natgillin/translations-raw huggingface dataset:
The Brussels Court also noted that if the CPAS concerned (i.e. in the case at hand that of Uccle) had created its own psychiatric hospital or had concluded an agreement with such a hospital, the private hospital in question would not have had to provide care to the undocumented migrant in question but could instead have asked for his transfer to that hospital.
V strateškem načrtu združenja IRIS za obdobje 2002–2014 so ponovljena nekatera temeljna načela (dostop vsem pacientom, povečanje dostopa za revne), med drugim s sklicevanjem na člen 5 statutov bolnišnic IRIS [208] (glej tudi uvodno izjavo 175) in glavni cilj strateškega načrta združenja IRIS za obdobje 1996–2001 [209] (glej uvodno izjavo 177) ter listino o pacientovih pravicah [210] (glej uvodno izjavo 178), in v njem je poleg tega navedeno:
Since this was not the case, there was no alternative available and as a result the CPAS was ordered to pay the private hospital for the care provided to the patient.
„Javne storitve se opredelijo na podlagi treh temeljnih načel, in sicer univerzalnosti, enakosti in kontinuitete.
As a result, all that can be concluded from the Brussels Court judgment cited by the complainants is that in some cases, owing to the urgency, private hospitals may also provide urgent medical aid to undocumented migrants and that the CPAS, where their obligation to provide urgent medical aid is discharged in this specific way, have to pay these private hospitals.
Na podlagi navedenih treh načel in njihovega statusa javne bolnišnice bodo bolnišnice v omrežju IRIS:
Therefore, the fact that in a limited number [194] of cases urgent medical aid can be provided by the Brussels private hospitals cannot be interpreted as a general obligation for these hospitals to treat all patients regardless of their ability to pay.
sprejele vse paciente, ne glede na to, kdo so;
Third, with regard to the principle of non-discrimination (mentioned by the complainants, see recital 170) it is clear that no hospital in Belgium is allowed to discriminate based on a patient's wealth (and hence on the pure fact that they are rich or poor) nor on any other personal criterion (e.g. religion or ethnic background).
zdravile vse paciente brez diskriminacije;
However, in a non-emergency situation, the non-discrimination principle cannot force hospitals to provide care for free if it is clearly foreseeable that a patient will not be able to pay.
se zavezale, da bodo pacientom zagotovile kritje in kakršno koli zdravljenje, ki bi ga lahko potrebovali“ [211].(182) Komisija na podlagi navedenega ugotavlja, da morajo bolnišnice IRIS zdraviti vse paciente v vseh okoliščinah (tj. v nujnih in nenujnih primerih), tudi če ne morejo ali predvidoma ne bodo mogli plačati svojega zdravljenja in/ali niso zavarovani.
If these conditions are fulfilled in non-emergency situations, there is an objective justification for hospitals to differentiate by refusing these patients [195].
Ta obveznost je določena in naložena bolnišnicam IRIS v navedenih statutih bolnišnic IRIS in strateških načrtih združenja IRIS, ki so za bolnišnice IRIS zavezujoči in temeljijo na obveznosti zagotavljanja socialne pomoči iz zakona o CPAS (obveznosti, ki so jo CPAS bolnišnicam IRIS naložili s temi statuti in strateškimi načrti).
As indicated above (see recital 171) the deontology code that applies to Belgian doctors explicitly allows them to refuse patients in non-emergency situations.
Dejanski učinek obveznosti zagotavljanja splošnega zdravstvenega varstva na bolnišnice IRIS
A survey of debt counsellors [196] furthermore indicates that doctors and hospitals sometimes refuse patients who had difficulties paying for treatment in the past.
Komisija ugotavlja tudi, da se navedena ugotovitev, tj. da morajo bolnišnice IRIS zdraviti vse paciente v vseh okoliščinah (tj. v nujnih in nenujnih primerih) in ne glede na plačilno sposobnost pacientov, medtem ko morajo zasebne bolnišnice zdraviti vse paciente le v nujnih primerih (tj. ko je zaradi življenjsko nevarnega stanja potrebna takojšnja oskrba), kaže tudi v različnih profilih pacientov, ki jih zdravijo bolnišnice IRIS in zasebne bolnišnice v regiji glavnega mesta Bruselj ter njihovih zadevnih cenovnih politikah.
