natgillin/translations-raw huggingface dataset:
Hver kommune betalte derefter sin del af dette særlige tilskud, normalt primo det følgende år, på grundlag af hospitalets skøn over underskuddet (f.eks. primo 2015 for regnskabsåret 2014).
The extensive social services obligation therefore represents a significant burden for the IRIS-H which the private Brussels hospitals do not have to bear.
Underskuddet ansættes på grundlag af revisionen af hospitalet og det forventede resultat af årets ni første måneder.
Conclusion on the extensive social services obligation of the IRIS-H
Inden seks måneder efter afslutningen af regnskabsåret (med andre ord før udgangen af juni måned) godkender generalforsamlingen for hvert IRIS-hospital hospitalets regnskaber og vedtager det endelige regnskabsmæssige underskud.
On the basis of the foregoing, the Commission concludes that unlike the Brussels private hospitals, the IRIS-H have the obligation to operate elaborate social services departments who help patients and their families in resolving and managing administrative, financial, relationship and social problems.
Det regnskabsmæssige underskud, der er tilbage efter betaling af andelen af det særlige tilskud, afvikles, efterhånden som der er disponible midler i kommunernes kassebeholdning.
This obligation is defined in and entrusted to the IRIS-H by the IRIS strategic plans.
Afviklingsprocessen kan tage flere år yderligere, og i løbet af hele den omhandlede periode (1996-2014) har IRIS-hospitalerne konstant ventet på betalinger fra kommunerne (se de nærmere detaljer om de udestående betalinger i tabellen i betragtning 234).
The existence of this extensive social services obligation is reflected by the large number of social workers employed by the IRIS-H going far beyond what is applicable to other Belgian hospitals.
Tabel 2
The tasks of the IRIS-H's social services departments include taking care of the aforementioned difficulties of patients not only during their stay but also when leaving the hospital, helping the patients to obtain social security cover enabling them to meet their medical costs, preparing social inquiries and exchanging information with the other hospital departments and also with the CPAS.
Betalinger (finansieret gennem de særlige tilskud) fra kommunerne til IRIS-hospitalerne
This obligation and its burden are closely linked to the other obligations that constitute the social healthcare SGEI (see recital 167).
HIS
Indeed, it is because the IRIS-H have the obligation to treat all patients in all circumstances and regardless of their ability to pay that there is a greater demand for social workers.
I alt
It is precisely poor patients and their families who need additional social services and for whom a social inquiry has to be prepared.
Regnskabsmæssigt set har andelen af det særlige tilskud i visse år været indregnet direkte i hospitalets resultat (hvorved det reducerer det resterende underskud), mens beløbet i andre ord er bogført som underskudsdækning (med andre ord efter årets resultat).
Furthermore, it is also because the IRIS-H have the obligation to maintain multiple sites that the number of social workers is higher than what can be reasonably expected (i.e. one social worker for every 2000 admissions, see recital 213).
Endvidere havde CHU Saint-Pierre en forsinkelse i regnskabsaflæggelsen i 2004, således at hospitalets andel af det særlige tilskud først blev registreret i regnskaberne året efter.
Conclusion on the additional obligations
Tabel 3-7 nedenfor viser for hvert af de fem IRIS-hospitaler det regnskabsmæssige underskud, der er registreret hvert år (disse underskud udgør tilsammen næsten 250 mio. EUR i perioden 1996-2014) og de betalinger, der hvert år er foretaget af kommunerne (disse betalinger kan vedrøre underskud fra tidligere år).
No such additional obligations apply to the Brussels private hospitals who are only entrusted with the basic hospital mission defined by the LCH.
Tabel 3-7 viser datoerne (dvs. årene) for, hvornår kommunerne foretog de betalinger, der skulle dække underskuddene på de forskellige IRIS-hospitaler, men de viser ikke de år, som betalingerne vedrører [272].
