natgillin/translations-raw huggingface dataset:
68 As is clear from the wording of the second subparagraph of Article 22(2) of Regulation No 1408/71, and pursuant to the case-law set out in paragraphs 62 and 63 of the present judgment, in order to be entitled to refuse the authorisation referred to in Article 22(1)(c) of that regulation on the ground of waiting time, the competent institution must however establish that the waiting time, arising from objectives relating to the planning and management of the supply of hospital care pursued by the national authorities on the basis of generally predetermined clinical priorities, within which the hospital treatment required by the patient’s state of health may be obtained in an establishment forming part of the national system in question, does not exceed the period which is acceptable in the light of an objective medical assessment of the clinical needs of the person concerned in the light of his medical condition and the history and probable course of his illness, the degree of pain he is in and/or the nature of his disability at the time when the authorisation is sought.
68 Kako proizlazi iz samog teksta članka 22. stavka 2. drugog podstavka Uredbe br. 1408/71 i u skladu sa sudskom praksom navedenom u točkama 62. i 63. ove presude, kako bi imala pravo odbiti odobrenje iz članka 22. stavka 1. točke (c) te uredbe na osnovi vremena čekanja, nadležna institucija mora međutim ustanoviti da vrijeme čekanja, koje proizlazi iz ciljeva u vezi planiranja i upravljanja ponudom bolničke skrbi koje provode nacionalna tijela na temelju općenito prethodno utvrđenih kliničkih prednosti, u kojem se bolničko liječenje koje zahtijeva zdravstveno stanje pacijenta može obaviti u ustanovi u okviru dotičnog nacionalnog sustava, ne smije prelaziti rok koji je prihvatljiv s obzirom na objektivnu medicinsku procjenu kliničkih potreba dotične osobe u svjetlu njezinog zdravstvenog stanja, anamneze i vjerojatnog tijeka bolesti, stupnja boli i/ili prirode nesposobnosti u trenutku podnošenja zahtjeva za odobrenje.
69 Furthermore, as the Commission points out and as Advocate General Geelhoed observed in point 86 of his Opinion, the setting of waiting times should be done flexibly and dynamically, so that the period initially notified to the person concerned may be reconsidered in the light of any deterioration in his state of health occurring after the first request for authorisation.
69 Nadalje, kako je upozorila Komisija i kako je istaknuo nezavisni odvjetnik u točki 86. svojeg mišljenja, utvrđivanje vremena čekanja treba biti fleksibilno i dinamično, kako bi se vrijeme čekanja prvotno priopćeno dotičnoj osobi moglo ponovno razmotriti u svjetlu mogućeg pogoršanja njezinog zdravstvenog stanja do kojeg je došlo nakon prvog zahtjeva za odobrenje.
70 If the waiting time arising from the general planning objectives does not exceed a medically acceptable waiting time within the meaning of paragraph 68 of the present judgment, the competent institution is entitled to find that the second condition set out in the second subparagraph of Article 22(2) of Regulation No 1408/71 is not satisfied and to refuse to grant the authorisation sought by the person concerned under Article 22(1)(c)(i) of that regulation.
70 Ako vrijeme čekanja koje proizlazi iz općih ciljeva planiranja ne prelazi medicinski prihvatljivo vrijeme čekanja u smislu točke 68. ove presude, nadležna institucija ima pravo utvrditi da drugi uvjet naveden u članku 22. stavku 2. drugom podstavku Uredbe br. 1408/71 nije ispunjen i odbiti odobrenje koje je dotična osoba zatražila na temelju članka 22. stavka 1. točke (c) alineje (i) te uredbe.
