers some 60,000 highly
trained healthcare practitioners, which are a key additional source of
healthcare provision, particularly in a post COVID-19 health economy
The EU mission of “Free movement - EU nationals” will be further supported
when the osteopathic profession is regulated in all countries in the EU:
“Free movement of workers is a fundamental principle of the Treaty enshrined
in Article 45 of the Treaty on the Functioning of the European Union and
developed by EU secondary legislation and the Case law of the Court of Justice.
EU citizens are entitled to:
•
•
•
•
•
look for a job in another EU country
work there without needing a work permit
reside there for that purpose
stay there even after employment has finished
enjoy equal treatment with nationals in access to employment, working
conditions and all other social and tax advantages”
•
A brief history of osteopathy
Osteopathy is a primary contact and patient-centred healthcare discipline.
The
profession was founded by Dr. Andrew Taylor Still, an American physician and surgeon, in
the late 1800s, and was brought to Europe, by one of his students, John Martin Littlejohn,
in the early 1900s. John Martin Littlejohn founded one of the leading osteopathic
universities in Europe today, the University College of Osteopathy (UCO), founded in 1915
(formerly the British School of Osteopathy).
According to the CEN standard, osteopathy can be described as:
”The practice of osteopathy uses osteopathic, medical and scientific knowledge to apply the
principles of osteopathy to patient diagnosis and treatment. The aim of osteopathy is to
improve and support all aspects of health and healthy development. Osteopathic treatment
may be preventive, curative, palliative or adjuvant. Osteopaths analyse and evaluate the
structural and functional integrity of the body using critical reasoning of osteopathic principles
to inform individual diagnosis and treatment of the patient.”
•
•
History of regulation of the
osteopathic profession in Europe
12 countries in Europe have currently achieved regulation of the osteopathic profession
on a statutory basis. Those countries are: Cyprus, Denmark, Finland, France, Iceland,
Lichtenstein, Luxembourg, Malta, Norway, Portugal, Switzerland, and United Kingdom.
Statutory recognition of osteopaths started in Europe in 1993 with the Osteopaths’ Act
in the United Kingdom. This was followed five years later by the foundation of the UK
statutory regulator, the General Osteopathic Council (GOsC). Osteopaths in the UK are
first contact primary healthcare practitioners, to which the public can self refer. On
graduating, which is at either Bachelor or Masters level, they have been trained and
experienced to refer onwards to other healthcare professions as appropriate for the
patient, and have an adverse incident record that is significantly better than the average
in the National Health Service (NHS). Osteopaths in the UK are now recognised by NHS
England as Allied Health Professionals, playing an important role in NHS transformation,
as fellow health professions with the right skills and experience to relieve the immense
pressure on waiting lists.
Since then other European countries have followed the UK lead in recognising and
developing regulation for osteopaths, including Cyprus, Denmark, Finland, France,
Iceland, Liechtenstein, Luxembourg, Malta, Norway, Portugal and Switzerland. Italy have
now recognised the status of osteopaths as an independent healthcare profession, and
are working towards regulation. Most recently, Norway gained full statutory regulation, as
a primary healthcare profession and a protection of the title, from 1 May 2022. .
•
Source: https://ec.europa.eu/social/main.jsp?catId=457
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In one of the most recent examples, osteopaths in Denmark have been recognised
as a first contact healthcare profession in legislation passed in May 2018, by
unanimous vote in the Danish Parliament.
Authorisations, or license to practise as
osteopaths, are issued by the Patient Safety Authority, who are the official regulator
of all recognised healthcare professions. The authorisation process in Denmark was
assisted by the World Health Organisation (WHO) Benchmark for Training in Osteopathy,
published in 2010, and the
Comité Européen de Normalisation
(CEN) standard for
osteopathic practice and training, published in 2015. These two benchmark documents
were of great assistance to the Danish government in their determinations, and for the
Patient Safety Authority, where they served as a reference for the base level of education
and as an overall qualification frame for the osteopathic profession. Both standards are
used as reference standards by EFFO members and many of the osteopathic education
providers across Europe.
Osteopathic Education
The EFFO recognises the importance of maintaining and developing high standards
for osteopathic education, as described in CEN Type I and Type II programmes.
Education programmes should meet national requirements for recognised qualifications,
where applicable. Proof of qualification should state the level of education, preferably
in the format of university degrees based on a defined level of ECTS or equivalent. Proof
of qualification should be supported by a transcript of records or similar, describing the
content and amount of training, preferably stating the number of ECTS.
Education providers (EPs) should on a regular basis undergo external audit, based
on requirements described by CEN and/or national requirements for recognised
qualifications. EPs not yet accredited by a nationally recognised auditor, should actively
pursue accreditation by a relevant national governing body as a higher teaching
institution. This applies for EPs delivering both Type I and Type II education programmes.
Osteopathic standards
There are two international standards for osteopathy:
The CEN standard and WHO
Benchmarks for Training in Osteopathy. The two standards are almost congruent.
The WHO Benchmarks describes the core philosophy and principles of osteopathy, the
main types of osteopathic training programmes, core competencies, and a benchmark
training curriculum.
The World Health Organization published Benchmarks for Training in Osteopathy in 2010.
The
Comité Européen de Normalisation
(CEN) issued a European Standard on Osteopathic
Healthcare Provision in 2015 (EN 16686), which was developed in partnership with the
European Federation of Osteopaths (EFO) and the Forum for Osteopathic Regulation
in Europe (FORE), and took the preexisting WHO Benchmarks into account during
development. The CEN standard sets a benchmark for high quality clinical practice,
education, safety and ethics for Osteopathy in Europe and has been published in 33
European countries.
Read more about the CEN standard here:
www.cencenelec.eu
Tomas Collin, (Norway)
Chair of the Education Committee
Members:
•
•
•
•
•
•
•
•
•
Jonathan Bailey-Teyletche (UK/EFFO)
Maurice Cheng (UK/EFFO)
Giacomo Consorti (Italy)
Robert Grech (Malta)
Sandra Lois (Spain)
Sandra Rinne (Finland)
Dirk Segers (Belgium)
Vangelis Skotiniotis (Greece)
Nancy Spence (Canada)
 
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Population and Regulation Overview