In this context, it is worth pointing out that hospitals do not per se bluntly refuse patients but request them to pay an advance which can be a deterrent for those who are poor.
Najprej je treba opozoriti, da so v strateškem načrtu za obdobje 2002–2014 navedeni tudi nižji prihodki [212] in višji stroški [213], povezani z zdravljenjem pacientov, ki so v negotovem socialno-ekonomskem položaju in ki sestavljajo velik del pacientov bolnišnic IRIS.
There is also anecdotal evidence suggesting that private hospitals sometimes refer patients to a CPAS hospital for treatment [197].
V zvezi s tem je treba poudariti, da so se bolnišnice IRIS s svojimi zdravniki dogovorile, da se dodatki (za ozadje glej uvodno izjavo 46(c)) ne smejo zaračunati pacientom CPAS in pacientom z nizkim prihodkom (tj. tistim, ki so upravičeni do višjega povračila inštituta INAMI).
For these reasons, in 2013 a law was proposed (but not adopted) in the Belgian Senate to exclude the refusal of healthcare provision due to the financial difficulties of patients and which would also prohibit charging advances [198].
Poleg tega je odstotek sprejemov v zasebne sobe (tj. edine sobe, za katere se lahko zaračuna dodatek) precej pod povprečjem regije glavnega mesta Bruselj [214].
The non-discrimination principle can hence not be invoked as entrusting all Belgian hospitals (public and private) with an obligation to treat all patients in all circumstances (i.e. outside emergency situations) even if patients cannot pay for the treatment.
Iz razpoložljivih podatkov ene od organizacij mutuelles [215] je razvidno tudi, da je znesek dodatka, kadar ga zaračunajo bolnišnice IRIS, tudi precej nižji od povprečja regije (tj. za 25–67 %).
From the above, the Commission concludes that it is appropriate to distinguish between emergency and non-emergency situations.
Za primerjavo, v zadevnem obdobju so nekatere bolnišnice v Bruslju svojim pacientom zaračunale v povprečju 180 % višje cene od cen, ki jih je določil sistem socialne varnosti.
In emergency situations, public and private hospitals are equally subject to the general obligation (based on the Belgian Criminal Code) to treat patients in a situation of medical emergency.
Obveznost zagotavljanja splošnega zdravstvenega varstva je bila bolnišnicam IRIS naložena, da se zagotovi potrebna zdravstvena oskrba pacientom, ki je ne morejo plačati, nimajo zasebnega zavarovanja in za katere se stroški ne bodo povrnili iz socialnega zavarovanja (ali pa se bodo povrnili le delno).
However, there is no legal basis which obliges or entrusts the private hospitals to treat patients also in non-emergency situations and regardless of their ability to pay.
V pomembno podskupino teh pacientov spadajo navedeni migranti brez dokumentov, saj nimajo belgijskega socialnega zavarovanja in običajno ne morejo sami plačati oskrbe.
Indeed, neither the LCH nor the Criminal Code contain such an obligation and the non-discrimination principle can also not be considered as entrusting such an obligation.
V 85 % primerov v regiji glavnega mesta Bruselj ti migranti prejmejo nujno zdravstveno oskrbo v bolnišnicah IRIS (glej uvodno izjavo 172), čeprav te bolnišnice upravljajo le 35 % bolnišničnih postelj v navedeni regiji.
Finally, the obligation to provide urgent medical aid to undocumented migrants applies to the CPAS, not to the hospitals that deliver such care.
Drugi zgovorni kazalnik je razvrstitev [216] vseh belgijskih bolnišnic, ki jo zvezna javna služba za javno zdravje izvede na podlagi socialno-ekonomskega profila svojih pacientov (glej preglednico 1 v nadaljevanju in uvodno izjavo 40).