71 That is because if patients covered by a national health service such as that in issue in the main proceedings had to be authorised to go to another Member State to receive there, at the expense of the competent institution, hospital treatment which the hospitals covered by that service are able to supply within a medically acceptable period within the meaning of paragraph 68 of the present judgment merely because treatment which is the same or equally effective is available more quickly in that other Member State, the resulting patient migration would be liable to put at risk the competent Member State’s planning and rationalisation efforts in the vital healthcare sector so as to avoid the problems of hospital overcapacity, imbalance in the supply of hospital medical care and logistical and financial wastage (see to that effect Smits and Peerbooms, paragraph 106, and Müller-Fauré and van Riet, paragraph 91).
71 Razlog tome je ako je pacijentima obuhvaćenima nacionalnom zdravstvenom službom poput one u glavnom postupku trebalo odobriti odlazak u drugu državu članicu na bolničko liječenje na trošak nadležne institucije, koje su ustanove obuhvaćene navedenom službom u mogućnosti obaviti u medicinski prihvatljivom vremenskom razdoblju u smislu točke 68. ove presude samo zato što je istovjetno ili jednako učinkovito liječenje brže dostupno u toj drugoj državi članici, to bi dovelo do migracijskih tokova pacijenata koji bi ugrozili napore planiranja i racionalizacije koje je nadležna država članica provela u osnovnom sektoru zdravstvene skrbi kako bi se izbjegli problemi prenatrpanosti bolnica, neuravnotežene ponude bolničkog liječenja te logističkih i financijskih gubitaka (vidjeti, u tom smislu, ranije navedenu presudu Smits i Peerbooms, t. 106., kao i Müller-Fauré i van Riet, t. 91.).
72 In the situation opposite to that referred to in paragraph 70 of the present judgment, however, the second condition set out in the second subparagraph of Article 22(2) of Regulation No 1408/71 must be regarded as satisfied.
72 Suprotno tome, u situaciji suprotnoj onoj iz točke 70. ove presude, drugi uvjet naveden u članku 22. stavku 2. drugom podstavku Uredbe br. 1408/71 treba smatrati zadovoljenim.
73 The fact that the cost of the hospital treatment envisaged in another Member State may be higher than it would have been had it been provided in a hospital covered by the national system in question cannot in such a case be a legitimate ground for refusing authorisation.
73 Činjenica da trošak bolničkog liječenja predviđenog u drugoj državi članici može biti veći nego da je liječenje obavljeno u ustanovi u okviru dotičnog nacionalnog sustava ne može u tom slučaju činiti opravdani razlog odbijanja odobrenja.
74 In such a situation, the fact that the grant of the authorisation sought would oblige a national health service such as that in issue in the main proceedings, which is characterised by free hospital treatment provided within its own establishments, to establish a financial mechanism so as to enable that service to satisfy the request for reimbursement from the institution of the host Member State and relating to the benefits in kind provided by that institution to the patient in question is also not a legitimate ground for refusing authorisation (see to that effect Müller-Fauré and van Riet, paragraph 105).
74 U takvoj situaciji, činjenica da bi davanje zatraženog odobrenja obvezivalo nacionalnu zdravstvenu službu poput one u glavnom postupku, koju karakterizira pružanje besplatnog bolničkog liječenja u okviru njezinih ustanova, na uspostavu financijskog mehanizma kako bi ta služba bila u mogućnosti udovoljiti zahtjevu za nadoknadu troškova od institucije u državi članici privremenog boravišta i koji se odnose na davanja u naravi koje ta institucija pruža dotičnom pacijentu, također ne može činiti opravdani razlog odbijanja odobrenja (vidjeti u tom smislu presudu Müller-Fauré i van Riet, t. 105.).
75 Contrary to the fears expressed by the United Kingdom Government in its written observations, the interpretation of the time referred to in the second subparagraph of Article 22(2) of Regulation No 1408/71, set out in paragraphs 59 to 72 of the present judgment, is not liable to undermine the national competent authorities’ power to manage the available hospital capacity in their territory by the use of waiting lists, provided that the existence of such lists does not prevent the taking account in each individual case of the medical circumstances and the clinical needs of the person concerned when he requests authorisation to receive hospital treatment in another Member State at the expense of the system with which he is registered.