Iceland
Population
Osteopaths in Total
Primary Health Care
Title ‘Osteopath’ Protected
Legislation based on
CEN/WHO Benchmark
376,000
8
Yes
Yes
No
1
Finland
Population
Osteopaths in Total
Primary Health Care
Title ‘Osteopath’ Protected
Legislation based on
CEN/WHO Benchmark
5.5 million
500
Yes
Yes
No
1
United Kingdom
Population
Osteopaths in Total
Primary Health Care
Title ‘Osteopath’ Protected
Legislation based on
CEN/WHO Benchmark
68 million
5,500
Yes
Yes
No
1
Norway
Population
Osteopaths in Total
Primary Health Care
Title ‘Osteopath’ Protected
Legislation based on
CEN/WHO Benchmark
5.5 million
500 approx
Yes
Yes
Yes
France
Population
Osteopaths in Total
Primary Health Care
Title ‘Osteopath’ Protected
Legislation based on
CEN/WHO Benchmark
67 million
25,600
No
Yes
No
1
Luxembourg
Population
Osteopaths in Total
Primary Health Care
Title ‘Osteopath’ Protected
Legislation based on
CEN/WHO Benchmark
Population
636,000
250-300
Yes
Yes
Partly
Denmark
5.8 million
320 approx
Yes
Yes
Yes
Osteopaths in Total
Primary Health Care
Title ‘Osteopath’ Protected
Legislation based on
CEN/WHO Benchmark
Liechtenstein
Population
Osteopaths in Total
Primary Health Care
Switzerland
Population
Osteopaths in Total
Primary Health Care
Title ‘Osteopath’ Protected
Legislation based on
CEN/WHO Benchmark
8.6 million
1,300
Yes
Yes
No
1
Malta
Population
Osteopaths in Total
Primary Health Care
Title ‘Osteopath’ Protected
Legislation based on
CEN/WHO Benchmark
Title ‘Osteopath’ Protected
500,000
26
Yes
Yes
No
1
Italy
Population
Osteopaths in Total
Primary Health Care
Title ‘Osteopath’ Protected
Legislation based on
CEN/WHO Benchmark
60.36 million
12,000
Yes
3
Yes
3
No
2
Portugal
Population
Osteopaths in Total
Primary Health Care
Title ‘Osteopath’ Protected
Legislation based on
CEN/WHO Benchmark
10.1 million
2,050
Yes
Yes
No
Cyprus
Population
Osteopaths in Total
Primary Health Care
Title ‘Osteopath’ Protected
Legislation based on
CEN/WHO Benchmark
650,000
18
Yes
Yes
Yes
1
2
3
No
- legislation passed prior to CEN publication
No
- CEN has been presented to the Ministry
Not yet
- Italy is in process of regulation
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Education Overview
Education Level
Required
to Practise
Type I educated
within association
Type II educated
within association
Osteopathic
Physicians
Type of education
offered
Osteopathic Practice
Private
Practice
National
Health
Services
Restrictions
to practise
Reimbursed
by State
Reimbursed by
Insurance
VAT on
consultations
Master/DO
16
2
None
None
3
3
3
3
3
3
7
7
7
7
7
3
****
7
7
7
3
7
3
7
7
7
7
7
*
3
****
3
3
3
3
7
3
7
7
7
7
7
7
**
Bachelor
50
227
1
Type II
Bachelor
120
80
3
Both Type I & Type II
See page 21
550
150
1.000-2.000
Both Type I & Type II
Bachelor
3
0
None
None
See page 26
1634
2590
23
Both Type I & Type II
Master*
30
50
Between 5-10
None
3
3
3
3
3
3
3
***
7
3
7
7
3
3
7
7
7
7
7
7
7
7
7
7
7
3
3
3
3
3
3
7
7
7
7
7
7
Bachelor
26
0
No data
Type I **
Bachelor/DO
220
170
None
Type I
Bachelor
1845
205
No data
Type I
Master
No data
No data
No data
Type 1
Bachelor
5000
50
50 - estimate
Both Type I & Type II
* Read more on page 28
** Read more on page 30
* No, but unions
** Yes - until regulation wil be finalized!
*** In theory
**** When the regulation process will be over
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Regulation in Cyprus
Based on information received from the national osteopathy association,
Cyprus Osteopathic Association, COA.
Country Population, Numbers of Osteopaths & National Association
Cyprus has a population of 850,000 inhabitants, and there are a total of 18 practicing
osteopaths. All 18 osteopaths are members of the only osteopathic professional
association, the Cyprus Osteopathic Association, COA.
There are at present no student members of COA, and no osteopathy students in Cyprus.
There are also no osteopathic physicians within COA, and no official data on any
osteopathic physicians practising in Cyprus.
Regulation, Regulator & Links to Official Documents Related to Regulation
Osteopathy has been regulated as a Healthcare Profession in Cyprus since 3 July 2020 by
Law Number 2020 (N. 78(I) of 2020, and the title ‘Osteopath’ is protected.
The Regulatory Body is Cyprus Registration Board:
Telephone Number: +357-99 444252.
First Contact Healthcare Profession & Standards for Practise
The osteopathic profession is a first contact health profession in Cyprus, and patients can
self-refer. Osteopaths need to be registered before practicing osteopathy in Cyprus, but
otherwise there are no restrictions to the scope of practice.
The Registration Council has the power to ask the applicant (osteopath) to do more
clinical hours or cover academic areas, as well as testing the knowledge of the osteopath
with oral, written, practical (technique) and clinical environment exams to bring them up
to the Comité Européen de Normalisation (CEN), the European standard for osteopathic
practice and training, in order to register.
Osteopaths in Cyprus only work in private practice.
Educational Levels & Programmes
The level of education required to practice osteopathy in Cyprus is University Degree/
Masters or DO acquired in an EU state where there is a state register and the osteopath is
able to join and practice in that state.
16 osteopaths in COA are Type I educated, and 2 are Type II educated.
No educational osteopathy programmes are offered in Cyprus.
Continuing Professional Development – CPD
There is a legal obligation of 30 hours of Continuing Professional Development per
year. This involves lectures, seminars, webinars, workshops, etc., related to professional
practice approved by the Cyprus Osteopathic Association.
VAT
There is no VAT on osteopathic consultations in Cyprus.
Insurance
Osteopathic treatments are covered by most insurance companies. Depending on the
insurance policy some cover fully and some cover partly.
If you need further information, please contact:
Evangelos Evangelou, DO
President Cyprus Osteopathic Association, COA
Member of the Registration Board
Telephone Number: +357-99 444252
Email: [email protected]
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Regulation in Denmark
Based on information received by the national osteopathy association,
Danske Osteopater.
Country Population, Numbers of Osteopaths & National Association
Denmark has a population of 5.8 million, and 277 registered osteopaths in the national
association. Almost all osteopaths in Denmark are members of the national association,
Danske Osteopater (DO). Beside the fully qualified osteopaths practicing in Denmark
there are about 150 osteopathy students in total, and about 30 of them hold student
membership of Danske Osteopater.
Regulation, Regulator & Links to Official Documents Related to Regulation
Osteopaths in Denmark have been recognised as a first contact healthcare profession
since the legislation passed 15 May 2018, by unanimous vote in the Danish Parliament.
Osteopathy has officially been regulated in Denmark since 1 July 2018.
Authorisations (official license to practise as osteopaths) are issued by
Styrelsen for
Patientsikkerhed,
the Patient Safety Authority, who are the national regulator of all 19
recognised healthcare professions in Denmark. It is the Patient Safety Authority who
evaluates each individual educational level, and issues an official license to practice as
an osteopath, if the applicant meets the official qualification. The title “Osteopath” is
protected. Practitioners are only allowed to use terms indicating that they are a osteopath
offering osteopathy, if they are a licensed osteopath.
Link to the official register of osteopaths:
There is an official register, on The Patient Safety Authority website, of all healthcare
professionals in Denmark, holding a Danish license to practice within their profession,
including osteopaths. You can find the link to the register of licensed osteopaths here:
https://autregweb.sst.dk/authorizationsearch.aspx
Link to the national legislation on authorisation on osteopaths:
The legislation describing the Danish regulation of Osteopaths ‘Bekendtgørelse om
autorisation af osteopater” can be found here:
https://www.retsinformation.dk/eli/lta/2018/981
You can find a certified translation to English of the legislation, “The Executive Order on
the Authorisation of Osteopaths”, on Danske Osteopater’s webite here:
https://www.danskeosteopater.dk/autorisation/
Read more about the Danish law on regulation of osteopaths, on page 39.
First Contact Healthcare Profession & Standards for Practise
The osteopathic profession in Denmark is a primary contact healthcare profession, with
no restrictions to scope of practice and patients can self-refer. Osteopaths in Denmark
work currently only in private practices. The national law and baseline for the educational
level for obtaining an official license to practise as an osteopath has been adapted from
the WHO Benchmarks for Training in Osteopathy and The European CEN standard.
Educational Level & Programmes
There are no accredited Danish educational programmes, but two Type II, or part-
time, educational programmes, on top of prior healthcare profession, are offered in
Denmark by: The International Academy of Osteopathy, IAO, and The European School of
Osteopathy, ESO. The IAO program leads to both a DO degree and a Master of Science in
Osteopathy, accredited by the Buckinghamshire New University. The ESO program leads
to a DO degree. A bachelor’s degree or equivalent to bachelor level, which corresponds to
level 6 of the European Qualifications Framework (EQF) is required to obtain a license to
practise Osteopathy in Denmark. The total amount of hours should be no less then 4200,
incl. 1000 hours of supervised clinical practice (adopted from The WHO Benchmarks).
Continuing Professional Development – CPD
There are currently no mandatory requirements for Continuing Professional
Development – CPD, but there are plans to implement CPD in the future.
VAT
Osteopathy services are exempt from VAT.
Insurance
About 15 insurance companies reimburse osteopathic treatment, partly or fully, and
more are on their way due to increased demand by the public.
