natgillin/translations-raw huggingface dataset:
On the basis of that report and, where appropriate, a recommendation from the HIA, the Minister for Health decides whether it is appropriate to commence RES payments.
Seda HIA aruannet ja vajaduse korral soovitust arvestades otsustab tervishoiuminister, kas tuleb alustada RES maksed.
His decision is subject to the following conditions (Article 10 of the RES):
See otsus peab vastama järgmistele tingimustele (RES-i artikkel 10):
— where the risk differential between operators is under 2% RES payments are not commenced;
– väiksem kui 2% erinevus ettevõtjate riskide vahel ei ole piisav RES maksete käivitamiseks;
— where the risk differential is between 2 and 10% the Minister for Health decides, on the recommendation of the HIA, whether or not to commence RES payments;
– 2-10% erinevus riskide vahel võimaldab tervishoiuministril algatada RES maksed üksnes HIA soovituse korral;
— where the risk differential between operators is more than 10%, the Minister for Health will, in principle, commence RES payments, unless there are good reasons for not doing so.
– suurem kui 10% erinevus ettevõtjate riskide vahel kohustab tervishoiuministrit põhimõtteliselt algatama RES maksed, välja arvatud siis, kui esinevad mõjuvad põhjused seda mitte teha.
C — Method of calculation of RES payments
C – RES maksete arvutamise meetod
The method of calculating RES payments payable following a decision to commence those payments is set out in the Second Schedule to the RES and explained in greater detail in the Guide to the Risk Equalisation Scheme, 2003 as prescribed in Statutory Instrument No 261 of 2003, July 2003 (‘the RES guide’).
Pärast otsust käivitada RES maksed toimub nende kavatsetavate maksete arvutamine RES-i II lisas täpsustatud meetodi alusel, mida selgitatakse üksikasjalikumalt dokumendis Guide to the Risk Equalisation Scheme, 2003 as prescribed in Statutory Instrument No. 261 of 2003, July 2003 (2003. aastal HIA kehtestatud RES juhend, edaspidi „RES juhend”).
Determination of RES payments is directly linked to the differential between the risk profiles of the PMI insurers, the assessment of which involves consideration of a number of risk factors.
RES maksete kindlaksmääramine on otseselt seotud ERK kindlustusandjate riskiprofiilide erinevustega, mille hindamine sõltub rea riskikriteeriumide arvestamisest.
Those factors include, first, the age and sex of the persons covered and, if appropriate, a weighting (between 0 and 50%) known as the ‘health status weight’, which is based on hospital bed utilisation.
Nende kriteeriumide hulgas on esiteks kindlustatute vanus ja sugu ning vajaduse korral ka kohandustegur (0 ja 50% vahel), mida nimetatakse „tervisliku seisundi kaalumisteguriks” (health status weight factor) ja mis tugineb haiglavõimsuse täheldatud kasutamisele.
The HIA has not thus far applied that weighting, which is currently zero, and has based its assessment of risk differentials between PMI insurers solely on the factors of the age and sex of the persons covered.
Kuni praeguse ajani ei ole HIA kasutanud seda tegurit, mis on hetkel null, ning on toetunud ERK kindlustusandjate vaheliste riskide erinevuse hindamisel üksnes kindlustatute vanuse ja soo kriteeriumidele.
According to the RES guide (page 14 et seq.), the principle governing the calculation of RES payments is that each PMI insurer must bear the costs which it would have had to bear if its own risk profile had been equivalent to the average market risk profile.
Vastavalt RES juhendile (lk 14 jj) reguleerib RES maksete arvutamist põhimõte, mille kohaselt peab iga ERK kindlustusandja kandma need kulud, mida ta oleks pidanud tasuma, kui tema enda riskiprofiil oleks võrdne turu keskmise riskiprofiiliga.
The costs relating to the insurer’s real risk profile and to the average market risk profile are calculated according to the age and sex of the persons covered.
Kindlustusandja tegeliku riskiprofiiliga seotud kulud ning turu keskmise riskiprofiiliga seotud kulud arvutatakse kindlustatute vanuse ja soo alusel.
