natgillin/translations-raw huggingface dataset:
However, the Commission notes that the principle of non-discrimination is not mentioned as a compatibility criterion in the 2012 SGEI Decision.
Storitev splošnega gospodarskega pomena zagotavljanja socialnega zdravstvenega varstva: Javni status (dvojezičnost, uradniki …)
Nevertheless, the Commission will assess whether or not the public IRIS-H and the private Brussels hospitals are in a legally and factually comparable or different situation.
Zasebne bolnišnice
In this context, when describing the content of the public service obligations that are entrusted to the IRIS-H, the Commission will indicate whether or not a comparable obligation has been entrusted to the private Brussels hospitals.
Javne bolnišnice IRIS
As has been explained above (see Section 2.3), the IRIS-H are subject to a regulatory framework which consists of the Loi CPAS (on which basis the IRIS-H were created), the LCH, the bylaws of the local hospital associations, and the strategic plans adopted by the IRIS umbrella organisation.
Osnovna bolnišnična naloga (zakon LCH)
Since the public authorities (i.e. the municipalities and CPAS) have majority control on the Chapter XII Loi CPAS local associations and the IRIS umbrella organisation, both the bylaws and strategic plans are binding on the IRIS-H and hence qualify to be valid entrustment acts, the content of which will be specified below (see recitals 164, 170 et seq.).
Dodatna socialna obveznost
In this context, it is also worthwhile to point out that the public authorities can directly monitor the day-to-day operation of the IRIS-H and provide further instructions where necessary.
Ker zadevne tri dodatne obveznosti opravljanja storitev splošnega gospodarskega pomena presegajo minimalne zahteve, ki veljajo za vse bolnišnice (javne ali zasebne v Belgiji), zaradi njih nastanejo stroški, ki se ne krijejo ali pa se le delno krijejo v okviru proračuna finančnih sredstev (glej oddelek 2.5.1) in sistema socialne varnosti.
It was also noted (see recital 24) that the IRIS-H were initially managed and controlled directly by the CPAS who had created these hospitals to help fulfil their social aid obligation in line with the Loi CPAS.
Zadevni bruseljski CPAS želijo in morajo [190] zagotoviti kontinuiteto (pérennité) svojih bolnišnic IRIS, da se zagotovi opravljanje storitev splošnega gospodarskega pomena zagotavljanja socialnega zdravstvenega varstva in izpolnijo obveznosti zagotavljanja socialne pomoči CPAS (glej tudi oddelek 2.2).
To ensure the continuity and viability of the Brussels public hospitals (see recital 24), a restructuring was necessary which resulted in the creation of the IRIS-H (which took the form of Chapter XII Loi CPAS local associations with financial and legal independence).
Zato zagotovijo popolno kritje primanjkljaja, s katerim nadomestijo preostale stroške storitev splošnega gospodarskega pomena zagotavljanja socialnega zdravstvenega varstva (ki obsegajo osnovno bolnišnično nalogo in tri dodatne obveznosti opravljanja storitev splošnega gospodarskega pomena) [191], s čimer zagotovijo pérennité bolnišnic IRIS (glej uvodno izjavo 91).
The medical care provided by the IRIS-H is also shaped by the LCH which sets the relevant framework for the organisation of the Belgian hospital sector as a whole.
Zato je primerno izvesti preskuse glede prekomernega nadomestila, ki so opisani v nadaljevanju (glej preglednice od 9 do 13 v oddelku 7.3.5) na skupni podlagi (tj. za vse različne storitve splošnega gospodarskega pomena skupaj).
Articles 23 to 45 LCH determine the requirements concerning the hospital programming mechanism which sets limits to the number of hospital beds, hospital services and certain medical equipment (such as scanners) that can be put and kept in operation.
Poleg tega je izpostavljeno tudi, kako so te dodatne obveznosti opravljanja storitev splošnega gospodarskega pomena medsebojno povezane in kako prispevajo k storitvi splošnega gospodarskega pomena zagotavljanja socialnega zdravstvenega varstva.
