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

“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.