If you need further information, please contact:
Hanna Tómasdóttir
President Danske Osteopater
[email protected]
+45 2625 5699
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Regulation in Finland
Based on information received from the national association, Suomen
Osteopaattiliitto ry/Finlands Osteopatförbund rf (Finnish Osteopathic Association).
Country Population, Numbers of Osteopaths & National Association
Finland has a population of 5.5 million inhabitants, and it is estimated there are around
530 practicing osteopaths. About 200 of those are members of the national association,
Suomen Osteopaattiliitto.
In addition to the practicing osteopaths there about 200 osteopathy students in Finland,
and 50 of them hold student membership of the association.
There are no osteopathic physicians practising within the association, but there are
known to be 3 osteopathic physicians practising outside the association in Finland.
There is another osteopathic association in Finland, Suomen ortopediset osteopaatit ry
(Soory), an association for orthopedic osteopaths with around 140 members.
Regulation, Regulator & Links to Official Documents Related to Regulation
Osteopathy has been officially considered a Healthcare Profession in Finland since 1994,
and the title ‘Osteopath’ is protected.
Links to the National Law
Health care law since 1994. Decree on health care professionals
http://www.finlex.fi
Healthcare act
www.finlex.fi/en/laki/kaannokset/2010/en20101326_20131293.pdf
A link to the regulator website:
Valvira, National Supervisory Authority for Welfare and Health
https://www.valvira.fi/
The National Supervisory Authority for Welfare and Health (Valvira) grants, upon
application, the right to practice as a licensed or authorised healthcare professional and
authorises the use of the occupational title of healthcare professional.
Valvira supervises and guides healthcare professionals and medical facilities both in
private and public sector. With supervision and guidance, Valvira ensures the adequacy of
services different healthcare professionals and medical facilities provide.
First Contact Healthcare Profession & Standards for Practise
The osteopathic profession is a first contact health profession in Finland and patients can
self-refer.
There are no restrictions to scope of practice.
Members of the Finnish Osteopathic Association need to be accepted to the national
Valvira registry as authorized osteopaths prior to the acceptance as a full member.
Comité Européen de Normalisation (CEN), the European standard for osteopathic practice
and training is utilized by the National Supervisory Authority for Welfare and Health,
Valvira, to asses the educational criteria for registering as an osteopath following their
graduation.
Osteopaths in Finland are all working in private practice.
Educational Levels & Programmes
The level of education required to practice osteopathy in Finland is either a 240 ECTS
University of Applied Sciences diploma, Type I education or equal requirements, Type II
education, 4 years part-time.
About 60% or 120 osteopaths in the Finnish Osteopathic Association are Type I educated,
and about 40% or 80 osteopaths in the association are 2 Type II educated.
Both Type I and Type II educational programmes audited according to the CEN-standard
are offered in Finland:
•
Type I at Metropolia University of Applied Sciences, of Healthcare (Osteopathy) in
Helsinki.
•
Type II at Osteopatiakoulu Atlas in Espoo.
Student members of the Finnish Osteopathic Association are currently students of these
two institutions.
Master’s Degree Programme in Osteopathy (EQF European Qualifications Framework,
Master’s level competencies, level 7) is offered at the Metropolia University of Applied
Sciences. The language of the degree programme is English. The programme is open to
osteopaths with at least 2 years of professional experience.
Continuing Professional Development – CPD
There are currently no mandatory requirements for Continuing Professional
Development – CPD, but the FOA offers high quality CPD for its members.
VAT
There is no VAT on osteopathic consultations in Finland.
Insurance
Osteopathic treatments are currently covered by a couple of private insurance
companies. There is a possibility to be re-imbursed when presenting a doctor’s referral.
Osteopathy may be offered as part of occupational healthcare.
If you need further information, please contact:
Laura Lee Kamppila
President
Suomen Osteopaattiliitto/Finlands Osteopatförbund
[email protected]
+358 40 743 1030
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Regulation in France
Based on information received by from the national osteopathy association,
Association Française d’Ostéopathie, AFO, (French Association of Osteopathy).
Country Population, Numbers of Osteopaths & National Association
France has a population of 67 million, and there are estimated to be around 12,600
qualified osteopaths, of which 700 are members of the AFO.
About 13,000 physiotherapists and physicians who offer osteopathic services are
registered on their own directory (Répertoire partagé des professionnels de santé - RPPS).
In addition to the practicing osteopaths, there are between 8,000 and 10,000 osteopathy
students in France, and 500 of them hold student membership of the Association
Française d’Ostéopathie, AFO.
According to a 2018 survey of the osteopathic profession (emost): 40% of osteopaths
are also healthcare professionals (11,715 in 2018), among them are a small number of
physicians – this roughly corresponds to the numbers given above.
A reasonable estimate of osteopathic physicians in France would be between 1,000 and
2,000, of which 700 are with the association for osteopathic physicians, Ostéos de France.
There are several associations of osteopaths in France. The best established are AFO,
CNO, ROF, SFDO, and UFOF/ODF, and some smaller ones. They represent in total some
4,000 members amongst the 25,000+ registered practitioners.
There are also many associations reserved for osteopaths who are also healthcare
professionals (physicians, physiotherapists).
Regulation, Regulator & Links to Official Documents Related to Regulation
Osteopathy is not recognised as a healthcare profession in France, but patients can
consult an osteopath without a medical prescription, unlike physiotherapists. The terms
‘osteopathic treatment and diagnosis’ are written in law. The 4th of March, 2002, Article
75 of the law 2002-303 on patients’ rights and the quality of the health system gave birth
to the professions of osteopath and chiropractor.
Since 2003, AFO has participated in working groups, aimed at supervising osteopathy,
within the Ministry and the Regional Health Agencies. AFO lobbied the Conseil d’Etat
(the highest administrative authority) in 2005 to have the decrees implementing the
March 2002 law passed. AFO also lobbied to ensure the teaching of cranial and visceral
osteopathy was reintroduced by the Conseil d’Etat, as well as CADA (Commission of
access to administrative documents) to make public report of IGAS (General Inspectorate
of Social Affairs) on school compliance checks.
At the end of 2014 the guidelines (activities, skills and training) applicable to the
profession were issued after 20 months of consultation between the Administration and
the professional organizations.
The directory ADELI (Automation of Lists) is held by Regional Health Agencies to register
professionals related to health.
The directory classifies into 4 categories:
•
•
•
•
The paramedical professions
Professions of the apparatus
Professional title use: Osteopath, Psychotherapist, Chiropractor
Professions of the social field: Assistant of social service, Psychologist
To be able to practice osteopathy, an osteopath must register his degree or diploma from
an approved school in the Adeli Directory and be covered by a professional CPR.
Name of Regulatory Body:
Ministry of Health
DGOS : Direction générale de l’offre de soins, which provides the secretariat for the
national advisory approval commission placed with the Minister responsible for health,
receives and validates the files submitted by the establishments for examination by the
commission.
ARS : Agence Régionale de Santé (Regional Health Agencies) responsible for regional
management of the national health system. They reflect the national policies of the
Ministry of Health.
Link to National Register:
Osteopaths wishing to practice osteopathy must submit a request to the ARS to be
registered in the Adeli professional directory.
Formulaire de demande
Read more about the French law on regulation of osteopaths, on page 43.
Recognition & Standards for Practice
The osteopathic profession is regulated in France and patients can self-refer. However,
osteopathy is recognised as an alternative practice to traditional medicine by the general
public and the media, less by standard health bodies which still have many difficulties in
integrating osteopathy into the course of care of patients.
The Comité Européen de Normalisation (CEN), the European standard for osteopathic
practice and training is not used by the French administration. Only a few association
bodies have used the standard to develop a code of ethics.
Osteopaths only practice in private clinics or private maternity hospitals, usually being
volunteers. Some physiotherapists and also osteopaths may practice osteopathy within
the National Health Services but not under the title of osteopath.