Only authorised hospital services that meet the programming conditions are eligible for public financing.
I. Obveznost zdravljenja vseh pacientov v vseh okoliščinah ne glede na njihovo plačilno sposobnost (obveznost zagotavljanja splošnega zdravstvenega varstva)
This however does not have to mean that the basic hospital mission and the additional SGEI are necessarily to be assessed in isolation from each other.
Po njihovem mnenju so javne in zasebne bolnišnice enako zavezane k zdravljenju pacientov v primerih, ko je potrebno urgentno in „posturgentno“ zdravljenje.
In this respect, it was mentioned in recital 23 of the opening decision that the Belgian authorities argued that the basic hospital mission is part of, or complementary to, a larger SGEI, namely the obligation to provide social aid as required by the Loi CPAS.
Komisija ugotavlja zlasti, da zakon LCH ne vsebuje nobenega besedila, ki ga je mogoče razumeti tako, da bolnišnice (javne ali zasebne) zavezuje k zdravljenju pacientov v vseh okoliščinah in ne glede na njihovo plačilno sposobnost.
Against this backdrop, the Commission considers that the basic hospital mission entrusted to all hospitals under the LCH and the three additional SGEI obligations entrusted [189] only to the IRIS-H together de facto form one ‘social healthcare SGEI’ which is specific to the IRIS-H and performed only by them.
Vendar na podlagi belgijskega prava obstaja splošna obveznost pomoči osebam v nevarnosti.
Indeed, the additional SGEI obligations on the one hand are grounded in and build upon the IRIS-H's basic hospital mission under the LCH and on the other hand also significantly go beyond this basic obligation by obliging the IRIS-H (1) to deliver a wide range of healthcare services to everybody regardless of their ability to pay (universal care, see recitals 170-190); (2) at multiple hospital sites (ensuring proximity care, see recitals 191-204); while (3) attaching special attention to the social needs of the patients (via additional social services, see recitals 205-214).
Bolnišnice morajo torej zagotoviti pomoč v primerih nujne medicinske pomoči v skladu s svojo organizacijo in razpoložljivim strokovnim znanjem.
In relation to the basic hospital mission entrusted under the LCH (see recital 164), the three additional obligations cannot be considered standalone activities, as is clear from the fact that these obligations would never have been entrusted without the foundational obligation under the LCH to provide the basic hospital mission.
Zato ni dvoma, da morajo bruseljske javne in zasebne bolnišnice zdraviti paciente v nujnih primerih ne glede na njihovo plačilno sposobnost.
Finally, this approach is to some extent also confirmed by the complainants when making the argument (see recital 71) that the additional social services cannot be separated from a broader healthcare service.
Podobno deontološki kodeks, ki velja za zdravnike, tem izrecno dovoljuje, da zavrnejo paciente, razen v nujnih primerih [192].
With regard to the approach developed in the foregoing (see recitals 162-166), the Commission would like to underline the following three points.
Pritožniki so se sklicevali na sodbo bruseljskega sodišča prve stopnje [193], da bi utemeljili, da ni razlike med javnimi in zasebnimi bolnišnicami glede zdravljenja „socialnih pacientov“ v primeru „urgentnega“ ali „posturgentnega“ zdravljenja.
First, the social healthcare SGEI which is performed by the IRIS-H consists of no more than the basic hospital mission entrusted to them (see recital 164) and the three additional SGEI obligations entrusted to them (see recitals 170 et seq.).
Ta sodba se nanaša na zelo poseben primer nujne zdravstvene oskrbe, ki jo morajo CPAS zagotoviti na podlagi člena 57(2) zakona o CPAS.
Second, as will be demonstrated below, the IRIS-H and the Brussels private hospitals are not in a comparable situation in particular because only the IRIS-H are entrusted with the three additional SGEI obligations (see recitals 170 et seq.) and hence only the IRIS-H perform the social healthcare SGEI as defined above (see recitals 166-167).
