natgillin/translations-raw huggingface dataset:
Klageren bemærker, at der tilsyneladende ikke skelnes mellem underskud, der skyldes de påståede specifikke opgaver, og dem, der hidrører fra omkostningerne ved den basale opgave.
In their view, there would be no difference between public hospitals and private hospitals with regard to the treatment of ‘social patients’, whether in an ‘emergency’ or ‘post emergency’ situation.
Endelig henviser CBI til en række udtalelser fra det belgiske finanstilsyn, som konkluderer, at det er umuligt at kontrollere anvendelsen af særlige tilskud tildelt på grundlag af bekendtgørelsen af 13. februar 2003, fordi denne bekendtgørelse ikke præciserer de opgaver af kommunal interesse, som tilskuddene bevilges til.
In this context, CBI refers to a judgment of the Brussels Court of First Instance [120] concerning urgent medical aid [121] for foreigners living illegally in Belgium (hereinafter ‘undocumented migrants’) which would demonstrate that in this context such aid can be provided by both public and private hospitals.
CBI gentager ligeledes sine tidligere fremsatte påstande om, at der ikke er truffet foranstaltninger til at undgå overkompensation.
The CBI adds that according to a February 2004 publication [122] of the Mutualités Chrétiennes [123], the private hospitals treat more than 60 % of ‘social patients’ in the Brussels Capital Region.
CBI tilføjer, at det i mangel af en præcis definition af de specifikke opgaver, som IRIS-hospitalerne udfører, er umuligt at fastslå, hvilke aktiviteter der bør være genstand for kompensation.
The complainants also consider that no additional mission is laid down in the Loi CPAS, in the strategic IRIS plans nor in ‘domicile de secours’ conventions [124].
Efter CBI's mening er det derfor umuligt at verificere, om der findes en kontrolmekanisme til hindring af overkompensation.
As regards the ‘multi-site mission’, CBI considers that it is still not explained what the obligation to offer complete ‘multi-site’ hospital care activities comprises, nor to what extent this obligation imposes additional burdens on the IRIS-H.
Endelig bemærker CBI, at der ikke i samarbejdsaftalen af 19. maj 1994 defineres en opgave af denne type, omend de offentlige hospitalers videreførelse nævnes, og at dette dokument ikke udgør en overdragelsesakt.
As regards the additional social mission, CBI is of the opinion that Article 57 of the Loi CPAS does not create additional obligations with respect to the IRIS-H and, in any case, does not define them in an intelligible manner (no more than the strategic IRIS plans or the ‘domicile de secours’ conventions).
Navnlig mener CBI ikke, at denne aftale på nogen måde antyder, at en kommune eller en by har pligt til at have et offentligt hospital på sit område, eller at den rummer nogen som helst regel om planlægning af hospitalstjenester i Belgien, der fordrer drift af en tjeneste i et offentligt hospital.
With regard to the question of a clear definition of the compensation parameters CBI points out that, according to the Belgian authorities, the IRIS-H perform a specific mission distinct from that of private hospitals and that specific mission is not defined in the LCH but has another legal basis.
Sammenslutningen ABISP (Association bruxelloise des institutions de soins privées), som er en af de oprindelige klagere (se betragtning 1), anfører i sine bemærkninger til åbningsafgørelsen, at alle belgiske hospitaler, uanset status eller ejerforhold, har pligt ifølge loven til at udføre en almennyttig opgave.
According to CBI, it is clearly excluded that the LCH can establish the compensation parameters with respect to one or more public service mission(s) for which the LCH does not provide.
I denne forbindelse henviser ABISP til artikel 2 i LCH [125].
In addition, CBI notes that there is no correspondence between the claimed legal bases for the specific missions in question and the compensation mechanisms.
Endelig minder ABISP om, at den har trukket sin klage tilbage.
The complainants observe that it seems that no distinction is made between deficits resulting on the one hand from the costs of the claimed specific missions and on the other hand those resulting from the costs of the basic mission.