Educational Levels & Programmes
The level of education required to practice osteopathy in France, since 2014, publication
of decrees defining:
•
•
•
•
A training framework
4,860 hours for high school graduates
1,894 hours for physiotherapists
700 hours for physicians
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Here are the texts published since September 2014 which are binding on osteopaths:
•
Un nouveau cadre réglementaire pour une formation officielle dès la rentrée 2015
•
Décret 2014-1043 du 12 septembre 2014 Agrément des établissements de formation
en ostéopathie
•
Arrêté du 12 décembre 2014 Formation en ostéopathie
•
Arrêté du 12 décembre 2014 Dispenses d’enseignement susceptibles d’être
accordées
Osteopathic programmes are only accredited by the Ministry of Health. The training has
no university equivalence. Some schools have had their training validated in the National
Directory of Professional Certifications (RNCP), which gives an estimate of the value of
professional experience (British A-level +5 years, 300 ECTS).
31 schools are approved. See the list on our website:
https://www.afosteo.org/
Continuing Professional Development – CPD
There are not yet any mandatory requirements for Continuing Professional Development
– CPD. The code of ethics co-produced by professional associations and supervised by
AFNOR recommends a minimum of 42 hours over a period of three years of continuous
training but there is no control body.
VAT
There is no VAT on osteopathic consultations in France.
Insurance
Osteopathic treatments are covered by 80% of private insurance companies.
The level and the number of refunds depend on an individual contract, most of time
about three treatments a year are refunded.
Regulation in Iceland
Based on information received from the national osteopathy association,
Osteópatafélag Íslands (The Icelandic Osteopathic Association).
Country Population, Numbers of Osteopaths & National Association
Iceland has a population of 376,000 inhabitants, and there are a total of 8 practicing
osteopaths . Three osteopaths are members of the professional association,
Osteópatafélag Íslands.
Beside the practicing osteopaths there are between 6 and 10 osteopathy students in
Iceland, but none of those hold student membership as association statues do not
currently permit student members. The statutes will be changed soon to allow student
membership.
There are no osteopathic physicians within the national association, and no official data
of any osteopathic physicians practising in Iceland.
Osteópatafélag Íslands is the only osteopathic association in Iceland.
Regulation, Regulator & Links to Official Documents Related to Regulation
Osteopathy has been regulated by law as a Healthcare Profession in Iceland since
2005. The title ‘Osteopath’ (the Icelandic professional name is ‘osteópati’) is protected
(paragraph 2 in the osteopathic regulation).
The National Law number is 1131/2012 (formerly 229/2005):
www.reglugerd.is/
www.government.is/media/velferdarraduneyti-media/media/health-reg/Regulation-No-
1131-2012---osteopaths.pdf
The regulation is issued by the Ministry of Health:
www.government.is/ministries/ministry-of-health/
But it is overseen by the Directorate of Health:
www.landlaeknir.is/english/
First Contact Healthcare Profession & Standards for Practise
The osteopathic profession is a first contact healthcare profession in Iceland, and patients
can self-refer. There are no restrictions to the scope of practice.
Osteopaths in Iceland only work in private practices. There is a national register of
osteopaths, which is found here:
www.osteopatia.is/
If you need further information, please contact:
Marie-Hélène SALA
President Association Française d’Ostéopathie, AFO
To-loan SALA, Secretary
Thomas LOCHER, Vice-President
AFO Association Française d’Ostéopathie
French Association of Osteopathy
3 rue Ribot 34000 Montpellier France
+33 6 72 72 65 00
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Educational Levels & Programmes
The minimum level of education required to practice osteopathy in Iceland is a Bachelors
degree in osteopathy.
All three osteopaths in Osteópatafélag Íslands are Type I educated.
No educational osteopathy programmes are offered in Iceland.
Continuing Professional Development – CPD
There are no mandatory requirements for Continuing Professional Development – CPD,
for osteopaths in Iceland.
VAT
Services offered by healthcare workers in Iceland are VAT excluded.
Insurance
Osteopathic treatments are not covered by private insurance companies. But almost all
trade unions pay a part of osteopathic treatment for their members.
If you need further information, please contact:
Haraldur Magnússon
President Osteópatafélag Íslands
[email protected]
Regulation in Italy
Based on information received from the Registro degli Osteopati d’Italia, ROI.
Country Population, Numbers of Osteopaths & National Association
Italy has a population of 60.4 million inhabitants, and it is estimated there are
approximately 12,000 practicing osteopaths. About 4,000 of those are members of the
professional association, Registro degli Osteopati d’Italia, ROI.
In addition, there are approximately 5000 osteopathic students in Italy. An unknown
number of those hold student membership of ROI, but the data will be available soon.
There is currently no data available on the number of osteopathic physicians who are
practising within the Registro degli Osteopati d’Italia, ROI, but the data will be available
soon.
There are other osteopathic associations in Italy, with unknown numbers of members.
The major ones are :
•
Fesios
•
APO
Regulation, Regulator & Links to Official Documents Related to Regulation
Italy is currently in the process of being regulated and osteopathy is now recognised as a
healthcare profession. The law is in place, but we are awaiting the implementing decrees.
The title ‘osteopath’ is therefore not yet protected.
Link to the National Law 3/2018. Please note, that the law will not be effective until the
end of the regulatory process:
Law 3/2018
www.gazzettaufficiale.it
Useful links:
Ministry of Health
www.salute.gov.it/portale/home.html
Ministry of University
www.mur.gov.it/it/home
An official national register of practicing osteopaths will be created at the end of the
regulatory process.
Standards for Practise
Italy is still in the process of regulation, so more details about the status of the
osteopathic professional standards will be provided when in place.
The professional profile that has just been approved does not allow osteopaths to use
internal and invasive techniques.
Comité Européen de Normalisation (CEN), the European standard for osteopathic practice
and training has been presented to the ministry during the discussions about recognition.
Osteopaths in Italy are all working in private practice.
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Educational Levels & Programmes
Due to the ongoing regulation process no requirements have been set as yet, but it will
change to university degree (BSc equivalent) when regulation is implemented.
Both Type I and Type II educational programmes are currently offered in Italy, but on
regulation, only Type I university programmes will be offered. There are more than 40
educational institutions right now, some are validated by foreign universities
(e.g. UCO, BNU).
Continuing Professional Development – CPD
There are currently no mandatory requirements for Continuing Professional
Development – CPD.
VAT
VAT is currently charged at 22% on osteopathic consultations in Italy, however, when
the regulation process is complete, VAT will no longer be charged on osteopathic
consultations.
Insurance
Some private insurance companies cover osteopathic treatments.
Regulation in Luxembourg
Based on information received from the national osteopathy association,
Association Luxembourgeoise des Osteopathes, ALDO.
Country Population, Numbers of Osteopaths & National Association
Luxembourg has a population of 626,000 inhabitants, and it is estimated there are
approximately 250-300 practicing osteopaths. About 190 of those are licensed to
practice as osteopaths, and 83 are members of the professional association, Association
Luxembourgeoise des Osteopathes, ALDO.
It is not known how many osteopathic students there are in Luxembourg, and less than 5
hold student membership of ALDO.
There are no osteopathic physicians within ALDO, and no official data on how many
physicians there might be practising outside ALDO, but there are known to be between
5-10 osteopathic physicians practising in Luxembourg.
Regulation, Regulator & Links to Official Documents Related to Regulation
Osteopathy has been regulated as a Healthcare Profession in Luxembourg since 23
September 2018, but the profession was recognised from 28 August 2018. The title
‘Osteopath’ is protected to a certain extent.
Links to the National Law:
1)
Recognition of the profession: Loi du 28 août 2018 portant modification de la loi
modifiée du 26 mars 1992 sur l’exercice et la revalorisation de certaines professions
de santé:
data.legilux.public.lu
Regulation: Règlement grand-ducal du 23 septembre 2018 portant règlementation de
la profession d’ostéopathe, n) 873 du 27 septembre 2018:
data.legilux.public.lu/
If you need further information, please contact:
Paola Sciomachen
President Registro degli Osteopati d’Italia, ROI
2)
Giacomo Consorti MSc, DO
Registro degli Osteopati d’Italia, ROI
[email protected]
+39 3405204077
While there is no official register of osteopaths, the regulatory body is Conseil Supérieur
de Certaines Professions de Santé.
A link to the regulator website:
www.cscps.lu
First Contact Healthcare Profession & Standards for Practise
The osteopathic profession is a first contact health profession in Luxembourg, and
patients can self-refer.