The universal care obligation incumbent on the IRIS-H
Iz te razvrstitve je med drugim razviden delež pacientov, ki ne morejo plačati in nimajo socialnega zavarovanja ter za katere lahko CPAS [217] povrne stroške zdravljenja (glej tudi uvodni izjavi 187 in 188) [218].
In contrast to the private hospitals, however, the IRIS-H are obliged [199] to treat all patients in all circumstances, including in non-emergency situations, regardless of patients' ability to pay and/or their insurance status on the basis of the specific rules applying only to the IRIS-H, namely their bylaws and the IRIS strategic plans as specified below.
Prva tri mesta v tej razvrstitvi za obdobje 2007–2013 in celotno Belgijo v celoti zasedajo bolnišnice IRIS (Institut Bordet in HUDERF sta izjemi zaradi svoje specializirane narave).
As explained above (see recital 24), the IRIS-H were established by the CPAS to allow the latter to fulfil their task to provide social aid to everyone who needs it.
V enakem obdobju bruseljske zasebne bolnišnice niso niti na prvih 20 mestih, kar pomeni, da je povprečni socialno-ekonomski profil njihovih pacientov precej boljši od profila pacientov bolnišnic IRIS.
The CPAS are obliged to provide such aid (including medical and socio-medical care) to all individuals and families who require it [200].
Čeprav se merila, uporabljena za pripravo te razvrstitve, ne nanašajo le na paciente, ki ne morejo plačati ali niso zavarovani, se zato pojavijo pomisleki zaradi trditve pritožnika, da morajo bruseljske zasebne bolnišnice zdraviti vse paciente v vseh okoliščinah, razvrstitev pa je dodatni dokaz, da imajo namesto tega tako obveznost le bolnišnice IRIS.
The CPAS provide their services for free and were created in particular to help the poor and needy.
Če bi taka obveznost dejansko veljala za bruseljske zasebne bolnišnice, bi lahko pričakovali, da se bodo uvrstile na višja mesta.
In this context, Article 5 of the IRIS-H bylaws states:
Preglednica 1
Without prejudice to the competences of the IRIS umbrella association and the competences of IRIS-Achats [procurement branch] and of any other bodies that the umbrella association might set up pursuant to Article 135 undecies of the Organic Law of 8 July 1976 on Public Social Assistance Centres and in accordance with the laws and regulations, the association shall have the most extensive powers in the exercise of its hospital mission.
Razvrstitev bolnišnic na podlagi socialno-ekonomskega profila njihovih pacientov, ki jo je pripravila zvezna javna služba za javno zdravje (* = bolnišnice IRIS, + = zasebne bruseljske bolnišnice)
It shall exercise that mission with a view, firstly, to providing quality medical care at optimum cost for everyone, irrespective of their income, insurability, origins and philosophical beliefs, and, secondly, to establishing a sustainable financial equilibrium for the association’ [201].
Ni podatkov.
Likewise, the introduction to the IRIS strategic plan 1996-2001 mentions:
Pritožnikovo sklicevanje na publikacijo Mutualités Chrétiennes iz februarja 2004 (glej uvodno izjavo 72), ki se nanaša le na leto 2001 in naj bi dokazala, da zasebne bolnišnice zdravijo več kot 60 % „socialnih pacientov“ v regiji glavnega mesta Bruselj, je treba umestiti v kontekst.
‘In order to fulfil its social task at any moment, the public hospitals of the IRIS network will offer a range of services guaranteeing to everyone the best quality care at generally acceptable financial conditions for all and will be accessible to all patients, regardless of their income, their insurability, their origins and their ideological convictions’ [202].(177) That same introduction continues:
Na podlagi izraza „socialni pacienti“ je mogoče sklepati, da se nanaša na paciente, ki ne morejo plačati zdravljenja in bi zato spadali na področje uporabe obveznosti zagotavljanja splošnega zdravstvenega varstva.