Zorgnet Vlaanderen er en sammenslutning, der repræsenterer over 500 flamske leverandører af sundhedstjenester (såsom de almindelige hospitaler, psykiatriske behandlingssteder og alderdomshjem).
Finally, CBI makes reference to a series of opinions by the Belgian Inspectorate of Finance which concluded that it was impossible to monitor the use of the special subsidies awarded on the basis of the Ordonnance of 13 February 2003 because that Ordonnance did not specify the tasks of communal interest for which these subsidies were granted.
I sine bemærkninger til åbningsafgørelsen understreger Zorgnet Vlaanderen, at alle de belgiske hospitaler, offentlige som private, er omfattet af de samme forpligtelser til offentlig tjeneste i henhold til LCH.
CBI also repeats its previous assertions that there are no measures to avoid overcompensation.
Sammenslutningen bemærker i øvrigt, at der i LCH ikke defineres betingelser for den juridiske form (offentlig eller privat enhed), der er nødvendig for, at et hospital kan anerkendes som et sådant.
They add that in the absence of a precise definition of the specific missions performed by the IRIS-H, it is impossible to say what activities should be subject to compensation or not.
I øvrigt bemærker Zorgnet Vlaanderen, at definitionen af hospitalernes forpligtelser til offentlig tjeneste ikke indeholder nogen regional henvisning.
In CBI's view, it is consequently impossible to verify the existence of a monitoring mechanism to avoid overcompensations.
Endelig hævder sammenslutningen, at hospitalerne i Flandern og hovedstadsregionen Bruxelles udfører samme sociale opgave.
Finally, CBI points out that while the pérennité of the public hospitals is cited in the cooperation agreement of 19 May 1994, this document does not define such a mission and does not constitute an entrustment.
UNCPSY (Union nationale des cliniques psychiatriques privées) er en sammenslutning af de private psykiatriske klinikker i Frankrig.
In particular, according to CBI this agreement would in no way indicate that a municipality or a city must have a public hospital on its territory and would also not lay down any rule for hospital service programming in Belgium requiring the operation of a service in a public hospital.
I sine bemærkninger til åbningsafgørelsen hævder UNCPSY, at hvis man skal fastslå, om den offentlige finansiering overstiger nettoomkostningen ved den offentlige tjeneste, kan denne nettoomkostning ikke være ubegrænset.
The Association bruxelloise des institutions de soins privées (ABISP), one of the initial complainants (see recital 1), notes in its comments on the opening decision that all Belgian hospitals, regardless of their bylaws (statuts) or owners, are required by law to fulfil a mission of general interest.
I øvrigt skal denne bedømmelse efter sammenslutningens mening omfatte kvaliteten af ledelsen hos leverandøren.
In this context, ABISP makes reference to Article 2 of the LCH [125].
I denne forbindelse mener UNCPSY, at Kommissionen bør sammenligne offentlige og private hospitaler for at fastslå, om støtten er proportionel efter artikel 106, stk. 2, i TEUF.
Finally, ABISP recalls that it has withdrawn its complaint.
I denne forbindelse bemærker Kommissionen, at UNCPSY's bemærkninger strider mod Rettens konklusion i præmis 300 i dens dom af 7. november 2012 (T-137/10), ifølge hvilken en virksomheds økonomiske effektivitet i forbindelse med levering af tjenesteydelser af almindelig økonomisk interesse ikke hører ind under vurderingen i henhold til artikel 106, stk. 2, i TEUF af foreneligheden af den offentlige finansiering, som virksomheden modtager, i henseende til statsstøttereglerne (se i denne forbindelse betragtning 63).
Zorgnet Vlaanderen represents over 500 Flemish care providers (such as general hospitals, psychiatric care institutions, and nursing homes).