The social healthcare SGEI is therefore only provided by the IRIS-H as only they are entrusted with more stringent and far reaching obligations on top of the minimum requirements (i.e. the basic hospital mission) that apply to all hospitals in Belgium under the LCH.
Disse tabeller viser også akkumuleringen af underskud i løbet af perioden 1996-2002 og forsinkelsen i betalingerne fra kommunerne.
The performance of this social healthcare SGEI entails significant costs for the IRIS-H that are not or only partially covered by the financing sources common to both public and private hospitals, and as a result lead to the deficits reported by the IRIS-H.
Endvidere fremgår det klart, at de forskellige berørte kommuner i perioden 1996-2014 permanent skyldte IRIS-hospitalerne store beløb i underskudsdækning.
In order to ensure the continuity of their public hospitals, the respective Brussels CPAS and municipalities therefore compensate the deficits of the IRIS-H as described in Sections 7.3.4.4 and 7.3.5.
Restgælden ved udgangen af 2014 oversteg samlet set 15 mio. EUR for de fem IRIS-hospitaler.
The undertaking entrusted and, where applicable, the territory concerned
I denne forbindelse skal det understreges, at når IRIS-hospitalerne genererer et overskud, udloddes det ikke, men bruges til at dække tidligere eller kommende underskud og reducerer dermed kommunernes bidrag.
Each individual IRIS-H has its own bylaws which specify their objective and the IRIS strategic plans apply to each of the five IRIS-H.
Endelig fremgår det også klart af disse tabeller, at der, som de belgiske myndigheder hævder (se betragtning 89), og i modsætning til, hvad klagerne påstår, ikke findes en forskudsordning (se betragtning 55).
In addition, like all Belgian hospitals, the IRIS-H have received an individual authorisation which they need in order to be eligible for the other types of public financing (such as the BMF).
Kommunernes betalinger foretages nemlig med en betydelig forsinkelse i forhold til det tidspunkt, hvor underskuddet er registreret, og hvor pligten i henhold til artikel 46 i IRIS-hospitalernes vedtægter træder i kraft.
These entrustment acts do not specify a territory for the performance of their SGEI.
Derfor kan datoen for betalingen af underskudsdækningen vedrørende udførelsen af tjenesteydelsen af almindelig økonomisk interesse og de forbundne aktiviteter ikke anses for at give IRIS-hospitalerne en fordel.
Exclusive or special rights
Tabel 3
The IRIS-H are not entrusted with any exclusive or special rights.
Dato for betaling af underskudsdækning og restgæld for CHU Saint-Pierre
The compensation mechanism
Regnskabsmæssigt underskud
The deficit compensation mechanism is described in Article 46 of the bylaws of each of the five IRIS-H.
Betaling fra kommunen
This article currently reads as follows (see also footnote 48):
Restgæld
‘Without prejudice to Article 109 [LCH], the result of the financial year shall be allocated between partners holding at least one fifth of the votes in the General Assembly by decision of the General Assembly.’
Tabel 4
It is clear from Article 46 of the IRIS-H bylaws that:
Dato for betaling af underskudsdækning og restgæld for CHU Brugmann [273]
This deficit compensation is without prejudice to the mechanism foreseen by Article 109 LCH (now Article 125 of the LCH in the version of the Law of 10 July 2008) which requires that municipalities cover the deficit of their public hospital with the exclusion of certain activities [261].
Tabel 5
However, as will be explained below (see recital 235), the Article 109 deficit compensation has no real impact in this case since upon reception, the IRIS-H immediately fully repay these amounts to the municipality.The result to be covered is that which is reported in the hospital accounts (i.e. it concerns the accounting deficit of the hospital as a whole and hence also includes the result of the ancillary activities of the IRIS-H, see also recital 41).
Dato for betaling af underskudsdækning og restgæld for HUDERF
Unlike Article 109 LCH, Article 46 of the IRIS-H bylaws does not exclude certain activities from the deficit.