For that purpose, those persons are first divided into different age and sex cells in order to identify the sum of the costs generated by those cells respectively and to determine the actual average cost per person covered within each cell.
Selle tarvis jaotatakse need kindlustatud esiteks erinevatesse vanuse- ja soogruppidesse, et tuvastada vastavalt nende gruppide tekitatud kulude summad ja määrata kindlaks iga grupi kindlustatu tegelik keskmine kulu.
According to Article 3 of the RES, the costs to be taken into account in that context are exclusively those generated by claims (claims costs) submitted to PMI insurers during the reference period for payment of the fees due for medical services received during a hospital stay.
RES-i artikli 3 alusel tuleb sellega seoses arvesse võtta üksnes neid kulusid, mis tekkisid hüvitisenõuetest (claims costs), mille kindlustatud esitasid ERK kindlustusandjatele vaatlusalusel perioodil ja milles palutakse hüvitada kulud, mis tervishoiutalitustel tekkisid kindlustatu haiglas viibimise ajal.
Subsequently, the HIA determines the average market risk profile for each age and sex cell, in comparison to the total population insured in the market, on the basis of data provide by the PMI insurers.
Seejärel määrab HIA kindlaks turu keskmise riskiprofiili vanuse- ja soogruppide kaupa, võrreldes kogu kindlustatud elanikkonnaga, tuginedes ERK kindlustusandjate esitatud andmetele.
That average market risk profile is then substituted for the real risk profile of the PMI insurers by age and sex cell in order to identify the hypothetical costs that those insurers would have incurred if they had actually had such an average market risk profile.
See turu keskmine riskiprofiil asendatakse seejärel ERK kindlustusandjate tegeliku riskiprofiiliga vanuse- ja soogruppide kaupa, et määrata oletatavad kulud, mis neil kindlustusandjatel oleks tekkinud, kui neil oleks tegelikult olnud selline turu keskmine riskiprofiil.
The cost differential determined on the basis of the comparison between the actual costs (on the basis of the insurer’s real risk profile) and the hypothetical costs (on the basis of the insurer’s average market risk profile) ultimately provides the basis for calculating the equalisation payments, as referred to in paragraph 27 above.
Tegelike kulude (mis on arvutatud kindlustusandja tegeliku riskiprofiili alusel) ja oletatavate kulude (mis on arvutatud kindlustusandja turu keskmise riskiprofiili alusel) võrdluse põhjal kindlaks määratud kulude erinevust kasutatakse lõpuks selleks, et arvutada tasakaalustusmakseid, mida käsitleti eespool punktis 27.
Those payments must correspond precisely to that cost differential and may be adjusted, by application of the ‘zero sum adjustment factor’, to ensure that the system is self-financing.
Need maksed peavad vastama täpselt sellele kulude erinevusele ning neid võib kohandada nullsumma parandustegurit (zero sum adjustment factor) kohaldades, et tagada süsteemi isefinantseerimine.
Although in theory the RES is intended to apply to every PMI insurer active on the Irish market, the parties are agreed that as matters currently stand its application would essentially lead to a transfer of funds from BUPA Ireland for the benefit of the VHI.
Kuigi teoorias võib RES-i kohaldada kõigile Iirimaa turul tegutsevatele ERK kindlustusandjatele, on pooled nõus tunnistama, et praeguses olukorras viiks selle kohaldamine sisuliselt BUPA Irelandi vahendite ülekandmiseni VHI-le.
III — Contested decision
III – Vaidlustatud otsus
On 23 January 2003, the Irish authorities formally notified the RES to the Commission pursuant to Article 88(3) EC.
Iirimaa ametiasutused teatasid 23. jaanuaril 2003 EÜ artikli 88 lõike 3 alusel ametlikult komisjonile RES-ist.
By Decision C(2003) 1322 final of 13 May 2003 (State aid N 46/2003-Ireland; ‘the contested decision’), the Commission decided not to raise objections, under Article 4(2) and (3) of Regulation No 659/1999, concerning the establishment of the RES in Ireland.