Bruseljsko sodišče prve stopnje je ugotovilo, da nujne zdravstvene oskrbe dejansko nikoli ne zagotovijo sami CPAS, ampak specializirane zdravstvene službe, in da nič ne utemeljuje razlikovanja med tem, ali je ta služba javna ali zasebna.
Third, the IRIS-H are also subject to constraints affecting the performance of the social healthcare SGEI, i.e. their public status (see recital 42), and the necessity to ensure the continuity (pérennité, see recitals 91 and 168) of the provision of this SGEI.
Komisija kljub temu ugotavlja, da obveznost zagotavljanja nujne zdravstvene oskrbe velja za CPAS in ne za bolnišnice, ki zagotovijo oskrbo.
Figure 2 below illustrates these two points.
V zadevnem primeru je bruseljska zasebna psihiatrična klinika urgentno sprejela migranta brez dokumentov in od CPAS zahtevala, naj zaradi očitnega socialno šibkega položaja priseljenca plača njegovo nujno zdravstveno oskrbo.
Figure 2
Bruseljsko sodišče je razsodilo, da mora CPAS, če ne zagotavlja nujne zdravstvene oskrbe v bolnišnici, ki jo upravlja, plačati stroške oskrbe, ki jo je zagotovila zasebna bolnišnica, kadar so se službe za nujno pomoč zaradi nujnosti odločile, da pacienta peljejo v zasebno bolnišnico.
Obligations, constraints and public financing mechanisms applicable to the public IRIS hospitals respectively private hospitals Pérennité (continuity of public hospital services)
Ta sodba se jasno nanaša na izjemen primer, ki odstopa od običajnega okvira za socialno pomoč, v katerem CPAS uporabi lastne (javne) bolnišnice.
Public status (bilingualism, officials, …)
V zadevnem primeru je bilo to odstopanje posledica dejstva, da javne bolnišnice IRIS ne zagotavljajo psihiatrične oskrbe, ki je bila v navedenem primeru potrebna.
Municipal deficit financing (art.
Poleg tega je bruseljsko sodišče poudarilo, da, „če se ta pomoč običajno bolj pogosto zagotavlja v ustanovi, ki je odvisna od zadevnega CPAS ali s katero je ta sklenil dogovor, se lahko osebo sprejme v drugo ustanovo zaradi nujnosti, ki izhaja iz položaja osebe, ki jo je treba sprejeti v bolnišnico“.
46 bylaws IRIS-H)
Ugotovilo je tudi, da, če bi zadevni CPAS (tj. v zadevnem primeru CPAS občine Uccle) ustanovil svojo psihiatrično bolnišnico ali s tako bolnišnico sklenil dogovor, zadevni zasebni bolnišnici ne bi bilo treba zagotoviti oskrbe zadevnemu migrantu brez dokumentov, ampak bi namesto tega lahko zahtevala, da se premesti v navedeno bolnišnico.
Private hospitals
Ker to ni bilo mogoče, ni bilo nobene druge možnosti in CPAS je moral zasebni bolnišnici plačati oskrbo, ki jo je zagotovila pacientu.
Public IRIS hospitals
Zato se lahko na podlagi sodbe bruseljskega sodišča, na katero so se sklicevali pritožniki, sklepa le, da lahko v nekaterih primerih zaradi nujnosti tudi zasebne bolnišnice migrantom brez dokumentov zagotovijo nujno zdravstveno oskrbo in da morajo CPAS, kadar svojo obveznost zagotavljanja nujne zdravstvene oskrbe izpolnijo na ta posebni način, plačati tem zasebnim bolnišnicam.
Universal Care Obligation
Zato dejstva, da lahko bruseljske zasebne bolnišnice zagotovijo nujno zdravstveno oskrbo v majhnem številu [194] primerov, ni mogoče razlagati kot splošno obveznost teh zasebnih bolnišnic, da zdravijo vse paciente ne glede na njihovo plačilno sposobnost.