Tabel 6
However, it is also clear that the compensation cannot go beyond the accounting deficit as the compensation is limited to the result of the financial year.
Dato for betaling af underskudsdækning og restgæld (i EUR) for Institut Bordet
Only partners that have at least one fifth of the votes in the General Assembly are required to contribute to cover the deficit.
Tabel 7
In practice, this means that only the municipalities and the CPAS have to contribute [262].(220) On the basis of the fact that the IRIS-H only perform SGEI and ancillary activities, Article 46 of the bylaws of each IRIS-H establishes a clear compensation mechanism by indicating that the result of the financial year (without any exceptions) has to be covered.
Dato for betaling af underskudsdækning og restgæld (i EUR) for HIS [274]
This result is determined on the basis of a clear set of accounting principles that apply equally to both public and private Belgian hospitals.
I praksis er underskudsdækningen i henhold til artikel 46 i IRIS-hospitalernes vedtægter vigtigere end underskudsdækningen i henhold til artikel 109 i LCH.
Furthermore, each hospital is required (on the basis of Articles 80-85 LCH) to appoint an independent auditor who checks their accounts and results (see recital 49).
Efter at det føderale sundhedsministerium har fastsat underskuddet i henhold til artikel 109 i LCH (se betragtning 47), sendes der nemlig et brev til kommunen, og dens bank får besked på straks at overføre beløbet til det pågældende hospital under hensyntagen til eventuelle kompensationsbeløb, der allerede er overført af kommunen til dette hospital i henhold til artikel 46 i dettes vedtægter.
By requiring that the entire deficit of the IRIS-H is covered, Article 46 of the bylaws goes beyond the minimum requirement foreseen by Article 109 LCH.
Endvidere har kommunerne og IRIS-hospitalerne aftalt, at hospitalerne straks refunderer kommunerne disse beløb, som udbetales til dem i medfør af artikel 109 i LCH, for at undgå enhver dobbeltdækning af det samme underskud.
The reason for this full deficit cover for the performance of SGEI and ancillary activities [263] is that the Brussels local authorities want to guarantee the continuity and viability of the IRIS-H (see recital 91) at all times.
I denne forbindelse har Kommissionen fra Belfius, kommunernes bank, modtaget et brev og en tabel, som bekræfter, at disse refusioner hvert år og for alle de fem IRIS-hospitalers vedkommende er sket straks, hvilket udelukker dobbeltdækning af underskuddet.
Article 46 is also consistent with Article 61 of the Loi CPAS which reads:
Tabel 8 nedenfor giver en fuldstændig oversigt over alle de beløb til dækning af »underskuddet i henhold til artikel 109 i LCH«, som kommunerne har betalt til IRIS-hospitalerne, og som umiddelbart derefter blev refunderet, således at disse transaktioner blev udlignet.
‘The CPAS can rely upon the cooperation with persons, facilities or services, which, established either by public authorities or by private initiative, will be able to use the means to achieve the various solutions that present themselves, while respecting the free choice of the person concerned.
Derfor fik IRIS-hospitalerne ingen fordel af disse betalinger i henhold til artikel 109 i LCH, og kun underskudsdækningen i henhold til artikel 46 i IRIS-hospitalernes vedtægter har betydning for fortsættelsen af vurderingen i forbindelse med nærværende afgørelse.
The CPAS can bear the potential costs of this cooperation when these are not covered by the implementation of another law, regulation, agreement or a judicial decision.’
Tabel 8 omfatter kun betalinger indtil regnskabsåret 2006, da det er det seneste år, hvor underskuddet i henhold til artikel 109 i LCH blev fastsat af SPF Santé publique.
Finally, as explained above (see recitals 22 and 44) municipalities are required to cover the deficit of their CPAS.
Dette illustrerer den betydelige forsinkelse, der i praksis har kendetegnet betalingen af underskudsdækningen i henhold til den mekanisme, der er fastlagt i artikel 109 i LCH, og det forklarer også, hvorfor IRIS-hospitalerne ikke har brugt den (men refunderet den straks efter at have modtaget den).