13. mai 2003. aasta otsusega K(2003) 1322 (lõplik) (riigiabi N 46/2003-Iirimaa) (edaspidi „vaidlustatud otsus”) otsustas komisjon määruse nr 659/1999 artikli 4 lõigete 2 ja 3 alusel mitte esitada vastuväiteid Iirimaal RES-i kehtestamisele.
Article 1 of the operative part of the contested decision states:
Vaidlustatud otsuse resolutiivosa artiklis 1 on sedastatud:
‘The [RES] involves payments which are limited to the minimum necessary to compensate [PMI] insurers for [SGEI] obligations and therefore does not involve State aids in the sense of Article 87(1) EC.’
„[RES] tähendab makseid, mis on piiratud [ERK] kindlustusandjatele nende üldist majandushuvi pakkuva teenuse osutamise hüvitamiseks vajaliku miinimumiga ning ei kujuta endast seetõttu riigiabi EÜ artikli 87 lõike 1 tähenduses.”
In the presentation of the facts relating to the RES at recitals 17 to 30 to the contested decision, the Commission described in detail the scope and the functioning of the RES.
RES-i faktiliste asjaolude tutvustamise raames vaidlustatud otsuse punktides 17-30 kirjeldas komisjon üksikasjalikult RES-i kohaldamisala ning toimimist.
Recitals 20 to 30 to that decision describe the conditions for the commencement of the RES (recitals 20 to 24) and the criteria and method of calculation of the RES payments (recitals 25 to 30).
Selle otsuse punktides 20–30 kirjeldatakse RES maksete käivitamise tingimusi (punktid 20–24) ning RES maksete arvutamise kriteeriume ning meetodit (punktid 25–30).
In its legal assessment, the Commission concluded that the notified measure ‘[did] not constitute State aid within the meaning of Article 87(1) EC or [could] be declared compatible with the common market pursuant to Article 86(2) [EC]’ (recitals 37 and 61 to the contested decision).
Oma õigusliku hinnangu raames leidis komisjon, et teatatud meede „ei kujuta endast riigiabi EÜ artikli 87 lõike 1 tähenduses, või et teise võimalusena võib seda lugeda ühisturuga kokkusobivaks EÜ artikli 86 lõike 2 alusel” (vaidlustatud otsuse punktid 37 ja 61).
In support of that appraisal, the Commission essentially considered, initially, that the RES fulfilled in principle the conditions set out in Article 87(1) EC.
Selle hinnangu toetuseks leidis komisjon põhiliselt ühest küljest, et RES vastab põhimõtteliselt EÜ artikli 87 lõikes 1 esitatud tingimustele.
It observed in that regard that the RES payments came from public resources, originating in a fund established by national legislation, financed by compulsory contributions and controlled by the public authorities, which in practice benefited the VHI, an undertaking in a dominant position with an 85% market share, to compensate it for the costs which it would normally have had to bear.
Sellega seoses märkis komisjon, et RES maksed tulenevad avalikest vahenditest, nimelt siseriiklike õigusnormidega asutatud fondist, mida rahastavad kohustuslikud sissemaksed ja kontrollivad riigi ametiasutused ja millest saab praktikas kasu VHI, valitseva seisundiga ettevõtja, kelle käes on 85% turust, et hüvitada neid kulusid, mida see ettevõtja oleks tavalises olukorras pidanud kandma.
The Commission considered that those payments were capable of affecting competition and intra-Community trade and that the RES could therefore be qualified as State aid (recital 39 to the contested decision).
Ta leidis, et need maksed võivad mõjutada konkurentsi ja ühendusesisest kaubandust ja et RES-i võib seetõttu lugeda riigiabiks (vaidlustatud otsuse punkt 39).
However, the Commission concluded that the compensation provided by the RES none the less did not constitute State aid within the meaning of Article 87(1) EC, since according to the caselaw of the Court of Justice (Case C-53/00 Ferring [2001] ECR I-9067, paragraph 27), it was intended as compensation for the obligations of services in the general economic interest (‘SGEI obligations’) imposed on all insurers active on the Irish PMI market, namely obligations designed to ensure that all persons living in Ireland would receive a minimum level of PMI services at an affordable price and on similar quality conditions.