There are two restrictions to the scope of practice:
•
•
No High Velocity Thrust (HVT) on the Cervical Spine without a medical screening;
No HVT Manipulations on infants (cervical spine, vertebral column and cranium) less
than 6 months.
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ALDO has been using the Comité Européen de Normalisation (CEN) standard for
osteopathic practice and training to establish membership criteria, and the CEN Standard
was proposed to the Ministry of Health during preliminary discussions to the regulation
process, as a reference. Some elements of the CEN standard were adopted by the
Ministry.
Osteopaths in Luxembourg work mainly in private practice. They could also, in theory,
practice in the National Health Service, but as there is no formal compensation through
the National Health Service (CNS), there are only anecdotal accounts of this actually
occurring.
Educational Levels & Programmes
The level of education required to practice osteopathy in Luxembourg is either a
Master’s degree in Osteopathy (Type I – fulltime education), or with a previous healthcare
professional’s’ degree, e.g. Physical Therapist, with an additional 2,000 hours of training
in Osteopathy (Type II - Part-time education).
About 30 osteopaths in the ALDO are Type I educated, and around 50 are Type II
educated.
There are no educational osteopathy programmes offered in Luxembourg.
Continuing Professional Development – CPD
There is a legal obligation to complete 40 hours each year of Continuing Professional
Development – CPD. The process if this is not achieved has not been specified.
VAT
There is no VAT on osteopathic consultations in Luxembourg.
Insurance
Osteopathic treatments are covered by five private insurance companies, and most of
them cover 80% of the treatment costs.
If you need further information, please contact:
Jean Bofferding
President
Association Luxembourgeoise des Osteopathes, ALDO
[email protected]
Regulation in Malta
Based on information received by the national osteopathy association, Malta
Association of Osteopaths.
Country Population, Numbers of Osteopaths & National Association
Malta has a population of 500.000 and 10 registered osteopaths in the Malta Association
of Osteopaths (MAO). There is only one national association in Malta, but there 5 more
osteopaths who practice outside the national association.
There are currently two Schools offering osteopathy education in Malta. These schools
were formerly established in Italy and due to changes in Italian legislation, they opted
to seek a license to operate in Malta in order to continue serving their students. It is
projected that most of the students would go back to Italy to practice after graduation.
Regulation, Regulator & Links to Official Documents Related to Regulation
Osteopathy is regulated by national law in Malta and the terms “Osteopath”, “osteopathy”
and “Osteopathic treatment” are all protected. Regulation was in place even before
osteopaths were actually working in Malta. Historically, the regulation became in place
after lobbying by the Chiropractic professionals. The president at the time, saw fit to also
regulate osteopathy if chiropractic were to be regulated.
A link to the official Regulatory Body in Malta:
Council for the Professions Complementary to Medicine
deputyprimeminister.gov.mt
Benchmarks for education and practice have now been published and are available by
contacting the CPCM registrar, Mr. Brady Saliba on
[email protected]
Law
Article 21 (a) (b) (d) and the First Schedule (Art 6) of the Health Care Professions Act (Cap
464)
464. 1. CHAPTER 464. HEALTH CARE PROFESSIONS ACT. To regulate the practice of health
care professions in Malta. 21st November, 2003. ACT XII of 2003
chapter 464 health care professions act - Laws of Maltajusticeservices.gov.mt ›
DownloadDocument
justiceservices.gov.mt/
Reference is made to the code of practice and is available for download here:
deputyprimeminister.gov.mt/en/regcounc/cpcm/Documents/Osteopathy%20Code%20
fo%20Practice.pdf
A link to the Malta Osteopathy Register is available here:
https://deputyprimeminister.gov.mt/en/regcounc/cpcm/Documents/Osteopathy%20
Register.pdf
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First Contact Healthcare Profession & Standards for Practise
The osteopathic profession in Malta is a primary contact healthcare profession,
with no restrictions to scope of practice and patients can self-refer. Osteopaths
in Malta work in private practice and there are no jobs in the National Health
Services
available to date. The European standard for osteopathy CEN standard is being
used both for education of patients, other professionals and government institutions.
Reference is made to the CEN standard when an application to join the register is
processed.
Educational Levels and Programmes
Bachelor of Science with Honours (MQF Level 6) is required to practice osteopathy
in Malta. The educational programs offered in Malta are accredited by the National
Commission for Further and Higher Education (NCFHE). License is required both for the
institution itself and for the courses. The institution (ICOM) does not have a University
status, therefore, the degree is issued by an external University (University of Kingston,
UK).
Malta ICOM
Osteopathy
Educational Ltd
Malta ICOM
Osteopathy
Educational Ltd
Malta ICOM
Osteopathy
Educational Ltd
Full Licence
Undergraduate
Higher Diploma
in Osteopathy
Full Licence
Short Cycle
Qualification in
Osteopathy
Full Licence
Malta ICOM
Educational
Ltd
Malta ICOM
Educational
Ltd
Level 6
120 ECTS
Level 5
120 ECTS
Level 5
60 ECTS
Insurance
Osteopathic treatments are covered by insurance companies, depending on the policy.
Most companies cover by they differ according to the individual policy. This is an area yet
to be explored further. Costs are again fully or partially covered, depending on the policy
the patient holds. The majority of cases, osteopathy services are capped at a rate of 30-35
Euros. The argument by insurers is that this is what physiotherapists charge.
If you need further information, please contact:
Robert Grech
President
Malta Association of Osteopaths
[email protected]
Marco Coccia
Secretary
Malta Association of Osteopaths
[email protected]
Bachelor of
Malta ICOM
Science (Honours Educational
in Osteopathy
Ltd
Source: NCFHE Website: https://ncfhe.gov.mt/en/register/Pages/register.aspx
Continuing Professional Development – CPD
CPD is not mandatory in Malta but is encouraged. Malta Association of Osteopaths will
make it mandatory for membership.
VAT
Osteopathy services are exempt from VAT without credit.
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Regulation in Norway
Based on information received from the national osteopathy association,
Norsk Osteopatforbund (NOF).
Country Population, Numbers of Osteopaths & National Association
Norway has a population of 5.5 million inhabitants, and there are estimated to be around
500 practicing osteopaths. About 390 of those are qualified osteopaths and members of
the professional association, Norsk Osteopatforbund (NOF).
In addition, there are approximately 150 osteopathy students in Norway, with about 60
of them holding student membership of NOF.
There are no osteopathic physicians within NOF, and no official data on how many
physicians there might be practising outside NOF.
There is one other osteopathic association in addition to NOF, which is not active and
only comprises a handful of members.
Regulation, Regulator & Links to Official Documents Related to Regulation
As of 1st. May 2022 osteopathy is regulated as a primary healthcare profession, and the
title is protected by the Healthcare Personnel Law, see link:
https://lovdata.no/dokument/NL/lov/1999-07-02-64
The Healthcare Personnel Law is universal for all regulated healthcare professions in
Norway, and osteopaths need to apply and register with the state regulatory body for all
healthcare professions in Norway, Helsedirektoratet:
www.helsedirektoratet.no/english/authorisation-and-license-for-health-personnel
All healthcare professionals, including osteopaths, holding a license to practice will be
listed on a public register:
https://register.helsedirektoratet.no/hpr
First Contact Healthcare Profession & Standards for Practice
The osteopathic profession is a first contact healthcare profession in Norway, and
patients can self-refer. There are no restrictions to the scope of practice.
The title ‘osteopath’ is legally protected and will consequently ensure that only qualified
osteopaths can deliver osteopathy/osteopathic treatment. All healthcare professionals
need to be able to provide documentation of the qualifications and apply for a license to
practice, for the service they deliver. It is a criminal offence to present or practice as an
osteopath without a license.
Comité Européen de Normalisation
(CEN), the European standard for osteopathic practice
and training levels of education is included in membership criteria. It has also been an
important reference throughout the regulatory process.
Osteopaths mostly provide their services as private practitioners, so there are very few
working within the NHS. With regulation in place, it is expected this will change.