KONGERIGET BELGIENS BEMÆRKNINGER
In its observations on the opening decision, Zorgnet Vlaanderen emphasises that all Belgian hospitals, whether they are public or private, fulfil the same public service obligations in the framework of the LCH.
Belgiens bemærkninger til åbningsafgørelsen
In addition, Zorgnet Vlaanderen points out that the LCH does not set out any conditions regarding the legal form (i.e. public or private) to be recognised as a hospital.
I deres svar på Kommissionens afgørelse af 1. oktober 2014, navnlig betragtning 17 heri, bemærker de belgiske myndigheder, at de finansielle foranstaltninger fra hovedstadsregionen Bruxelles (dvs. de særlige tilskud på maksimalt 10 mio. EUR om året) og FRBRTC udgjorde finansielle overførsler alene tildelt kommunerne og ikke IRIS-hospitalerne.
Furthermore, Zorgnet Vlaanderen observes that the definition of the public service obligations of the hospitals does not refer to a regional specificity.
Derfor mener de belgiske myndigheder, at det drejer sig om finansielle overførsler mellem offentlige myndigheder, som ikke falder ind under artikel 107, stk. 1, i TEUF.
Finally, Zorgnet Vlaanderen claims that hospitals in Flanders and in the Brussels Capital Region do not perform a different social task.
Ifølge de belgiske myndigheder har hverken hovedstadsregionen Bruxelles eller FRBRTC tildelt støtte til IRIS-hospitalerne.
The Union Nationale des Cliniques Psychiatriques Privées (UNCPSY) is the federation of private psychiatric clinics in France.
De mener, at disse overførsler fandt sted inden for rammerne af regionens kompetence med hensyn til den generelle finansiering af kommunerne, som sætter disse i stand til at varetage deres almennyttige opgaver og især CPAS' opgaver.
In its comments on the opening decision, UNCPSY argues that for the check of whether the public funding does not exceed the net costs of the public service, this net cost cannot be without a limit and cannot ignore whether or not the service provider is well managed.
I denne forbindelse vedrører klagernes henvisninger til finanstilsynets udtalelser alene hovedstadsregionen Bruxelles og kommunerne og ikke IRIS-hospitalerne.
In this context, UNCPSY is of the opinion that the Commission should compare public and private hospitals to determine whether or not the aid is proportionate within the meaning of Article 106(2) TFEU.
Endelig hævder de belgiske myndigheder, at hovedstadsregionen Bruxelles på grundlag af særloven af 8. august 1980 om institutionelle reformer og det belgiske Conseil d'États udtalelse [126] alene kan finansiere kommunerne og ikke IRIS-hospitalerne, eftersom finansieringen af specifikke hospitalstjenester ikke falder ind under regionens kompetencer.
In this context, the Commission observes that UNCPSY's comments run counter to the GC's conclusion in paragraph 300 of its judgment of 7 November 2012 (T-137/10) that economic efficiency of an undertaking in supplying the SGEI is not a criterion for the assessment under Article 106(2) TFEU of the State aid compatibility of the public funding which this undertaking receives (see in this respect recital 63).
Hvad angår den tvivl, der udtrykkes i betragtning 26 i åbningsafgørelsen, klarlægger de belgiske myndigheder forskellen mellem kravet i artikel 60, stk. 6, i CPAS-loven på den ene side og mulighederne for at lukke et offentligt hospital ved hjælp af hospitalsplanlægningsmekanismen på den anden side.
COMMENTS FROM THE KINGDOM OF BELGIUM
Ifølge de belgiske myndigheder fastsættes i artikel 60, stk. 6, i CPAS-loven [127] de betingelser, som et CPAS skal opfylde for at etablere et hospital.
Comments from Belgium on the opening decision
Et CPAS skal bl.a. analysere, om et sådant hospital reelt er nødvendigt i betragtning af regionens behov, især de socialmedicinske, og forekomsten af lignende infrastrukturer.
