Skatteverket v PCF Clinic AB.
Date: 2013-03-21
23. With respect to those points, it must be recalled from the outset that the terms used to specify the exemptions in Article 132 of the VAT Directive are to be interpreted strictly, since they constitute exceptions to the general principle that VAT is to be levied on all goods and services supplied for consideration by a taxable person. Nevertheless, the interpretation of those terms must be consistent with the objectives pursued by those exemptions and comply with the requirements of the principle of fiscal neutrality. Thus, the requirement of strict interpretation does not mean that the terms used to specify the exemptions referred to in Article 132 should be construed in such a way as to deprive the exemptions of their intended effect (see by analogy, in particular, Case C‑86/09 Future Health Technologies [2010] ECR I‑5215, paragraph 30 and the case-law cited).
24. As regards medical services, it is apparent, by analogy, from the case-law on Directive 77/388 that Article 132(1)(b) and (c) of the VAT Directive, which have distinct fields of application, are intended to regulate all exemptions of medical services in the strict sense (see Future Health Technologies , paragraphs 26, 27 and 36 and the case-law cited). Article 132(1)(b) of that directive covers all services supplied in a hospital environment while Article 132(1)(c) thereof covers medical services provided outside such a framework, at the private address of the person providing the care, at the patient’s home or at any other place (see, to that effect, Case C‑141/00 Kügler [2002] ECR I‑6833, paragraph 36, and Future Health Technologies , paragraph 36).
25. Accordingly, the concept of ‘medical care’ in Article 132(1)(b) of the VAT Directive and that of ‘the provision of medical care’ in Article 132(1)(c) are both intended to cover services that have as their purpose the diagnosis, treatment and, in so far as possible, cure of diseases or health disorders (see Future Health Technologies , paragraphs 37 and 38).
26. In that regard, it should be borne in mind that, whilst ‘medical care’ and ‘the provision of medical care’ must have a therapeutic aim, it does not necessarily follow that the therapeutic purpose of a service must be confined within a particularly narrow compass (see Future Health Technologies , paragraph 40 and the case-law cited).
27. Accordingly, it is clear from the case-law that medical services effected for the purpose of protecting, including maintaining or restoring, human health can benefit from the exemption under Article 132(1)(b) and (c) of the VAT Directive (see Future Health Technologies , paragraphs 41 and 42 and the case-law cited).
28.  It follows, in the context of the exemption laid down in Article 132(1)(b) and (c) of the VAT Directive, that the purpose of the services such as those at issue in the main proceedings is relevant in order to determine whether those services are exempt from VAT. That exemption is intended to apply to services whose purpose is for diagnosing, treating or curing diseases or health disorders or to protect, maintain or restore human health ( Future Health Technologies , paragraph 43).
33. As far as concerns whether the subjective understanding that the recipients of services, such as those at issue in the main proceedings, have must be taken into consideration in the assessment of the purpose of a specific intervention, which is the subject of the third question, it follows from the case-law that the health problems covered by exempt transactions under Article 132(1)(b) and (c) of the VAT Directive may be psychological (see to that effect, in particular, Case C‑45/01 Dornier  [2003] ECR I‑12911, paragraph 50, and Joined Cases C‑443/04 and C‑444/04 Solleveld and van den Hout-van Eijnsbergen  [2006] ECR I‑3617, paragraphs 16 and 24).
37. In order to give a complete answer to the questions referred, it must be recalled that, in order to determine whether services such as those at issue in the main proceedings are exempt from VAT, pursuant to Article 132(1)(b) or (c) of the VAT Directive, account must be taken of all the requirements laid down in Article 132(1)(b) or (c) and of the other relevant provisions of Title IX, Chapters 1 and 2 thereof (see by analogy, in particular, Case C‑262/08 CopyGene  [2010] ECR I‑5053, paragraph 37), and not simply of the issue of whether such services fall within the concepts of ‘medical care’ and ‘the provision of medical care’ within the meaning of Article 132(1)(b) and (c) of that directive.