Educational Levels & Programmes
The legal requirement to practise is in line with the CEN Standard, which is a minimum of
4 years accredited fulltime education, or similar. The same criteria apply for membership
of NOF. There is a well established and accredited Type I education offered in Norway. It
is a fulltime 4 year course of 240 ECTS, from Kristiania University College (www.kristiania.
no/en/).
The programme is accredited by NOKUT, the national institution for higher
education, and follows the Bologna Convention standards. About 220 osteopaths in NOF
are Type I educated, and around 170 are Type II educated.
Continuing Professional Development – CPD
CPD is mandatory by law for all healthcare professionals, however this is not specified in
credits or hours. The legal framework states that you need to continuously update and
refresh your knowledge to be a safe practitioner and it is the individual’s responsibility to
ensure this is undertaken in a relevant way. In other words, as long as an osteopath can
deliver safe and qualitative good practice, they will keep their license. In reality, this will
mean osteopaths undertake CPD activities, but not a specified number of hours or types
of areas. This way of regulating all healthcare professionals is similar throughout the
whole Nordic region.
VAT
There is no VAT on osteopathic consultations in Norway.
Insurance
Osteopathic treatments are covered by several major companies, about 5 or 6 out of 10
companies cover osteopathy. There are still a few who do not cover it and this is a work
in progress. The coverage varies, as coverage is a private agreement.
If you need further information, please contact:
Tomas Collin
President Norsk Osteopatforbund
[email protected]
+47 913 284 30
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Regulation in Portugal
Based on information received from the national osteopathy association,
Associação dos Osteopatas de Portugal (AOST).
Country Population, Numbers of Osteopaths & National Association
Portugal has a population of 10.1 million inhabitants, and there are estimated to be
around 2,050 practicing osteopaths in total. About 250 of those are members of the
professional association, Associação dos Osteopatas de Portugal, AOST.
Beside the practicing osteopaths there are about 400 osteopathy students in total in
Portugal. AOST recently changed their statutes, so students can now become members of
the association. It is mandatory to be students of undergraduate courses in Osteopathy
in Higher Education Institutions that offer validated osteopathy programs (BSc Hons).
These members do not have the right to vote or be elected to the Association’s Board.
There are no osteopathic physicians practising within the AOST, and there are no data on
osteopathic physicians practicing in Portugal.
There are three main osteopathic associations in Portugal:
Associação dos Osteopatas de Portugal - AOST
Associação Independente de Osteopatia - AIO
Associação de Profissionais de Osteopatia - APO
There are about 700 associates among osteopaths with professional cédula and
undergraduate students.
Regulation, Regulator & Links to Official Documents Related to Regulation
Osteopathy has been officially considered as a Healthcare Profession in Portugal
since 2003, by Act 45/2003. The title ‘Osteopath’ is protected by law (Act 71/2013, and
Government Ordinance No.207-B/2014), and the practice of osteopathy performed
by non-osteopaths, is punishable by Law: Act 2/2021 (limits access to the regulated
profession, or its exercise)
Read more about the Portuguese law on regulation of osteopaths, on page 46.
First Contact Healthcare Profession & Standards for Practise
The osteopathic profession is a first contact healthcare profession in Portugal and
patients can self-refer.
There are no restrictions to scope of practice. Osteopaths, by law, are autonomous and
independents in their exercise of clinical practice. However, only osteopaths accredited
and registered in the Portuguese Central Administration of the Health System/ Ministry
of Health, can exercise Osteopathy in Portugal.
Currently, the only mandatory requirement to be a member of our association, or
to practice osteopathy in our country, is to be registered as an Osteopath in Central
Administration of the Health System, I.P (ACSS)/ Ministry of Health, and to have the
respective professional ballot issued by ACSS.
We are trying to get involved in standardization, especially in terms of teaching and
practicing osteopathy, in order to shape and unify the content of teaching standards and
osteopathic practice in the European Union.
Osteopaths in Portugal are all working in private practice.
Educational Levels & Programmes
The level of education required to practice osteopathy in Portugal is BSc Hons, Graduate
Level, 4 years full time – 240 ECTS.
About 90% of all osteopaths in AOST are Type I educated, and about 10% are Type II
educated.
Higher education in osteopathy, BSc Hons, has existed in Portugal since 2016. Currently
there are eight higher osteopathic education programs in osteopathy, BSc Hons.,
approved by the Portuguese Higher Education Assessment and Accreditation Agency ,
and the Ministry of Science, Technology and Higher Education. These courses are running
in eight higher health schools across the country.
Continuing Professional Development – CPD
There are no mandatory requirements for Continuing Professional Development – CPD.
VAT
No. Osteopathic treatments performed exclusively by osteopaths are exempt from VAT,
by law (Act. Nr. 1/2017).
Insurance
Osteopathic treatments are currently partly covered, by three major private insurance
companies in Portugal.
If you need further information, please contact:
Rui Coelho
President AOST – Associação dos Osteopatas de Portugal
Av. 5 de Outubro, 89-9º
1050-050 Lisboa, Portugal
+351 918112406
Luis Andrade
AOST – Associação dos Osteopatas de Portugal
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Regulation in Switzerland
Based on information received from the national association, SuisseOsteo.
Country Population, Numbers of Osteopaths & National Association
Switzerland has a population of 8.6 million inhabitants, and it is estimated there are
around 1,300 practicing osteopaths. About 1,000 of those are members of the national
association, SuisseOsteo.
There is no data on numbers of osteopathic physicians practising in Switzwerland
Regulation, Regulator & Links to Official Documents Related to Regulation
Osteopaths in Switzerland are recognised as a first contact healthcare profession, and
the title “Osteopath” is protected.
First Contact Healthcare Profession & Standards for Practise
The osteopathic profession is a first contact health profession in Switzerland and patients
can self-refer. There are no restrictions to scope of practice. Osteopaths in Switzerland
are all working in private practice.
Educational Levels & Programmes
The level of education required to practice osteopathy is a master degree (bachelor level
is 190 ECTS, and then master + 90 ECTS) and only full-time education, or Type I, is offered.
Continuing Professional Development – CPD
The members are required to do 30 hours of CPD per year.
VAT
There is no VAT on osteopathic consultations in Switzerland.
Insurance
Osteopathic treatments are covered by private insurance companies.
Regulation in the United Kingdom
Based on information received by the national osteopathy association,
Institute of Osteopathy, iO.
Country Population, Numbers of Osteopaths & National Association
The United Kingdom (UK) has a population of 68 million, and 5,500 registered osteopaths.
Some two thirds are members of the sole professional association, the Institute of
Osteopathy (iO). There are a number of specialist groups that focus on specific aspects
within the osteopathic profession in the UK, as well as over 30 regional groups who meet
for Continuing Professional Development (CPD), which is mandatory.
Beside the practicing osteopaths there are about 1,100 osteopathy students in total in the
UK, and about 900 of them are student members of the iO.
Regulation, Regulator & Links to Official Documents Related to Regulation
Osteopathy has been regulated in the UK under the Osteopaths’ Act, since 1993, and the
profession is officially considered as a Healthcare Profession by the same National Law
and the title ‘Osteopath’ and related terms are protected.
The official register of osteopaths is operated by the UK regulator, the General
Osteopathic Council, (GOsC).
www.osteopathy.org.uk.
The Osteopaths’ Act and many other regulatory documents are freely available on the
GOsC website www.osteopathy.org.uk. The iO is focussed on developing osteopaths as a
mainstream health profession, in particular by establishing a close working relationship
with the National Health Service. In 2017 the iO was recognised as the representative
body for osteopaths by the NHS, and osteopaths have been recognised in England as
Allied Health Professionals. We have many documents we can share around building
recognition with the health system and other health professions.
First Contact Healthcare Profession & Standards for Practise
The osteopathic profession is a first contact health profession in the UK, with no
restrictions to scope of practice. Patients can self-refer. Both the iO and GOsC
contributed to the formulation of the Comité Européen de Normalisation (CEN), the
European standard for osteopathic practice and training, and UK educations standards
are consistent with the CEN standard.
Osteopaths in the UK work mainly in private practice, but they do also fulfill a variety
of roles, from first contact to specialist secondary care, up to consultant and senior
management levels, in the National Health Service. Since 2017 NHS England has
recognised osteopaths as Allied Health Professionals, and actively encouraged the
profession to engage in health service transformation, and most recently in COVID-19
crisis teams.