Teisest küljest leidis komisjon, et RES-i tagatud hüvitis ei kujuta endast siiski riigiabi EÜ artikli 87 lõike 1 tähenduses, kuna Euroopa Kohtu praktika kohaselt (Euroopa Kohtu 22. novembri 2001. aasta otsus kohtuasjas C-53/00: Ferring, EKL 2001, lk I-9067, punkt 27) on tegemist hüvitisega kõigile Iirimaa ERK turul tegutsevatele kindlustusandjatele pandud üldist majandushuvi pakkuvate teenuste osutamise kohustuse eest (edaspidi „ÜMPT kohustused”), millega tuleb tagada kõigile Iirimaal elavatele isikutele minimaalne ERK teenuste tase taskukohaste hindadega ning sarnaste kvaliteeditingimustega.
The Commission observed (at recitals 40 and 41 to the contested decision) that that objective would be achieved by establishing solidarity between policyholders and that, in particular:
Ta märkis (vaidlustatud otsuse punktid 40 ja 41), et see eesmärk saavutatakse solidaarsuse kehtestamisega kindlustatute vahel ja eeskätt et:
— the open enrolment requirement, that is to say, the obligation for the PMI insurer to offer a PMI contract to any person requesting such a contract, independently
– avatud liitumise kohustus, st ERK kindlustusandja kohustus pakkuda ERK lepingut igale isikule, kes seda on taotlenud, sõltumata tema vanusest, soost või
— the lifetime cover requirement ensured that insurers would not reject the policyholders when they became sick or old;
– eluaegse kindlustuskaitse kohustus väldib seda, et ERK kindlustusandjad jätaksid kindlustatud kaitseta siis, kui need jäävad haigeks või saavad vanaks;
— community rating imposed upon the insurers the obligation to apply the same premium to all policyholders for the same type of product irrespective of their health status, age or sex; premiums would therefore be fixed at a higher rate than young persons would have to pay for PMI services priced on the basis of risk assessment and premiums paid by old or sick persons would be much more affordable than if they were fixed by reference to the risk covered; thus, community rating constituted the very basis of inter-generational solidarity and provided all insured persons with the certainty that the advent of a chronic illness or serious injury would not render the cost of cover unaffordable;
– ühtsed hinnad kohustavad ERK kindlustusandjaid kohaldama kõigile kindlustatutele sama kindlustusmakset sama liiki toote eest, sõltumata nende tervislikust seisundist, vanusest või soost; seega on kindlustusmaksed kõrgemad nendest, mida peaksid noored maksma ERK teenuste osutamise eest, mille hinnad lähtuvad riski hindamisest, ja vanurid või haiged maksavad oluliselt soodsamaid kindlustusmakseid, võrreldes sellega, mida nad peaksid tasuma kindlustatud riski alusel; nii on ühtsed hinnad põlvkondadevahelise solidaarsuse aluseks, tagades kõigile kindlustatutele selle, et krooniline haigus või tõsine vigastus ei muuda kindlustuskaitse kulusid ülikalliks;
— last, the regulations on minimum benefits ensured that the products proposed would respect certain minimum quality standards, although PMI insurers were free to design their insurance products.
– lõpuks tagab miinimumhüvitisi käsitlev määrus seda, et pakutud tooted järgivad teatud minimaalseid kvaliteedinõudeid, kuigi ERK kindlustusandjatel on õigus määratleda oma kindlustustooted.
As regards the applicants’ denial, in their complaint, that the obligations referred to in paragraph 41 above constitute SGEI obligations, the Commission considered, in essence, that the national authorities were entitled to take the view that certain services were in the general interest and must be provided by means of SGEI obligations when market forces were not sufficient to ensure that they would be provided.
Mis puudutab seda, et hagejad vaidlustasid oma kaebuses selle, et eespool punktis 41 esitatud kohustused kujutavad ÜMPT kohustusi, siis leidis komisjon sisuliselt, et siseriiklikud ametiasutused võivad lugeda teatud teenuseid üldist majandushuvi pakkuvateks teenusteks ja et need tuleb tagada ÜMPT kohustusega, kui turujõud ei ole piisavad nende osutamise tagamiseks.