‘The primary objective of the IRIS plan is to maintain a reinforced public hospital network in Brussels that is accessible to all patients, regardless of their income, their insurability, their origins and their ideological and philosophical convictions’ [203].(178) In another section of this plan it is noted that the IRIS patient charter guarantees:
Vendar to ne drži iz naslednjih razlogov:
‘access for all patients, without distinction as to their origins, income, philosophical and ideological convictions, their situation of insurability’ [204].(179) Furthermore, the IRIS strategic plan 1996-2001 has a subsection 2.5.4 entitled ‘Prise en charge et traitement de toute personne se présentant dans un des hôpitaux du réseau iris’ which contains the following statements:
opredelitev „socialnih pacientov“ [219] v publikaciji se nanaša le na osebe, ki imajo belgijsko socialno zavarovanje [220], in torej ne vključuje pacientov, ki ne morejo plačati in nimajo socialnega zavarovanja.
‘Public hospitals [i.e. the IRIS-H] have the basic aim of providing a social medicine; it requires them to meet the requirements of social missions, and this even if this function is not recognised in the legislative and regulatory framework governing the hospital sector.
Vendar je slednja skupina tista, ki ima največ koristi od obveznosti zagotavljanja splošnega zdravstvenega varstva in je največje finančno breme za bolnišnice IRIS (glej tudi uvodni izjavi 187 in 188).
The role of the public hospitals is to admit and treat all patients irrespective of their origins, circumstances, cultures, beliefs and pathologies.
Na podlagi široke opredelitve pojma, uporabljene v publikaciji, bi se skoraj 20 % (oziroma okoli 26 %) sprejemov v zasebne (oziroma javne) bolnišnice v Bruslju nanašalo na „socialne paciente“ in zasebne bolnišnice bi leta 2001 zdravile skoraj 66 % vseh teh pacientov,
Hence, since they are public, our hospitals must adhere to the principles of universality, equality, continuity and change.
tudi „prekarni pacienti“ [221], ki so v publikaciji opredeljeni kot podskupina „socialnih pacientov“, imajo socialno zavarovanje in ni razloga za predpostavko, da ne morejo plačati lastnega prispevka.
The universality principle requires that all patients be admitted, whoever they may be.
Vendar bi lahko trdili, da pri takih „prekarnih pacientih“ obstaja večja verjetnost, da bolnišnici ne bodo mogli plačati lastnega prispevka.
The hospital must therefore provide treatment at the highest possible level in order to be able to meet the needs of all.
Iz publikacije je razvidno, da javne bolnišnice zdravijo približno 48 % „prekarnih pacientov“ v primerjavi z 52 %, ki jih zdravijo zasebne bruseljske bolnišnice.
The equality principle, a constitutional right, requires that everyone be admitted without any discrimination.
Vendar sorazmerno javne bolnišnice zdravijo precej večje število takih pacientov, kot bi se pričakovalo na podlagi njihovega tržnega deleža (kar zadeva postelje in število sprejemov).
From the above it is clear that patients' ability to pay and their insurance status are not considered when admitting patients to the IRIS-H so that access to healthcare is guaranteed for all including in non-emergency situations.
Dejansko bi „prekarni pacienti“ obsegali 9,5 % sprejemov v javnih bolnišnicah v primerjavi z le 4,1 % v zasebnih bolnišnicah,
Several elements in the IRIS 1996-2001 strategic plan also demonstrate the social nature of the hospital care provided by the IRIS-H (e.g. ‘to continue the dispensation of medicine devoid of any market logic’ [206]) and the strong desire to offer quality care to all layers of the Brussels population, in particular to the poorest ones [207].
pripomba, da bi leta 2001 bruseljske zasebne bolnišnice zdravile 52 % (oziroma 66 %) „prekarnih“ (oziroma „socialnih“) pacientov, nikakor ne more vplivati na ugotovitev, da obveznost zagotavljanja splošnega zdravstvenega varstva velja le za bolnišnice IRIS.
The IRIS strategic plan covering the period 2002-2014 repeats some of the key principles (access for all patients, increasing accessibility for the poor) among others by quoting Article 5 of the IRIS-H bylaws [208] (see also recital 175) and the primary objective of the IRIS strategic plan for the period 1996-2001 [209] (see recital 177), and by also referring to the IRIS patient charter [210] (see recital 178) and adds:
Ker zasebne bolnišnice niso pravno zavezane zdravljenju vseh pacientov ne glede na njihovo plačilno sposobnost in njihovo zavarovanje, bi bila vsaka morebitna odločitev zasebnih bolnišnic, da zagotovijo oskrbo „prekarnim“ ali „socialnim“ pacientom v nenujnih primerih, popolnoma prostovoljna in bi jo bilo mogoče kadar koli spremeniti.