In their reply to the Commission's decision of 1 October 2014 and in particular to recital 17 of that decision, the Belgian authorities note that the financial interventions by the Brussels Capital Region (i.e. the special subsidies of up to EUR 10 million per year) and by the FRBRTC were financial transfers granted to the municipalities only and not to the IRIS-H.
De belgiske myndigheder understreger ligeledes, at hospitalsplanlægningsmekanismen består i, at den føderale regering bestemmer det maksimale antal senge pr. region.
As a result, the Belgian authorities consider these were financial transfers between public authorities which are not covered by Article 107(1) TFEU.
Den føderale regering bygger alene sin beslutning på det opgjorte hospitalsbehov uden at tage hensyn til, hvor stort det sociale behov er i hver region [128].
According to the Belgian authorities, neither the Brussels Capital Region nor the FRBRTC has granted aid to the IRIS-H.
De belgiske myndigheder forklarer, at det maksimale antal senge i hovedstadsregionen Bruxelles bestemmes for hele regionen og ikke for hver enkelt af de 19 kommuner.
Instead, they consider that these transfers were made as part of the Region's competence for the general financing of the municipalities, which enables the latter to fulfil their common interest missions, including the missions of the CPAS.
Modsat beslutter hver af de 19 CPAS i hovedstadsregionen Bruxelles selv, om de vil etablere et hospital i deres kommune ud fra det lokale behov.
In this context, the complainant's reference to the opinions of the Inspectorate of Finance only concerns the Brussels Capital Region and the municipalities but not the IRIS-H.
De belgiske myndigheder har ligeledes forklaret, at lukningen af et offentligt hospital eller overførslen heraf til en partner i den private sektor ikke reguleres formelt eller specifikt af LCH eller CPAS-loven [129].
Finally, the Belgian authorities argue that on the basis of the Special Law of 8 August 1980 on institutional reforms and the Opinion of the Belgian Council of State [126], the Brussels Capital Region can only finance the municipalities and not the IRIS-H since financing specific hospital missions does not fall within the Region's competences.
Ifølge de belgiske myndigheder har det belgiske Conseil d'États retspraksis imidlertid klarlagt de nærmere bestemmelser og betingelser for lukning og/eller overførsel af institutioner etableret af et CPAS.
With respect to the doubt expressed in recital 26 of the opening decision, the Belgian authorities clarify the difference between, on the one hand, the requirement of Article 60(6) Loi CPAS and the possibilities for a public hospital to close down with the hospital programming mechanism, on the other hand.
I sin dom nr. 113.428 af 9. december 2002 traf Conseil d'État afgørelse om annullation af overførslen af et rekonvalescenshjem tilhørende et CPAS til en privat erhvervsdrivende.
According to them, Article 60(6) Loi CPAS [127] lays down the conditions that need to be fulfilled for a CPAS to be able to establish a hospital.
Conseil d'État fandt navnlig, at også nødvendigheden af at levere socialmedicinske tjenester skulle vurderes, før der kunne træffes beslutning om at lukke eller overføre en institution.
In particular, a CPAS must analyse whether there is a genuine need for such a hospital taking into account the needs of the area, including the medico-social needs, and the presence of similar facilities.
Ved denne vurdering skal der tages behørigt hensyn til den vurdering, der blev foretaget ved oprettelsen af institutionen, samt alle ændringer, der er sket siden beslutningen om at etablere den.
The Belgian authorities further point out that the hospital programming mechanism consists of determining the maximum number of hospital beds per Region by the Federal Government who bases its decision solely on the hospital needs identified without taking into account the level of social needs in each area [128].
I øvrigt bemærker de belgiske myndigheder, at denne vurdering ikke kan være baseret alene på institutionens finansielle situation eller de omkostninger, der er ved driften heraf.
They explain that for the Brussels Capital Region, the maximum number of hospital beds is determined for the region as a whole and not for each of the 19 municipalities separately.