The Commission further observed that in the absence of harmonisation at Community level in the medical insurance sector, the national authorities were competent to
Komisjon märkis lisaks, et kuna ühenduse tasandil puudub ravikindlustussektoris ühtlustamine, siis on siseriiklikel ametiasutustel pädevus panna kõigile asjaomasel turul tegutsevatele ettevõtjatele ÜMPT
In that regard, the Commission observed that the freedom left to operators in Ireland to fix prices and define their insurance products did not call into question the fact that the obligations laid down by the relevant legislation constituted SGEI obligations in so far as the obligations served to achieve the objectives of a mission of general economic interest (‘SGEI mission’), such as access by anyone living in Ireland to a certain level of PMI services at affordable prices and on similar conditions of quality.
Sellega seoses märkis ta, et Iirimaal ettevõtjatele jäetud vabadus kehtestada hinnad ja määratleda oma kindlustustooted ei sea kahtluse alla asjaolu, et asjaomaste õigusnormidega ette nähtud kohustused kujutavad endast ÜMPT kohustusi, kui nende eesmärk on täita üldist majandushuvi pakkuva teenuse ülesandeid (edaspidi „ÜMPT ülesanded”), näiteks kõigi Iirimaal elavate isikute juurdepääs teatud tasemel ERK teenustele taskukohaste hindadega ning sarnaste kvaliteeditingimustega.
In that regard, the Commission considered that the Irish authorities had not made a manifest error by qualifying as SGEIs certain services going beyond those offered by the public social security scheme and accepted, in consequence, that the obligations at issue in the present case might be qualified as SGEI obligations within the meaning of Community law (recitals 42 to 49 to the contested decision).
Sellega seoses leidis komisjon, et Iirimaa ametiasutused ei olnud teinud ilmset viga, kui nad lugesid ÜMPT-ks need teenused, mis ületavad avalik-õigusliku sotsiaalkindlustussüsteemi raames pakutud teenuseid, ja nõustus seega, et käesolevas asjas käsitletud kohustusi võib lugeda ÜMPT kohustusteks ühenduse õiguse tähenduses (vaidlustatud otsuse punktid 42–49).
The Commission then found, in substance, that the application of the RES was strictly necessary in order to maintain stability on the relevant market, to neutralise the differential in risk profiles between PMI insurers and to compensate for the discharge of the SGEI obligations in question.
Seejärel leidis komisjon sisuliselt, et RES kohaldamine on rangelt vajalik, et säilitada asjaomase turu stabiilsust, neutraliseerida ERK kindlustusandjate riskiprofiilide erinevust ja hüvitada asjaomaste ÜMPT kohustuste täitmist.
It thus concluded that the RES was proportionate (recitals 50 to 59 to the contested decision).
Seega järeldas komisjon, et RES on proportsionaalne (vaidlustatud otsuse punktid 50–59).
As regards the necessity of the RES, the Commission observed that economic studies had highlighted the fact that in a community rated system, and notwithstanding the open enrolment obligation, PMI insurers would, in the absence of the RES, have a strong incentive to target, using selective marketing strategies, for example, low-risk, healthy consumers in order to be able to charge a lower community rate then their competitors.
Mis puudutab RES vajalikkust, siis märkis komisjon, et majandusuuringud on toonud välja asjaolu, et ühtsete hindade süsteemis ja vaatamata avatud liitumise kohustusele oleksid ERK kindlustusandjad ilma RES-ita oluliselt ajendatud näiteks valikulise turustamise strateegiate abil keskenduma madala riskiga ja hea tervisega tarbijatele, et kehtestada madalam ühine kindlustusmakse kui nende konkurentidel.
The Commission also observed that, in those circumstances, even in the absence of active risk selection, consumers would be likely to change insurers, which could give rise to spiralling costs for PMI insurers whose risk profile is made up of a greater proportion of insured persons in poor health.
Ta märkis samuti, et neis tingimustes võivad tarbijad isegi riskide aktiivse valiku puudumise korral vahetada kindlustusandjat, mis võib kaasa tuua nende ERK kindlustusandjate kulude spiraalse kasvu, kelle riskiprofiilis on rohkem halva tervisega kindlustatuid.