75 Suprotno bojaznima koje je u svojim pisanim očitovanjima izrazila vlada Ujedinjene Kraljevine, tumačenje vremenskog razdoblja iz članka 22. stavka 2. drugog podstavka Uredbe br. 1408/71, koje proizlazi iz točaka 59. do 72. ove presude, ne ugrožava ovlasti nadležnih nacionalnih tijela da upravljaju raspoloživim bolničkim kapacitetima na njihovom državnom području putem lista čekanja, pod uvjetom da postojanje takvih lista ne sprečava razmatranje, u svakom pojedinačnom slučaju, zdravstvenog stanja i kliničkih potreba dotične osobe u trenutku kada traži odobrenje za ostvarivanje bolničkog liječenja u drugoj državi članici na trošak sustava pri kojem je registrirana.
76 Furthermore, the effect of such an interpretation is to preclude the national competent authorities from refusing to grant the authorisation sought by a patient whose case, in the light of an objective medical assessment, was sufficiently urgent to justify obtaining treatment in another Member State within a shorter period than that which would result from waiting lists reflecting general planning and management objectives, and within which the person concerned may hope to obtain the treatment in question in a local hospital covered by the national health service. It does not undermine, by contrast, the right of those authorities to withhold authorisation where there is no urgency arising from the clinical condition of the patient in question such as to make the waiting time arising from such objectives appear unreasonable in the light of that condition.
76 Osim toga, takvo tumačenje onemogućuje nadležnim nacionalnim tijelima odbijanje davanja odobrenja koje je zatražio pacijent čiji je slučaj, s obzirom na objektivnu medicinsku procjenu, toliko hitan da opravdava dobivanje liječenja u drugoj državi članici u vremenskom razdoblju kraćem od onoga koje bi proizašlo iz lista čekanja, odražavajući opće ciljeve planiranja i upravljanja i u kojem bi pacijent lako mogao očekivati dobivanje dotičnog liječenja u lokalnoj ustanovi obuhvaćenoj nacionalnom zdravstvenom službom. Suprotno tome, ne dovodi u pitanje pravo tih tijela da se usprotive davanju odobrenja kada kliničko stanje dotičnog pacijenta nije hitno na temelju čega bi vrijeme čekanja koje proizlazi iz tih ciljeva izgledalo nerazumno s obzirom na tu situaciju.
77 That interpretation is also not liable to lead to an exodus of patients who, having sufficient resources for that purpose, might seek to go to another Member State to obtain the hospital treatment at the subsequent expense of the national health service with which they are registered, regardless of medical need, within a shorter time than that within which that treatment can be provided to them in a national establishment covered by that service. It preserves the right of the competent institution to refuse the authorisation necessary for the assumption of the cost of the hospital treatment to be obtained in another Member State in the absence of particular circumstances justifying the view that the waiting time imposed on the person concerned exceeds the medically acceptable period in his particular case.
77 Takvo tumačenje ne bi prouzročilo egzodus pacijenata koji raspolažu s dovoljno sredstava za tu svrhu i mogli bi zatražiti odlazak u drugu državu članicu na bolničko liječenje na naknadni trošak nacionalne zdravstvene službe pri kojoj su registrirani, bez obzira na zdravstvenu nužnost, u vremenskom razdoblju kraćem od onoga u kojem im takvo liječenje može biti pruženo u nacionalnoj ustanovi obuhvaćenoj tom službom. Ono ostavlja pravo nadležnoj instituciji da odbije dati odobrenje potrebno za financiranje bolničkog liječenja obavljenog u drugoj državi članici u nedostatku posebnih okolnosti kojima se opravdava vrijeme čekanja nametnuto dotičnoj osobi, koje prekoračuje vrijeme čekanja medicinski prihvatljivo u njezinom konkretnom slučaju.