If you need further information, please contact:
Secrétariat Général de la Fédération Suisse de l’Ostéopathie (SuisseOsteo)
[email protected]
www.suisseosteo.ch
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Educational Levels & Programmes
Students can study osteopathy either as a part-time or fulltime qualification. The
minimum degree level for osteopaths in UK is a Bachelors degree although over 90% of
students are on an integrated Masters level programme at present (MOst).
All educational programmes in the UK are validated or offered directly by accredited
universities, and quality assessed by the regulator and by the Office for Students.
Continuing Professional Development – CPD
Continuing Professional Development (CPD) is mandatory to practise osteopathy in the
UK. CPD requirements are specified by the regulator, and are generally 30 hours study
per year on average, with a particular focus on addressing key osteopathic practice
standards.
VAT
No VAT is charged.
Insurance
Osteopathic treatments are covered by all insurance Companies, but coverage varies
depending on type of scheme.
Appendix 1
Danish law on regulation
Executive Order on the Authorisation of Osteopaths
Pursuant to section 2(2), section 3(1) and section 70b(4) of the Act on the Authorisation of
Health Professionals and on Health Professions, cf. Consolidated Act no. 990 of 18 August
2017, as amended by Act no. 727 of 8 June 2018, the following is laid down by order: (A
certified translation to English)
www.retsinformation.dk/eli/lta/2018/981
Purpose
Section 1.
The purpose of the Executive Order is to describe the conditions to be met to
obtain authorisation as an osteopath.
Section 2.
Only persons who have been granted authorisation as an osteopath have
the right to use the title ‘osteopath’, cf. section 70b (2) of the Act on the Authorisation of
Health Professionals and on Health Professions.
Persons covered
If you need further information, please contact:
Maurice Cheng
Chief Executive Institute of Osteopathy, iO
[email protected]
Section 3.
This Executive Order covers persons who apply for a Danish authorisation as
an osteopath (the applicant) and who are:
(i)
Trained in osteopathy in Denmark.
(ii) EU/EEA nationals trained in osteopathy in an EU/EEA country other than Denmark.
(iii) EU/EEA nationals trained in osteopathy in a non-EU/EEA country, and whose diploma
is recognised in another EU/EEA country and who can demonstrate at least three
years’ professional experience as an osteopath in the EU/EEA country concerned.
(iv) EU/EEA nationals trained in osteopathy in a non- EU/EEA country, but who are not
covered by para (iii).
(v) Non-EU/EEA nationals trained in osteopathy in an EU/EEA country other than
Denmark or in a non-EU/EEA country.
Conditions for obtaining an authorisation as an osteopath
Section 4.
On application, the Danish Patient Safety Authority grants authorisation as
an osteopath to the persons referred to in section 3(1), para i), when the Danish Patient
Safety Authority assesses that the applicant complies with the requirements of sections
7-9.
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Section 5.
(1) On application, the Danish Patient Safety Authority grants authorisation as an
osteopath to the persons referred to in section 3(1), paras (ii) and (iii), when the
Danish Patient Safety Authority assesses that the applicant complies with all
requirements of the Executive Order on access for EU and EEA citizens to practice
as an authorised healthcare professional. In assessing the applicant’s training, the
requirements for training in osteopathy laid down in sections 7-9 apply.
(2) No aptitude test under the Executive Order mentioned in subsection (1) is
conducted, as there is no publicly regulated training in osteopathy in Denmark.
Section 6.
On application, the Danish Patient Safety Authority grants authorisation as an
osteopath to the persons referred to in section 3(1), paras iv) and v), when the Danish
Patient Safety Authority assesses that the applicant complies with all requirements of
the Executive Order on the authorisation of certain healthcare professionals who are
nationals of and/or trained in non-EU/EEA countries. In assessing the applicant’s training,
the requirements for training in osteopathy laid down in sections 7-9 apply.
Level of training
Section 7.
(1) The applicant must have completed healthcare training in osteopathy corresponding
to the level of a professional bachelor’s degree.
(2) A professional bachelor’s degree level means:
(i)
A training programme of three and generally four years’ duration as full-time
training, consisting of theory and practice and forming an independent training
course, cf. section 5(1) of the Act on vocational academy programmes and
professional bachelor programmes.
Duration of the training programme
Section 8.
(1) The training programme completed by the applicant, cf. section 7, must contain
a minimum of 4,200 hours of instruction in the academic elements and with the
weighting mentioned in Annex 1.
(2) For applicants with the level of training mentioned in section 7(4), the hour
requirement in subsection (1) is met by an overall assessment of the healthcare
training at a level corresponding to the professional bachelor level and the
superstructure in osteopathy.
Section 9.
(1) The applicant must have completed at least 1,000 hours of clinical practice (clinical
training).
(2) Clinical training means that part of the training programme where the student is in
direct contact with healthy or sick individuals or groups of people and learns to plan,
provide and assess overall osteopathic treatment; but see subsection (4).
(3) Clinical training must be provided under the supervision and guidance of an
osteopath.
(4) Selected elements of the clinical training may to a limited extent and, for example,
in preparation for patient contact be organised in a skills laboratory or simulation
laboratory, but cannot replace direct patient contact in the clinical department or
institution.
Advisory Forum
Section 10.
The Danish Patient Safety Authority sets up an advisory forum for the
authorisation of osteopaths, the purpose of which is to advise the Danish Patient Safety
Authority as needed in matters relating to:
1.
(i) the assessment of whether the applicant’s training meets the substantive
requirements;
(ii) the assessment of foreign education and training; and
(ii) A post-secondary education programme of at least three and not more than four
years’ duration or of an equivalent duration on a part-time basis, which may also be
expressed as an equivalent number of ECTS points, at a university or establishment
of higher education or another establishment providing the same level of training
as well as the professional training which may be required in addition to that
post-secondary course, cf. the Executive Order on access for EU and EEA citizens
to practice as authorised healthcare professionals, cf. Article 11 (d) of Directive
2005/36/EC of the European Parliament and of the Council of 7 September 2005 on
the recognition of professional qualifications.
(3) A professional bachelor’s degree programme may be organised as an independent
superstructure of education based on a vocational academy programme, cf. section
6(1) of the Act on vocational academy programmes and professional bachelor
programmes.
(4) Notwithstanding subsection (1), the applicant can meet the requirements for the
level of training by having completed training in osteopathy as a superstructure
of another healthcare training programme at a level equivalent to a professional
bachelor’s degree or another healthcare-related middle-range training programme
supplemented by theory and methods of science at diploma level or equivalent.
2.
(iii) the need to adapt the contents of Annex 1.
Section 11.
(1) The Advisory Forum consists of no less than six nor more than eight members
appointed by the Danish Patient Safety Authority for a term of four years with the
possibility of reappointment.
(2) The Advisory Forum consists of members appointed by professional organisations,
associations, relevant authorities and possibly employers and educational
institutions.
(3) The Danish Patient Safety Authority draws up terms of reference for the Advisory
Forum. The terms of reference and membership composition are published on the
Danish Patient Safety Authority’s website.
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Entry into force and transitional provisions
Section 12.
This Executive Order enters into force on 1 July 2018.
Section 13.
For applicants who have started training in osteopathy on or before 1
July 2018, the superstructure mentioned in section 7(4) may be completed before or
concurrently with another healthcare training programme at a level equivalent to the
level of professional bachelor.
Section 14.
For applicants who already perform osteopathic treatment in Denmark
on 1 July 2018, supervised clinical training completed in connection with another
healthcare training programme equivalent to a professional bachelor’s degree or another
healthcare-related middle-range training programme may be taken into account when
assessing whether the condition in section 9(1) is met, if the clinical training was aimed at
manual treatment techniques.