As a result, it is the municipality that has the ultimate responsibility to cover the entire deficit of its public hospital.
Dækningen i henhold til artikel 46 i IRIS-hospitalernes vedtægter er nemlig en hurtigere mekanisme (navnlig siden indførelsen af særlige tilskud til kommunerne, se betragtning 232) end den ifølge artikel 109 i LCH.
Arrangements in place for avoiding and recovering any overcompensation
I øvrigt rækker underskudsdækningsordningen i artikel 46 i IRIS-hospitalernes vedtægter ud over den delvise dækning af underskuddet, der er fastlagt i artikel 109 i LCH (se betragtning 47 og 48), eftersom den fuldt ud kompenserer for det regnskabsmæssige underskud, som IRIS-hospitalerne registrerer.
As will be explained below, the deficit compensation mechanism operates in such a way that the risk of overcompensation at all occurring is already very limited in the first place (see recital 247).
Af alle disse grunde omhandler vurderingen i forbindelse med nærværende afgørelse kun overskudsdækningsordningen i artikel 46 og ikke den, der er fastlagt i artikel 109 i LCH, i modsætning til Kommissionens beslutning af 2009, som blev annulleret, og som indeholdt en vurdering af mekanismen ifølge artikel 109 i LCH.
In addition, the Law of 14 November 1983 (see recitals 248-250) and the Loi CPAS (see recitals 251-252) provide the municipalities with the necessary legal means to control for overcompensation and to recover overcompensation, if any.
Tabel 8
Reference to the 2012 SGEI Decision
Fuldstændig oversigt over alle de beløb til dækning af underskuddet i henhold til artikel 109 i LCH [275], som blev overført og straks efter refunderet (status pr. 9. november 2015)
Article 4(f) of the 2012 SGEI Decision requires that the entrustment act includes a reference to that Decision.
0(236) Kommissionen har ligeledes vurderet, om IRIS-hospitalerne faktisk havde fået en overkompensation i løbet af perioden 1996-2014 [276].
Article 10(a) of the 2012 SGEI Decision foresees a transition period of two years for aid schemes that were put into effect before 31 January 2012 and that were compatible under the 2005 SGEI Decision.
På grund af fusionerne, der skete den 1. juli 1999 (se også betragtning 28), og den lange periode, som er forløbet siden da, kan analysen af overkompensationen ikke omfatte årene 1996-1998 for CHU Brugmann, for de pågældende arkiver har ikke kunnet findes frem.
For this reason, in the case at hand, a reference to the 2012 SGEI Decision was only introduced in 2014.
Af de samme grunde kan denne analyse kun foretages samlet for 1996-1998 for HIS' vedkommende.
In particular, from 2014 onwards each decision of the respective Brussels communes to make a payment to the IRIS-H on the basis of Article 46 of the IRIS-H bylaws also refers to the 2012 SGEI Decision.
I denne forbindelse skal det også understreges, at de belgiske myndigheder har leveret alle relevante regnskabsoplysninger for IRIS-hospitalerne og data for betalingerne af underskudsdækningen fra kommunerne, såfremt disse tal har været tilgængelige.
In addition, it should be noted that a reference to the 2012 SGEI Decision has been added in Article 108 of the current version of the LCH by means of the Law of 10 April 2014 [264].
Indtil SGEI-beslutningen af 2005 trådte i kraft den 19. december 2005, var medlemsstaterne da også kun forpligtet til at stille oplysninger til rådighed for Kommissionen i fem år [277] (i stedet for ti år i henhold til SGEI-beslutningen af 2005 og SGEI-afgørelsen af 2012 [278]).
More specifically, this article requires that each decision letter regarding the BMF-amount that is to be awarded to a hospital, contain an explicit reference to the 2012 SGEI Decision.