‘The public services are to be defined on the basis of three fundamental principles, universality, equality and continuity.
Poleg tega najranljivejša skupina pacientov, tj. pacienti, ki nimajo socialnega ali kakšnega drugega zavarovanja, v publikaciji ni vključena v statistične podatke.
will accept all patients, whoever they may be,
Obveznost zagotavljanja splošnega zdravstvenega varstva, ki je naložena bolnišnicam IRIS, zagotavlja, da se lahko pacienti, ki se soočajo z velikimi finančnimi težavami, politični begunci, nezakoniti priseljenci in druge osebe zdravijo v vseh okoliščinah.
will treat all patients without discrimination,
Če ti pacienti ne morejo plačati zdravljenja in niso zavarovani (nimajo socialnega ali zasebnega zdravstvenega zavarovanja), CPAS krije stroške teh pacientov le, če so izpolnjeni določeni pogoji.
will undertake to arrange cover for patients and provide any treatment they might require’ [211].(182) On the basis of the foregoing, the Commission concludes that the IRIS-H are obliged to treat all patients, in all circumstances (i.e. both in emergency and non-emergency situations), even if they cannot or foreseeably will not be able to pay for their treatment and/or are uninsured.
Da bi določili pravila, ki veljajo za takšno povračilo, so bolnišnice IRIS in 17 od 19 CPAS v regiji glavnega mesta Bruselj sklenili t. i. večstranske sporazume domicile de secours.
This obligation is laid down and entrusted to the IRIS-H in the above cited bylaws of the IRIS-H and the IRIS strategic plans which are binding on the IRIS-H and which are founded on the obligation in the Loi CPAS to provide social aid (an obligation which is delegated by the CPAS to the IRIS-H by means of these bylaws and strategic plans).
Za nenujno oskrbo CPAS napotijo osebe v bolnišnice IRIS in zagotovijo pisno zavezo (t. i. réquisitoire), da bodo krili stroške zdravljenja.
Practical impact of the universal care obligation on the IRIS-H
Če pacient pokaže ta dokument (réquisitoire), bolnišnice IRIS račun pošljejo neposredno CPAS.
The Commission also notes that the above conclusion, namely that the IRIS-H are obliged to treat all patients in all circumstances (i.e. both in emergency and non-emergency situations) and regardless of patients' ability to pay, while the private hospitals are only obliged to treat all patients in emergency situations (i.e. when care is needed immediately for a life-threatening condition), is furthermore reflected in the different profiles of the patients treated by the IRIS-H and the private hospitals in the Brussels Capital Region and their respective pricing policies.
V primeru nujne zdravstvene oskrbe tega postopka seveda ni mogoče upoštevati.
It should first be noted that the 2002-2014 strategic plan also refers to the lower revenues [212] and higher costs [213] related to the treatment of patients who socioeconomically find themselves in a precarious situation, and who make up a significant part of patients of the IRIS-H.
Namesto tega je povračilo CPAS odvisno od (i) zdravniškega potrdila, da je bil potreben nujni sprejem ali takojšnje zdravljenje osebe, in (ii) socialno šibkega položaja osebe, kot ga potrdi CPAS na podlagi informacij, ki jih je bolnišnica zbrala v okviru poizvedbe o socialnem položaju.
In this context, it is worth pointing out that the IRIS-H have agreed with their doctors that supplements (see recital 46(c) for more background) cannot be charged to CPAS patients and to patients with low incomes (i.e. who are entitled to a higher INAMI reimbursement).
Zbiranje potrebnih informacij je pomembna naloga oddelkov socialne službe bolnišnic IRIS (glej tudi uvodni izjavi 210 in 211) [222].
In addition, the percentage of admissions to single rooms (i.e. the only rooms where supplements can be charged) is well below the average for the Brussels Capital Region [214].
