Keywords

Summary



Keywords

1. Freedom to provide services - Services - Definition - Medical service provided in one Member State and paid for by the patient - Included - Reimbursement applied for under another Member State's sickness insurance legislation which is essentially of the type which provides for benefits in kind - No effect

(EC Treaty, Art. 60 (now Art. 50 EC))

2. Freedom to provide services - Services - Definition - Medical treatment in hospital financed directly by the sickness insurance funds on the basis of agreements and pre-set scales of fees - Included

(EC Treaty, Art. 60 (now Art. 50 EC)

3. Freedom to provide services - Restrictions - National rules on reimbursement of medical costs incurred in another Member State - Treatment provided in a hospital - Requirement of prior authorisation from the insurance fund in the Member State in which the person concerned is insured - Grant subject to requirements that the treatment must be normal and necessary - Whether permissible - Conditions

(EC Treaty, Art. 59 (now, after amendment, Art. 49 EC) and Art. 60 (now Art. 50 EC))

Summary

1. A medical service provided in one Member State and paid for by the patient should not cease to fall within the scope of the freedom to provide services guaranteed by the Treaty merely because reimbursement of the costs of the treatment involved is applied for under another Member State's sickness insurance legislation which is essentially of the type which provides for benefits in kind.

( see para. 55 )

2. The fact that hospital medical treatment is financed directly by the sickness insurance funds on the basis of agreements and pre-set scales of fees is not such as to remove such treatment from the sphere of services within the meaning of Article 60 of the Treaty (now Article 50 EC).

First, it should be borne in mind that that provision does not require that the service be paid for by those for whom it is performed and, second, the payments made by the sickness insurance funds under the contractual arrangements between them and the providers of health treatment, albeit set at a flat rate, are indeed the consideration for the hospital services and unquestionably represent remuneration for the hospital which receives them and which is engaged in an activity of an economic character.

( see paras 56-58 )

3. Article 59 of the EC Treaty (now, after amendment, Article 49 EC) and Article 60 of the EC Treaty (now Article 50 EC) do not preclude legislation of a Member State which makes the assumption of the costs of treatment provided in a hospital located in another Member State subject to prior authorisation from the insured person's sickness insurance fund and the grant of such authorisation subject to the condition that (i) the treatment must be regarded as normal in the professional circles concerned, a criterion also applied in determining whether hospital treatment provided on national territory is covered, and (ii) the insured person's medical treatment must require that treatment. However, that applies only in so far as

- the requirement that the treatment must be regarded as normal is construed to the effect that authorisation cannot be refused on that ground where it appears that the treatment concerned is sufficiently tried and tested by international medical science, and

- authorisation can be refused on the ground of lack of medical necessity only if the same or equally effective treatment can be obtained without undue delay at an establishment having a contractual arrangement with the insured person's sickness insurance fund.

In those circumstances such conditions are justifiable in view of the need to maintain an adequate, balanced and permanent supply of hospital care on national territory and to ensure the financial stability of the sickness insurance system.

( see paras 97, 105, 108 and operative part )