78 In the main proceedings, it is for the referring court to determine whether the waiting time invoked by the competent body of the NHS, and based on the planning objectives pursued by the United Kingdom authorities, in order to refuse the initial application for authorisation and the renewed request exceeded a medically acceptable period in the light of the patient’s particular condition and clinical needs at those respective times.
78 U glavnom postupku sud koji je uputio zahtjev treba provjeriti je li vrijeme čekanja na koje se poziva nadležno tijelo NHS-a i koje se temelji na ciljevima planiranja koje provode britanska tijela, s ciljem odbijanja prvotnog zahtjeva za odobrenje i ponovljenog zahtjeva, prekoračilo medicinski prihvatljivo razdoblje u pogledu pojedinačnog stanja i kliničkih potreba pacijenta u tim trenucima.
79 In the light of the foregoing, the answer to the fifth question must be that the second subparagraph of Article 22(2) of Regulation No 1408/71 must be interpreted as meaning that, in order to be entitled to refuse to grant the authorisation referred to in Article 22(1)(c)(i) of that regulation on the ground that there is a waiting time for hospital treatment, the competent institution is required to establish that that time does not exceed the period which is acceptable on the basis of an objective medical assessment of the clinical needs of the person concerned in the light of all of the factors characterising his medical condition at the time when the request for authorisation is made or renewed, as the case may be.
79 S obzirom na navedeno, na peto pitanje valja odgovoriti da članak 22. stavak 2. drugi podstavak Uredbe br. 1408/71 treba tumačiti tako da se, kako bi imala pravo odbiti odobrenje iz stavka 1. točke (c) alineje (i) tog članka na osnovi postojanja vremena čekanja na bolničko liječenje, od nadležne institucije zahtijeva utvrđivanje da to razdoblje ne prelazi prihvatljivo vremensko razdoblje na temelju objektivne medicinske procjene kliničkih potreba dotične osobe s obzirom na ukupnost čimbenika koji karakteriziraju njezino zdravstveno stanje u trenutku podnošenja zahtjeva za odobrenje ili ponovnog podnošenja takvog zahtjeva, ovisno o slučaju.
The first four questions
Prva četiri pitanja
80 By the first four questions, which it is convenient to consider together, the referring court asks essentially whether and in what circumstances an NHS patient is entitled under Article 49 EC to receive hospital treatment in another Member State at the expense of that national service.
80 Svojim prvim četirima pitanjima, koje valja razmotriti zajedno, sud koji je uputio zahtjev u biti pita ima li i u kojim okolnostima pacijent u okviru NHS-a pravo na temelju članka 49. UEZ-a na bolničko liječenje u drugoj državi članici na trošak te nacionalne službe.
81 The first question asks whether, given the particular characteristics of the NHS, a person residing in the United Kingdom is entitled under that article to receive hospital treatment in a Member State other than the United Kingdom at the expense of the NHS. As part of that question, the referring court asks in particular whether, in interpreting Article 49 EC in such a context, account should be taken, first, of the fact that there is no fund available to NHS bodies out of which such treatment may be paid for, and, second, of the fact that there is no duty on the NHS to pay for hospital treatment received by an NHS patient in a private hospital in England or Wales. It also asks whether the failure to request authorisation or notify the competent NHS body in advance has a bearing on the interpretation of Article 49 EC.
81 Prvim pitanjem pita se ima li, s obzirom na posebne značajke NHS-a, osoba s boravištem u Ujedinjenoj Kraljevini pravo, na temelju navedenog članka, na bolničko liječenje u drugoj državi članici osim u Ujedinjenoj Kraljevini na trošak NHS-a. U okviru toga pitanja sud koji je uputio zahtjev posebno se pita valja li za tumačenje članka 49. UEZ-a u tom kontekstu uzeti u obzir, s jedne strane, da tijela NHS-a ne raspolažu dovoljnim sredstvima iz kojih bi se takvo liječenje moglo platiti i, s druge strane, da NHS nije dužan platiti bolničko liječenje pacijentu u okviru NHS-a u privatnoj ustanovi u Engleskoj ili Walesu. Također želi znati utječe li nepodnošenje zahtjeva za odobrenje ili prethodne obavijesti nadležnom tijelu NHS-a na tumačenje članka 49. UEZ-a.