Če so navedeni pogoji izpolnjeni (tj. réquisitoire za nenujno oskrbo ter zdravniško potrdilo in poizvedba o socialnem položaju za nujno oskrbo), CPAS bolnišnicam IRIS povrne stroške zdravljenja pacientov, ki ne morejo plačati zdravljenja in niso zavarovani.
The available figures from one of the mutuelles [215] also show that when a supplement is charged by the IRIS-H, its amount is also much lower than the average for the Region (i.e. between 25 % and 67 % lower).
Vendar zato bolnišnice IRIS niso v celoti razbremenjene obveznosti zagotavljanja splošnega zdravstvenega varstva.
In comparison, for the period in question some private hospitals in Brussels charged their patients on average 180 % more than the prices laid down by the social security system.
Da bi namreč pridobile povračilo CPAS, morajo zbrati informacije za poizvedbo o socialnem položaju (kar so tudi storile za 25749 primerov leta 2012).
The universal care obligation has been entrusted to the IRIS-H to ensure that patients who cannot pay, have no private insurance and for whom there may not be any (or only partial) reimbursement by the social security, receive the medical care they need.
To je eden od razlogov, zakaj je v bolnišnicah IRIS zaposlenih več kot dvakrat toliko socialnih delavcev kot na primer v univerzitetnih bolnišnicah (glej uvodno izjavo 213).
One significant subgroup of these patients concern the abovementioned undocumented migrants as they are not covered by the Belgian social security and usually are not able to pay themselves for care.
Vendar pa CPAS bolnišnicam IRIS ne povrnejo stroškov zbiranja informacij za poizvedbe o socialnem položaju [223].
In 85 % of the cases in the Brussels Capital Region these migrants receive urgent medical aid from the IRIS-H (see recital 172) although these hospitals only operate 35 % of the hospital beds in that Region.
Poleg tega imajo CPAS večje zamude pri plačilu (včasih več kot eno leto) kot organizacije mutuelles in zavarovalnice (oboji plačajo račun v mesecu ali dveh po njegovem prejemu).
This ranking among others reflects the proportion of patients who cannot pay and are not covered by the social security and for which the CPAS [217] can reimburse the costs of treatment (see also recitals 187-188) [218].
Bruseljski CPAS so 31. decembra 2010 bolnišnicam IRIS dolgovali skoraj 35 milijonov EUR (od tega se je skoraj 71 % zneska nanašalo na račune za leto 2010, 12 % za leto 2009 in približno 13 % za leta poprej).
For the period 2007-2013 and for Belgium as a whole, this ranking's top three positions are occupied entirely by the IRIS-H (Institut Bordet and HUDERF being the exceptions due to their specialised nature).
Bolnišnice IRIS so z uporabo 2-odstotne letne obrestne mere ocenile, da so takrat stroški večjih zamud pri plačilu znašali skoraj 700000 EUR [224].
For the same period, the Brussels private hospitals on the other hand are not even part of the top 20 positions, which indicates that the average socioeconomic profile of their patients is significantly better than that of the IRIS-H.
Poleg tega do kritja CPAS niso upravičene vse osebe, ki imajo morda težave s plačilom računa [225].
Even though the criteria used to draw up this ranking do not only concern patients who cannot pay or who are uninsured, it does further put into doubt the complainant's claim that the Brussels private hospitals have an obligation to treat all patients in all circumstances and is further evidence that instead only the IRIS-H have such an obligation.
Bolnišnice IRIS na podlagi svoje obveznosti zagotavljanja splošnega zdravstvenega varstva kljub temu zdravijo paciente, za katere nimajo nobenega zagotovila, da bo CPAS plačal stroške.
Indeed, if such an obligation applied to the Brussels private hospitals one could expect them to rank higher in the classification.
V takih primerih pošljejo račun pacientom, ki ga v nekaterih primerih ne bodo mogli plačati.
Table 1
Zato morajo bolnišnice IRIS reševati težavo neizterljivega dolga, ki je precej višji od dolga drugih javnih bolnišnic in zasebnih bolnišnic v Belgiji [226].