På dette grundlag konkluderer de belgiske myndigheder, at et CPAS ikke kan lukke sit hospital uden på forhånd at have fastslået, at de medicinske og sociale behov, som hospitalet blev oprettet til at dække, ikke længere eksisterer.
In contrast, each of the 19 CPAS in the Brussels Capital Region determined autonomously for their municipality whether or not to establish a hospital based on the local needs.
Ifølge de belgiske myndigheder fordrer oprettelsen af et offentligt hospital overholdelse af både forpligtelserne i artikel 60, stk. 6, i CPAS-loven og de offentlige myndigheders hospitalsplanlægning, mens det for privathospitalernes vedkommende kun er planlægningen, der er relevant.
The Belgian authorities also explained that the closure of a public hospital or its transfer to a private sector partner are not dealt with formally or specifically in the LCH or the Loi CPAS [129].
I medfør af artikel 60, stk. 6, i CPAS-loven skal oprettelsen af et nyt offentligt hospital begrundes i eksistensen af et reelt behov.
However, according to the Belgian authorities the case law of the Belgian Council of State has clarified the arrangements and conditions for the closure and/or the transfer of institutions set up by a CPAS.
Endvidere forklarer de belgiske myndigheder, at hvis et offentligt hospital oprettes med en kapacitet, der målt i antal senge modsvarer antallet i hospitalsplanlægningen, er der ikke plads til endnu et hospital (offentligt eller privat) i det pågældende område i henhold til den pågældende plan, hvorfor der ikke findes andre måder at dække befolkningens behov på.
In its judgment 113.428 of 9 December 2002, the Council of State ruled that the transfer of a convalescent home belonging to a CPAS to a private operator was to be annulled.
De belgiske myndigheder bemærker, at hvis et CPAS på et givet tidspunkt ønsker at lukke sit offentlige hospital, skal det først og fremmest sikre sig, at dette hospital ikke længere er nødvendigt ifølge Conseil d'États retspraksis.
In particular, the Council of State found that the need to provide medico-social services also had to be assessed before a decision was taken to close or transfer an establishment.
I modsætning til et CPAS er en privat erhvervsdrivende, som beslutter at lukke sit hospital, ikke forpligtet ved lov til at sikre sig, at befolkningen fortsat har adgang til sundhedsydelser.
That assessment must take due account of the assessment made when the establishment was created and hence of any changes that had occurred since the decision to create the establishment.
Ifølge de belgiske myndigheder videreføres et privathospital alene ved ejerens beslutning, og denne kan omgøres til hver en tid.
Furthermore, the Belgian authorities note that this assessment could not be based purely on the financial situation of the establishment or on the costs incurred for its maintenance.
De belgiske myndigheder nævner som eksempel den pludselige lukning af det franske hospital, et privathospital i Berchem-Sainte-Agathe (Bruxelles), i 2008 [130].
On this basis, the Belgian authorities conclude that a CPAS cannot close its hospital unless it has first established that the medical and social needs the hospital was created to meet no longer exist.
Som konklusion forklarer de belgiske myndigheder, at hospitalsplanlægningsmekanismen begrænser både offentlige og private erhvervsdrivendes frihed til at oprette et hospital (idet oprettelsen af et hospital kun er mulig, hvis det maksimale antal senge i et givet område endnu ikke er nået).
According to the Belgian authorities, for a public hospital to be established, both the requirements of Article 60(6) Loi CPAS and of the authorities' hospital programming need to be fulfilled while for private hospitals only the latter applies.
De anfører dog, at forpligtelserne i CPAS-loven lægger supplerende bånd på CPAS med hensyn til at åbne og lukke et offentligt hospital, mens privathospitalerne til hver en tid kan beslutte at lukke.
Under Article 60(6) Loi CPAS, the opening of a new public hospital has to be justified by the existence of a genuine need.