82 By the second question, the referring court asks whether, in order to answer the first question, it is necessary to determine whether hospital treatment provided by the NHS constitutes services within the meaning of Article 49 EC.
82 Drugim pitanjem sud koji je uputio zahtjev pita je li, kako bi se odgovorilo na prvo pitanje, potrebno utvrditi je li bolničko liječenje koje osigurava NHS pružanje usluga u smislu članka 49. UEZ-a.
83 By the third question, it asks, on the assumption that that provision is applicable, whether a series of factors which it lists may validly be relied upon by the national competent authorities in refusing to grant the prior authorisation necessary in order for the NHS to assume the costs of hospital treatment to be obtained in another Member State.
83 U trećem pitanju navodi, pod pretpostavkom da se ova zadnja odredba primjenjuje, mogu li se nadležna nacionalna tijela valjano pozvati na niz čimbenika koji se navode prilikom odbijanja davanja prethodnog odobrenja potrebnog kako bi NHS preuzeo troškove bolničkog liječenja planiranog u drugoj državi članici.
84 The fourth question, which coincides with the third, asks which factors may or must be taken into account in determining whether the hospital treatment required by the patient’s state of health may be provided without undue delay in an NHS establishment and whether, consequently, the authorisation sought by that patient for reimbursement of the cost of treatment to be obtained in another Member State may be refused by the competent institution.
84 Četvrtim pitanjem, koje se podudara s trećim, pita se koji se čimbenici mogu ili moraju uzeti u obzir prilikom utvrđivanja može li se bolničko liječenje koje zahtijeva zdravstveno stanje pacijenta pružiti bez neopravdanog kašnjenja u ustanovi u okviru NHS-a i može li, posljedično, nadležna institucija odbiti odobrenje koje je zatražio pacijent za nadoknadu troškova liječenja planiranog u drugoj državi članici.
85 In order to answer those questions, it is first necessary to determine whether Article 49 EC applies to facts such as those in issue in the main proceedings.
85 Kako bi se odgovorilo na ova pitanja, prvo valja utvrditi primjenjuje li se članak 49. UEZ-a na činjenice poput onih u glavnom postupku.
"86 It should be noted in that regard that, according to settled case-law, medical services provided for consideration fall within the scope of the provisions on the freedom to provide services (see, inter alia, Case C-159/90 Society for the Protection of Unborn Children Ireland [1991] ECR I-4685, paragraph 18, and Kohll, paragraph 29), there being no need to distinguish between care provided in a hospital environment and care provided outside such an environment (Vanbraekel, paragraph 41; Smits and Peerbooms, paragraph 53; Müller-Fauré and van Riet, paragraph 38; and Inizan, paragraph 16)."
"86 U tom pogledu valja podsjetiti da prema ustaljenoj sudskoj praksi zdravstvene usluge obavljene uz naknadu ulaze u područje primjene odredaba o slobodnom pružanju usluga (vidjeti posebno presudu od 4. listopada 1991., Society for the Protection of Unborn Children Ireland, C-159/90, Zb., str. I-4685., t. 18., kao i onu ranije navedenu, Kohll, t. 29.), bez potrebe za razlikovanjem između skrbi pružene u bolničkom okruženju i skrbi pružene izvan takvog okruženja (ranije navedena presuda Vanbraekel i dr., t. 41.; Smits i Peerbooms, t. 53.; Müller-Fauré i van Riet, t. 38., te Inizan, t. 16.)."