As regards the Irish PMI market, the Commission considered, in light of the Report of the Society of Actuaries in Ireland of April 2002 and the available data, that the situation could change and lead to a ‘spiralling down’ since some PMI insurers had attempted to attract young and presumably healthier consumers, by means of a strategy based on risk selection rather than one of quality or efficiency (footnote 9 to the contested decision).
Mis puudutab Iirimaa ERK turgu, siis leidis komisjon Irish Society of Actuaries’i 2002. aasta aprilli aruande ja olemasolevate andmete põhjal, et käesolev olukord võis muutuda ja viia „surmava spiraalini”, kuna teatud ERK kindlustusandjad olid üritanud ahvatleda noori ja seega oletatavalt hea tervisega tarbijaid, kasutades riskide valiku strateegiat, mitte aga kvaliteedi ja tõhususe strateegiat (vaidlustatud otsuse 9. joonealune märkus).
Consequently, the Commission concluded that although such market instability had not yet been observed, the danger of risk selection on the Irish PMI market based on community rating could not be excluded, so that it was necessary to maintain stability on that market by introducing the RES, which ensured an appropriate distribution of risks on that market.
Seetõttu leidis ta, et kuigi turul ei täheldatud veel ebastabiilsust, ei saanud välistada ühtsetele hindadele tugineval Iirimaa ERK turul riskide valikut, nii et oli vajalik säilitada selle turu stabiilsus RES-i kehtestamise teel, mis tagab riskide sobiva jagamise nimetatud turul.
In fact, in a PMI market with a risk-based rating, the RES would not be necessary (recitals 50 to 52 to the contested decision).
Tegelikult ei oleks riskil põhinevate hindadega ERK turul RES vajalik (vaidlustatud otsuse punktid 50–52).
As regards the proportionality of the RES, the Commission observed, in substance, that an unequal distribution of risks among PMI insurers did not lead automatically to the activation of the RES, but that the RES would be activated when certain conditions were met and, in particular, when certain percentages of risk differential were reached.
Mis puudutab RES-i proportsionaalsust, siis märkis komisjon esiteks sisuliselt, et riskide ebavõrdne jaotamine ERK kindlustusandjate vahel ei viinud automaatselt RES-i käivitamiseni, vaid et see toimus siis, kui tingimused olid täidetud ja eeskätt kui oli saavutatud teatav riskide erinevuse protsent.
It further observed that the RES limited transfers of payments between PMI insurers to the level strictly necessary to neutralise the differential between their risk profiles.
Teiseks märkis ta, et RES piirab ERK kindlustusandjate vaheliste maksete ülekandmise tasemega, mis on rangelt vajalik nende riskiprofiilide erinevuste neutraliseerimiseks.
It considered that a system which compensates PMI insurers for expenditure incurred in covering ‘bad’ risks in excess of the market average was strictly necessary to compensate for the SGEI obligations with which they are entrusted, which prohibit them from setting premiums by reference to the risk insured and from rejecting ‘bad’ risks.
Ta leidis, et kord, mis hüvitab ERK kindlustusandjatele kulud, mis on tekkinud turu keskmisest kõrgemate „halbade” riskide katmisel, on rangelt vajalik hüvitamaks neile pandud ÜMPT kohustusi, mis keelavad neil kehtestada kindlustusmakseid sõltuvalt kindlustatud riskist ja hoiduda „halbadest” riskidest.
The Commission also observed that not all payments by PMI insurers to insured persons were equalised, as the RES provided for a specific ceiling corresponding to the level of benefits received by most insured persons on the Irish PMI market, to the exclusion of ‘luxury’ services.
Komisjon märkis lisaks, et kõik ERK kindlustusandjate tagasimaksed kindlustatutele ei tekita tasakaalustamist, kuna RES näeb ette kindlaksmääratud ülempiiri, mis vastab Iirimaa ERK turul enamiku kindlustatute saadud teenuste tasemele, kust on välja jäetud „de luxe” teenused.