I denne forbindelse minder Kommissionen om, at IRIS-hospitalerne kun har modtaget kompensation for de underskud, der er registreret på grund af udførelsen af tjenesteydelsen af almindelig økonomisk interesse og visse begrænsede forbundne aktiviteter.
The second key compatibility condition enshrined in the 2012 SGEI Decision is that the amount of compensation paid for the provision of the SGEI shall not exceed what is necessary to cover the net cost incurred in discharging the public service obligation, including a reasonable profit [265].
Tabel 9-13 nedenfor viser de relevante tal for hvert IRIS-hospital.
The 2012 SGEI Decision furthermore sets out how the net cost is to be calculated (including by defining the costs and revenues that can be taken into account), indicates how the reasonable profit must be determined, and requires that an undertaking carrying out activities falling both inside and outside the scope of the SGEI must keep separate internal accounts for the SGEI and other activities [266].
Det er imidlertid vigtigt at holde sig for øje, at disse tabeller ikke gør det muligt at se, hvornår kommunen (delvist) dækkede underskuddet.
In the case at hand, the IRIS-H only provide SGEI and the above described (see recitals 41 and 155) limited activities ancillary to these SGEI.
Det er nemlig i tabel 3-7 ovenfor (se betragtning 234), at årstallet anføres for, hvornår kommunerne overførte underskudsdækningsbeløb til IRIS-hospitalerne.
In performing all these activities (SGEI and limited ancillary activities), the IRIS-H incur costs which to a large extent [267] are covered by the various public and private financing sources described above (see recital 46).
Tabel 9-13 viser alene de beløb, der blev betalt til IRIS-hospitalerne af kommunerne (generelt i flere rater) til dækning af underskuddet et givet år, uden at angive tidspunktet for, hvornår de faktisk blev overført.
Nevertheless, as will be illustrated below (see Tables 3 to 7), in most years since 1996 the performance of these activities by the IRIS-H generated a deficit.
Selv om tabel 9-13 blev opstillet for at vise forekomsten af en eventuel overkompensation et givet år isoleret set, har intet IRIS-hospital som forklaret nedenfor (se betragtning 238) i praksis fået en reel overkompensation.
The Commission considers that these deficits are the residual net cost (i.e. the part of the net cost that has not been covered by the financing sources described in recital 46) of the SGEI and limited ancillary activities performed by the IRIS-H.
Som illustreret i følgende tabeller afdækker sammenligningen mellem det regnskabsmæssige underskud og den kompensation, der er betalt et givet år, kun nogle få tilfælde [279] af teknisk overkompensation, hvis man ser isoleret på det pågældende år.
By compensating these deficits, the municipalities cover no more than the residual net cost incurred by the IRIS-H in performing the SGEI and ancillary activities and do not even award a reasonable profit.
Det fremgår imidlertid klart af tabel 3-7 i betragtning 234, at intet IRIS-hospital i praksis nogensinde har modtaget en reel overkompensation, idet kommunerne i den omhandlede periode (1996-2014) permanent skyldte IRIS-hospitalerne store beløb i underskudsdækning.
Therefore, by its very definition, the compensation of deficits incurred by the IRIS-H should not and did not lead to actual overcompensation (see also recitals 234-245).
De tekniske overkompensationer kunne være motiveret af kommunens vilje et givet år til ikke alene at dække det regnskabsmæssige underskud det pågældende år, men også at indhente forsinkelsen i underskudsdækningen af de foregående år.
Pursuant to Article 77 LCH all hospitals are required to keep separate accounts which show the cost of each service.
Selv om denne motivation ikke kan bevises, er faktum, at det enkelte IRIS-hospital hvert af de år, hvor IRIS-hospitalerne modtog betalinger, som — hvis man ser isoleret på dette år — teknisk set ville svare til en overkompensation for tjenesteydelsen af almindelig økonomisk interesse og de begrænsede forbundne aktiviteter, hospitalet udførte det pågældende år, faktisk alt i alt modtog en utilstrækkelig kompensation for de samme tjenesteydelser af almindelig økonomisk interesse og begrænsede forbundne aktiviteter, som det udførte i løbet af de foregående og det omhandlede år [280].