Hvad angår de forpligtelser, der angiveligt kun skulle være pålagt IRIS-hospitalerne (se betragtning 87-89 i åbningsafgørelsen), gør de belgiske myndigheder gældende, at disse forpligtelser er den direkte følge af, at IRIS-hospitalerne var blevet oprettet til at bidrage til CPAS' levering af social støtte (se afsnit 2.2).
Furthermore, the Belgian authorities explain that if a public hospital is opened with a capacity that equals the number of beds foreseen under the hospital programming, then there is no longer room for another (public or private) hospital in that area under that programme, in which case there is no other way of meeting the needs of the population.
De belgiske myndigheder mener, at disse forpligtelser stammer fra CPAS-loven, i medfør af hvilken IRIS-hospitalerne blev oprettet, og at de pålægges IRIS-hospitalerne gennem disses vedtægter og IRIS' strategiplaner.
The Belgian authorities note that if at some point a CPAS wishes to close its public hospital it must first ensure that it is no longer needed in line with the jurisprudence by the Council of State.
De belgiske myndigheder henviser ligeledes til disse dokumenter i henseende til den nøjagtige definition af disse forpligtelser.
On the contrary, if a private operator decides to close its hospital, that operator, unlike the CPAS, is not legally required to ensure that the population continues to be provided with healthcare.
Af præcisionshensyn og for at undgå gentagelser citerer Kommissionen udelukkende relevante passager i sin vurdering (se afsnit 7.3.4.1).
According to the Belgian authorities, it is only its own choice that motivates a private hospital to remain open, a choice which can be changed at any time.
I sin åbningsafgørelse (se betragtning 48) udtrykte Kommissionen tvivl med hensyn til den økonomiske karakter af de supplerende sociale tjenester, som IRIS-hospitalerne leverede.
The Belgian authorities refer to the abrupt closure of the private Hôpital Français of Berchem-Sainte-Agathe (Brussels) in 2008 [130] as an illustration.
I deres svar til åbningsafgørelsen angiver de belgiske myndigheder, at disse sociale tjenester ikke havde økonomisk karakter.
To conclude, the Belgian authorities explain that the hospital programming mechanism equally restrains the freedom of public and private operators to establish a hospital (as this is only possible if the maximum number of hospital beds in an area has not yet been reached).
De hævder i alt væsentligt, at den sociale støtte, som CPAS i Bruxelles ydede i form af materiel, social, medicinsk, socialmedicinsk og psykologisk støtte, ikke leveres på et konkurrencebaseret marked, og at det stadig er tilfældet, selv om den del af den sociale støtte (nemlig de supplerende sociale tjenester) varetages af IRIS-hospitalerne på grundlag af en overdragelse.
In their view, the obligations arising from the Loi CPAS however put additional constraints on both the possibility for a CPAS to establish and to close a public hospital while private hospitals can close at any time.
Hvad angår retsgrundlaget for underskudsdækningen (se betragtning 91 i åbningsafgørelsen), mener de belgiske myndigheder, at kommunernes pligt til at dække deres offentlige hospitalers underskud er fastlagt i artikel 46 i IRIS-hospitalernes vedtægter og i artikel 109 i LCH.
With respect to the obligations that allegedly only apply to the IRIS-H (see recitals 87 to 89 of the opening decision), the Belgian authorities argue that these obligations are the direct consequence of the fact that the IRIS-H have been set up to contribute to the provision of social aid by the CPAS (see also Section 2.2).
De forklarer, at der i artikel 109 i LCH dels angives et generelt princip gældende for alle offentlige belgiske hospitaler, dels pålægges kommunerne en minimumspligt (eftersom de har pligt til alene at dække en del af underskuddet, se også betragtning 47).
The Belgian authorities consider that these obligations derive from the Loi CPAS, pursuant to which the IRIS-H were created, and are entrusted by means of the bylaws of the IRIS-H and the IRIS strategic plans.