Peter d'Ambrumenil and Dispute Resolution Services Ltd v Commissioners of Customs & Excise.
Date: 2003-11-20
52. According to the Court ' s case-law, the exemptions envisaged in Article 13 of the Sixth Directive are to be interpreted strictly since they constitute exceptions to the general principle that VAT is to be levied on all services supplied for consideration by a taxable person (see, in particular,  SDC , cited above, paragraph 20, and Case C-141/00  Kügler  [2002] ECR I-6833, paragraph 28). Those exemptions constitute independent concepts of Community law whose purpose is to avoid divergences in the application of the VAT system from one Member State to another ( CPP , cited above, paragraph 15, and  Commission  v  France , cited above, paragraph 21).
54. Even if other services provided by doctors may share the characteristics of activities in the public interest, it follows from the Court ' s case-law that Article 13A of the Sixth Directive does not exempt from VAT every activity performed in the public interest, but only those which are listed and described in great detail (Case C-149/97  Institute of the Motor Industry  [1998] ECR I-7053, paragraph 18, and  D.  v  W. , paragraph 20).
57. In relation to the concept of   " provision of medical care" , the Court has already held in paragraph 18 of its judgment in  D.  v  W. , and restated in paragraph 38 of its judgment in  Kügler , cited above, that that concept does not lend itself to an interpretation which includes medical interventions carried out for a purpose other than that of diagnosing, treating and, in so far as possible, curing diseases or health disorders.
58. While it follows from that case-law that the   " provision of medical care"  must have a therapeutic aim, it does not necessarily follow therefrom that the therapeutic purpose of a service must be confined within an especially narrow compass (see, to that effect,  Commission  v  France , paragraph 23).  Paragraph 40 of the judgment in  Kügler  shows that medical services effected for prophylactic purposes may benefit from the exemption under Article 13A(1)(c).  Even in cases where it is clear that the persons who are the subject of examinations or other medical interventions of a prophylactic nature are not suffering from any disease or health disorder, the inclusion of those services within the meaning of   " provision of medical care"  is consistent with the objective of reducing the cost of health care, which is common to both the exemption under Article 13A(1)(b) and that under (c) of that paragraph (see  Commission  v  France , paragraph 23, and  Kügler , paragraph 29).
59. On the other hand, medical services effected for a purpose other than that of protecting, including maintaining or restoring, human health may not, according to the Court ' s case-law, benefit from the exemption under Article 13A(1)(c) of the Sixth Directive.  Having regard to their purpose, to make those services subject to VAT is not contrary to the objective of reducing the cost of health care and of making it more accessible to individuals.
67. By contrast, regular medical checks at the behest of certain employers and certain insurance companies may satisfy the conditions for exemption under Article 13A(1)(c), provided that such checks are intended principally to enable the prevention or detection of illness or the monitoring of the health of workers or insured persons.  The fact that such medical checks take place at a third party ' s request, and may also serve the employers ' or insurance companies ' own interests, does not preclude health protection being regarded as the principal aim of such checks.