The accounting principles applicable to both public and private hospitals are enacted by the Royal Decree of 19 June 2007 [268].
Som påvist ovenfor (se tabel 3 i betragtning 234) modtog CHU Saint-Pierre imidlertid i praksis konstant en utilstrækkelig kompensation i perioden 1996-2014, og kommunen skyldte det stadig penge.
Under that Royal Decree, non-hospital activities (i.e. in the case at hand the ancillary activities described above in recitals 41 and 155) are to be recorded separately (more specifically they are to be listed under account codes 900 to 999, see also recital 49).
I løbet af perioden 1996-2014 beløb denne underkompensation sig til i alt 3666541 EUR.
The Commission received attestations by the independent auditors of each of the IRIS-H confirming that the account separation is implemented in line with the requirements of Belgian law [269].
I overensstemmelse med den pligt, IRIS-hospitalerne er pålagt i medfør af artikel 46 i deres vedtægter, bør de berørte kommuner i imidlertid fremover kompensere for det resterende regnskabsmæssige underskud [282].
On this basis, the Commission concludes that the requirement under Article 5(9) of the 2012 SGEI Decision to have separate accounts is fulfilled.
Tabel 9
As explained above (see recital 44), on the basis of Article 46 of the bylaws of the IRIS-H, the Brussels municipalities and CPAS are obliged to cover the full accounting deficit of their hospitals.
Regnskabsmæssigt underskud og dækning tildelt CHU Saint-Pierre
This obligation which exists since the creation of the IRIS-H goes beyond the partial deficit compensation mechanism foreseen by Article 109 LCH (see recital 47).
Finansieret via FRBRTC eller regionens særlige tilskud [283]
Nevertheless, the compensation on the basis of Article 46 of the bylaws of the IRIS-H can never exceed the accounting deficit of the financial year.
Supplerende kommunale bidrag
Finally, Article 46, while creating a clear obligation to compensate the deficits, however does not specify explicitly at what point in time the municipalities and CPAS actually have to transfer the money [270].
Overkompensation(+) eller underkompensation(–) for året
Since there usually was insufficient money available, the municipalities tended to postpone the payment of the hospital deficit.
Overkompensation(+) eller underkompensation(–) i alt
In theory, they could keep postponing until the moment when the Federal Public Service for Public Health determined the Article 109 LCH deficit since this would then force the municipalities to pay (part) of the hospitals' deficits.
Som forklaret ovenfor (se betragtning 236) har analysen af, hvorvidt der forekommer overkompensation af HIS, ikke kunnet gennemføres for de enkelte år 1996-1998, da de nødvendige tal mangler.
However, there was a long delay (of up to 10 years) between the moment when the accounting deficit was known and when the Article 109 LCH deficit was calculated.
Det er ikke desto mindre lykkedes de belgiske myndigheder at finde frem til de samlede beløb for denne periode, hvor HIS endnu udgjordes af fire uafhængige hospitaler.
This meant that between 1996 and 2002, the IRIS-H accumulated enormous deficits (i.e. more than EUR 50 million).
I løbet af disse tre år havde nogle af HIS-hospitalerne tab på i alt 2622714 EUR, mens de øvrige havde et overskud på i alt 703624 EUR.
To cover this gap in their financing, the IRIS-H were forced to take up bank loans, the costs of which further increased their deficits.
Overskuddene blev fremført til det følgende år, hvilket forklarer, hvorfor kompensationen af det underskud, der blev registreret i 1999, kun delvist dækker dette.
Given the lack of sufficient financial resources at the municipal level, the Brussels Capital Region had to intervene to make this possible.