87 It has also been held that the freedom to provide services includes the freedom for the recipients of services, including persons in need of medical treatment, to go to another Member State in order to receive those services there (see Joined Cases 286/82 and 26/83 Luisi and Carbone [1984] ECR 377, paragraph 16).
87 Također je presudio da slobodno pružanje usluga obuhvaća slobodu primatelja usluga, prije svega osobe kojima je potrebno liječenje, na odlazak u drugu državu članicu kako bi tamo obavile te usluge (vidjeti presudu od 31. siječnja 1984., Luisi i Carbone, spojeni predmeti 286/82 i 26/83, Zb., str. 377., t. 16.).
88 It should be noted as regards the main proceedings that the establishment in another Member State in which Mrs Watts received treatment was paid by her directly.
88 U pogledu spora u glavnom postupku treba napomenuti da je Y. Watts izravno platila ustanovi u drugoj državi članici u kojoj je obavila liječenje.
89 The fact that reimbursement of the hospital treatment in question is subsequently sought from a national health service such as that in question in the main proceedings does not mean that the rules on the freedom to provide services guaranteed by the Treaty do not apply (see to that effect Smits and Peerbooms, paragraph 55, and Müller-Fauré and van Riet, paragraph 39). It has already been held that a supply of medical services does not cease to be a supply of services within the meaning of Article 49 EC on the ground that the patient, after paying the foreign supplier for the treatment received, subsequently seeks the reimbursement of that treatment from a national health service (see Müller-Fauré and van Riet, paragraph 103).
89 Okolnost da je nadoknada troškova dotičnog bolničkog liječenja naknadno zatražena od nacionalne zdravstvene službe poput one u predmetu u glavnom postupku ne isključuje primjenu pravila slobodnog pružanja usluga zajamčenog Ugovorom (vidjeti, u tom smislu, ranije navedenu presudu Smits i Peerbooms, t. 55., kao i Müller-Fauré i van Riet, t. 39.). Sud je već presudio da pružanje zdravstvenih usluga ne prestaje biti pružanje usluga u smislu članka 49. UEZ-a na osnovi toga što je pacijent, nakon plaćanja stranom davatelju usluga za ostvareno liječenje, naknadno zatražio da troškove to liječenja pokrije nacionalna zdravstvena služba (vidjeti prethodno navedenu presudu Müller-Fauré i van Riet, t. 103.).
90 It must therefore be found that Article 49 EC applies where a patient such as Mrs Watts receives medical services in a hospital environment for consideration in a Member State other than her State of residence, regardless of the way in which the national system with which that person is registered and from which reimbursement of the cost of those services is subsequently sought operates.
90 Stoga valja ustanoviti da se članak 49. UEZ-a primjenjuje u slučaju kada pacijent poput Y. Watts ostvari zdravstvene usluge u bolničkom okruženju uz naknadu u drugoj državi članici, a ne u državi njegovog boravišta, bez obzira na način funkcioniranja nacionalnog sustava pri kojem je ta osoba registrirana i od kojeg je naknadno zatražena nadoknada troškova za te usluge.
91 It must therefore be found that a situation such as that which gave rise to the dispute in the main proceedings, in which a person whose state of health necessitates hospital treatment goes to another Member State and there receives the treatment in question for consideration, falls within the scope of the Treaty provisions on the freedom to provide services, there being no need in the present case to determine whether the provision of hospital treatment in the context of a national health service such as the NHS is in itself a service within the meaning of those provisions.
91 U ovom slučaju ne treba utvrditi jesu li usluge bolničkog liječenja pružene u okviru nacionalne zdravstvene službe poput NHS-a usluge u smislu odredaba Ugovora o slobodi pružanja usluga, stoga valja utvrditi da situacija poput one koja je dovela do spora u glavnom postupku, kada osoba čije zdravstveno stanje zahtijeva odlazak na bolničko liječenje u drugu državu članicu i tamo obavi dotično liječenje uz naknadu, ulazi u područje primjene navedenih odredaba.