Danish Patient Safety Authority, 28 June 2018
Anne-Marie Vangsted / Birgitte Drewes
Appendix 2
French law on regulation
Links to the National Law
2002
Loi 2002-303 du 4 mars 2002 (article 75)
2007
Arrêté du 25 mars 2007 (dossier DRASS et épreuves d’aptitude)
Décret 2007-435 du 25 mars 2007 (actes et exercice)
2007-2011
Décret 2011-1120 du 19 septembre 2011 prorogeant les agréments des établissements
de formation
Décret 2007-435 version consolidée du 1er avril 2010
Décret 2010-344 du 31 mars 2010 tirant les conséquences de la loi HPST
Loi HPST modifications des textes concernant l’ostéopathie
Loi 2009-879 du 21 juillet 2009 (Loi HPST – Bachelot)
Décret 2008-1441 du 22 décembre 2008 (modifiant le décret 2007-435)
Décret 2007-1564 du 2 nov 2007 (modifiant le décret 2007-435)
Arrêté du 25 mars 2007 (formation & commission agrément écoles)
Décret 2007-437 du 25 mars 2007 (formation & agrément écoles)
2014
Durant une vingtaine de mois, les travaux au sein du ministère de la santé avec la
participation des organisations socio-professionnelles représentatives de la profession
ont permis de redéfinir la profession d’ostéopathe et sa formation.
Référentiel activités et compétences
Référentiel de formation
Un nouveau cadre réglementaire pour une formation officielle dès la rentrée 2015
•
Décret 2014-1043 du 12 septembre 2014 Agrément des établissements de formation
en ostéopathie
•
•
Arrêté du 12 décembre 2014 Formation en ostéopathie
Arrêté du 12 décembre 2014 Dispenses d’enseignement susceptibles d’être
accordées
2016
La fin du secret médical
Décret 2016-994 du 20 juillet 2016 du CSP aux conditions d’échange et de partage
d’informations entre professionnels de santé et autres professionnels des champs social
et médico-social et à l’accès aux informations de santé à caractère personnel.
Article L1110-4 du CSP
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2020
Les écoles doivent représenter un dossier d’agrément tous les 5 ans.
Décret n° 2020-518 du 4 mai 2020 modifiant le décret n° 2018-90 du 13 février 2018
relatif à l’agrément des établissements de formation en chiropraxie et portant fusion de
commissions administratives à caractère consultatif
Recognition & Standards for Practice
The osteopathic profession is regulated in France and patients can self-refer. However,
osteopathy is recognised as an alternative practice to traditional medicine by the general
public and the media, less by standard health bodies which still have many difficulties in
integrating osteopathy into the course of care of patients.
There are some restrictions to scope of practice as defined in Décret 2007-435 du 25
mars 2007 (actes et exercice)
Les praticiens justifiant d’un titre d’ostéopathe sont autorisés à pratiquer des
manipulations ayant pour seul but de prévenir ou de remédier à des troubles
fonctionnels du corps humain, à l’exclusion des pathologies organiques qui nécessitent
une intervention thérapeutique, médicale, chirurgicale, médicamenteuse ou par agents
physiques. Ces manipulations sont musculo-squelettiques et myo-fasciales, exclusivement
manuelles et externes. Ils ne peuvent agir lorsqu’il existe des symptômes justifiant des
examens paracliniques.
Pour la prise en charge de ces troubles fonctionnels, l’ostéopathe effectue des actes de
manipulations et mobilisations non instrumentales, directes et indirectes, non forcées,
dans le respect des recommandations de bonnes pratiques établies par la Haute Autorité
de santé.
Art. 2. − Les praticiens mentionnés à l’article 1er sont tenus, s’ils n’ont pas eux-mêmes
la qualité de médecin, d’orienter le patient vers un médecin lorsque les symptômes
nécessitent un diagnostic ou un traitement médical, lorsqu’il est constaté une persistance
ou une aggravation de ces symptômes ou que les troubles présentés excèdent son champ
de compétences.
Art. 3. − I. − Le praticien justifiant d’un titre d’ostéopathe ne peut effectuer les actes
suivants :
1° Manipulations gynéco-obstétricales ;
2° Touchers pelviens.
II. − Après un diagnostic établi par un médecin attestant l’absence de contre-indication
médicale à l’ostéopathie, le praticien justifiant d’un titre d’ostéopathe est habilité à
effectuer les actes suivants :
1° Manipulations du crâne, de la face et du rachis chez le nourrisson de moins de six mois;
2° Manipulations du rachis cervical.
Educational Levels & Programmes
Official list of approved establishments - Government website:
•
Liste des établissements agréés au 1er septembre 2015 pour 5 ans (Téléchargement)
•
Liste des établissements ayant obtenu un agrément provisoire à la rentrée de 2015
(Téléchargement)
•
Liste des établissements agréés au 1er septembre 2016 pour 5 ans (Téléchargement)
•
Liste des établissements agréés en 2015 et ayant obtenu une augmentation
(Téléchargement)
•
•
•
Décret n° 2014-1505 du 12 décembre 2014 Formation en ostéopathie
Article 4
La formation se décompose en unités d’enseignement dans les domaines suivants :
1° Sciences fondamentales ;
2° Sémiologie des altérations de l’état de santé ;
3° Sciences humaines, sciences sociales, gestion et droit ;
4° Ostéopathie : fondements et modèles ;
5° Pratique ostéopathique ;
6° Méthodes et outils de travail ;
7° Développement des compétences de l’ostéopathe.
La maquette de formation, le référentiel de formation incluant les unités d’enseignement
et la formation pratique clinique ainsi que leur contenu sont définis par arrêté conjoint
des ministres chargés de l’enseignement supérieur et de la santé.
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Appendix 3
Portuguese law on regulation
Regulation, Regulator & Links to Official Documents Related to Regulation
Link to National Law:
Act 45/2003
Framework law for non-conventional therapies
https://dre.pt/pesquisa/-/search/656122/details/maximized
Regulated by Act 71/2013
https://dre.pt/web/guest/pesquisa/-/search/499569/details/normal?q=Lei+n.%C2%BA%20
71%2F2013
Also by Government Ordinance No.207-B/2014 (it regulates characterization and
functional content of the osteopathic profession)
https://dre.pt/web/guest/pesquisa/-/search/58217869/details/normal?q=Portaria+207-
%2F2014+de+8+de+outubro
And by Government Ordinance Nº. 172-E/2015 (it regulates the general requirements that
must be satisfied by the cycle of studies leading to a degree in Osteopathy)
https://dre.pt/web/guest/pesquisa/-/search/58217869/details/normal?q=Portaria+207-
%2F2014+de+8+de+outubro
Link to Regulator Body:
Administração Central do Sistema de Saúde, I.P. (ACSS, I.P.) – (Central Administration of
the Health System/Ministry of Health) - http://www.acss.min-saude.pt/
Link to the National Register:
Yes. Central Administration of the Health System, I.P. - http://www.acss.min-saude.pt/
Educational Levels & Programmes
Only Type I programs are offered in Portugal, at Higher Educational Institutions:
CESPU – ESCOLA SUPERIOR DE SAÚDE DO VALE DO AVE (Vila Nova de Famalicão)
ESCOLA SUPERIOR DE SAÚDE ATLÂNTICA (Oeiras)
ESCOLA SUPERIOR DE SAÚDE DA CRUZ VERMELHA PORTUGUESA (Lisboa)
ESCOLA SUPERIOR DE SAÚDE JEAN PIAGET DE VILA NOVA DE GAIA (Porto region)
ESCOLA SUPERIOR DE SAÚDE NORTE DA CRUZ VERMELHA PORTUGUESA (Oliveira de
Azemeis)
ESCOLA SUPERIOR DE SAÚDE RIBEIRO SANCHES (Lisboa)
ESCOLA SUPERIOR DE SAÚDE JEAN PIAGET DE SILVES (Algarve)
INSTITUTO POLITÉCNICO DO PORTO – ESCOLA SUPERIOR DE SAÚDE (Porto)
Only the above programs at the Higher Educational Institutions are allowed to offer
osteopathic education, and are accredited by the A3ES - Agência de Avaliação e
Acreditação do Ensino Superior (Higher Education Assessment and Accreditation Agency)
and by the Ministry of Science, Technology and Higher Education.
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The European Federation & Forum for Osteopathy promotes standards,
regulation and recognition for osteopaths in Europe.
www.effo.eu
Follow us on Social Media:
effo_eu
European Federation & Forum for Osteopathy