État belge v Nathalie De Fruytier.
Date: 2015-07-02
16. It should be noted at the outset that, under the Sixth Directive, the scope of VAT is very wide in that Article 2 thereof, which concerns taxable transactions, refers not only to the importation of goods but also to the supply of goods or services effected for consideration within the territory of the Member State by a taxable person acting as such (see judgment in Verigen Transplantation Service International , C‑156/09, EU:C:2010:695, paragraph 21 and the case-law cited).
17. Article 13 of the Sixth Directive nevertheless exempts certain activities from VAT. It is settled case-law that the exemptions referred to in that article constitute independent concepts of EU law whose purpose is to avoid divergences in the application of the VAT system as between one Member State and another (see judgment in Verigen Transplantation Service International , C‑156/09, EU:C:2010:695, paragraph 22 and the case-law cited).
18. The settled case-law further shows that the terms used to specify the exemptions 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 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 inherent in the common system of VAT. Thus, the requirement of strict interpretation does not mean that the terms used to specify the exemptions referred to in Article 13 must be construed in such a way as to deprive the exemptions of their intended effect (see judgment in Verigen Transplantation Service International , C‑156/09, EU:C:2010:695, paragraph 23 and the case-law cited).
19. Medical services may fall within the scope of the exemptions provided for in Article 13(A)(1)(b) and (c) of the Sixth Directive. It is apparent from the case-law that Article 13(A)(1)(b) of the Sixth Directive covers all services supplied in a hospital environment while Article 13(A)(1)(c) thereof covers medical services provided outside such a framework, both at the private address of the person providing the care and at the patient’s home or at any other place (see, to that effect, judgments in Kügler , C‑141/00, EU:C:2002:473, paragraph 36, and CopyGene , C‑262/08, EU:C:2010:328, point 27).
20. So far as concerns, specifically, the concept of ‘medical care’ in Article 13(A)(1)(b) of the Sixth Directive and that of ‘the provision of medical care’ in Article 13(A)(1)(c) of that directive, the Court has already held on many occasions that both are intended to cover services that have as their aim the diagnosis, treatment and, in so far as possible, cure of diseases or health disorders (see judgment in Klinikum Dortmund , C‑366/12, EU:C:2014:143, paragraph 29 and the case-law cited).
21. It follows that medical services effected for the purpose of protecting, of maintaining or of restoring human health qualify for the exemption under Article 13(A)(1)(b) and (c) of the Sixth Directive. Therefore, although that provision has separate fields of application, it is intended to regulate all exemptions of medical services in the strict sense (see judgment in Klinikum Dortmund , C‑366/12, EU:C:2014:143, paragraphs 30 and 31 and the case-law cited).
22. 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 judgment in CopyGene , C‑262/08, EU:C:2010:328, paragraph 29 and the case-law cited).
23. In the present case, it must be held that an activity such as that at issue in the main proceedings, namely transporting human organs and samples of human origin for various hospitals and laboratories, clearly does not constitute ‘medical care’ or ‘the provision of medical care’ within the meaning of Article 13(A)(1)(b) and (c) of the Sixth Directive, since it is not covered by m edical services which have as their direct purpose the actual diagnosis, treatment or cure of diseases or health disorders, or the actual protection, maintenance or restoration of health (see, to that effect, the judgment in Future Health Technologies , C‑86/09, EU:C:2010:334, paragraph 43).
24. Furthermore, the Court has already held that, unlike the wording of Article 13(A)(1)(b) of the Sixth Directive, the wording of Article 13(A)(1)(c) thereof does not contain any reference to activities closely linked to the provision of medical care, despite the fact that Article 13(A)(1)(c) immediately follows Article 13A(1)(b). Consequently, the Court has concluded that the concept of activities closely related to the provision of medical care is not relevant to the interpretation of Article 13(A)(1)(c) of the Sixth Directive (see, to that effect, judgment in Klinikum Dortmund , C‑366/12, EU:C:2014:143, paragraph 32).
28. The Court has already held that the concept of activities ‘closely related’ to ‘hospital or medical care’ within the meaning of Article 13(A)(1)(b) of the Sixth Directive is to be interpreted as not covering activities such as the collection and transport of blood where the medical care provided in a hospital environment to which those activities are merely potentially related has not been performed, commenced or yet envisaged (see judgment in Future Health Technologies , C‑86/09, EU:C:2010:334, paragraph 49). Therefore, transportation of samples of human origin cannot be characterised as an activity ‘closely related’ to ‘hospital or medical care’.
29. The Court has held, as regards medical services, that, in view of the objective pursued by the exemption provided for in Article 13(A)(1)(b) of the Sixth Directive, it follows that only the supply of services which are logically part of the provision of hospital and medical-care services, and which constitute an indispensable stage in the process of the supply of those services to achieve their therapeutic objectives, is capable of amounting to ‘closely related activities’ within the meaning of that provision, given that only such services are of a nature to influence the cost of health care which is made accessible to individuals by the exemption in question (see judgment in Ygeia , C‑394/04 and C‑395/04, EU:C:2005:734, paragraph 25).
35. It is apparent from the case-law relating to the characterisation of an operator as ‘of a similar nature’ to a hospital or a centre for medical treatment or diagnosis within the meaning of Article 13(A)(1)(b) of the Sixth Directive that, in particular, the concept of ‘establishment’ suggests the existence of an individualised entity performing a particular function (see judgment in Gregg , C‑216/97, EU:C:1999:390, paragraph 18). The Court has also held that a laboratory governed by private law and undertaking diagnostic medical tests must be regarded as being an establishment ‘of a similar nature’ to ‘hospitals’ and ‘centres for medical treatment or diagnosis’ within the meaning of that provision since diagnostic medical tests, in the light of their therapeutic purpose, come within the concept of ‘medical care’ as referred to in that provision (see judgments in L.u.P. , C‑106/05, EU:C:2006:380, paragraphs 18 and 35, and CopyGene , C‑262/08, EU:C:2010:328, paragraph 60).
37. Contrary to what Ms De Fruytier contends, the principle of fiscal neutrality cannot alter that conclusion. As the Court has already held, that principle cannot extend the scope of an exemption in the absence of clear wording to that effect, given that the principle in question is not a rule of primary law which can condition the validity of an exemption, but a principle of interpretation to be applied concurrently with the principle of strict interpretation of exemptions (see the judgment in Klinikum Dortmund , C‑366/12, EU:C:2014:143, paragraph 40 and the case-law cited).