Federal hospital financing (LCH)
Kar zadeva načelo nediskriminacije (ki so ga navedli pritožniki, glej uvodno izjavo 170), je jasno, da nobena bolnišnica v Belgiji ne sme diskriminirati na podlagi pacientovega premoženja (in s tem na podlagi golega dejstva, da je nekdo reven) ali katerega drugega osebnega merila (npr. religije ali etničnega ozadja).
Basic Hospital Mission (LCH)
Vendar v nenujnem primeru po načelu nediskriminacije bolnišnic ni mogoče prisiliti, da oskrbo zagotovijo brezplačno, če je mogoče jasno predvideti, da je pacient ne bo mogel plačati.
Multi-Site Obligation
Če so ti pogoji izpolnjeni v nenujnih primerih, lahko bolnišnice na podlagi objektivne utemeljitve razlikujejo med pacienti in te paciente zavrnejo [195].
Additional Social Obligation
Kot je bilo navedeno (glej uvodno izjavo 171), deontološki kodeks, ki velja za belgijske zdravnike, izrecno dovoljuje, da v nenujnih primerih zavrnejo paciente.
Social Healthcare SGEI:
Iz raziskave med finančnimi svetovalci [196] je poleg tega razvidno, da zdravniki in bolnišnice včasih zavrnejo paciente, ki so imeli v preteklosti težave s plačevanjem zdravljenja.
Since the three additional SGEI obligations go further than the minimum requirements that apply to all hospitals (public or private in Belgium) they lead to costs which are not or only partially covered by the BMF (see Section 2.5.1) and the social security system.
V zvezi s tem je treba poudariti, da bolnišnice same po sebi pacientov ne zavračajo neposredno, ampak od njih zahtevajo, naj plačajo vnaprej, kar lahko odvrne revne.
Combined with the higher costs that follow from their public status (public servants, bilingualism, etc., see also recital 42) this explains why the IRIS-H have reported deficits for most of the years in the period 1996-2014.
Obstajajo tudi nepreverjeni dokazi, da zasebne bolnišnice včasih napotijo paciente na zdravljenje v bolnišnico CPAS [197].
Combined, the accounting deficits of the IRIS-H over the period 1996-2014 amount to approximately EUR 250 million (see recital 234).
Iz teh razlogov je belgijski senat leta 2013 predlagal zakon (vendar ga ni sprejel), s katerim bi se izključila zavrnitev zagotavljanja zdravstvenega varstva zaradi finančnih težav pacientov in prepovedalo zaračunavanje predplačil [198].
The respective Brussels CPAS and municipalities want and have [190] to guarantee the continuity (pérennité) of their IRIS-H to ensure that the social healthcare SGEI is provided and the social aid obligation of the CPAS is fulfilled (see also Section 2.2).
Za načelo nediskriminacije torej ni mogoče trditi, da vsem belgijskim bolnišnicam (javnim in zasebnim) nalaga obveznost zdravljenja vseh pacientov v vseh okoliščinah (tj. v nenujnih primerih), tudi če pacienti zdravljenja ne morejo plačati.
This is why they give a full deficit cover, which compensates the residual costs of the social healthcare SGEI (consisting of the basic hospital mission and the three additional SGEI obligations) [191], hence ensuring the pérennité of the IRIS-H (see recital 91).
Komisija na podlagi navedenega ugotavlja, da je treba razlikovati med nujnimi in nenujnimi primeri.
In doing so, the deficit compensation does not distinguish between separate SGEI obligations.
V nujnih primerih za javne in zasebne bolnišnice enako velja splošna obveznost (na podlagi belgijskega kazenskega zakonika), da zdravijo paciente v primeru nujne medicinske pomoči.
Against this backdrop it is appropriate to conduct the overcompensation tests that are described below (see Tables 9 to 13 in Section 7.3.5) on a global basis (i.e. for the different SGEI combined).
Vendar ni nobene pravne podlage, ki bi zasebne bolnišnice zavezovala k zdravljenju pacientov tudi v nenujnih primerih in ne glede na njihovo plačilno sposobnost oziroma bi jim to nalagala.
As explained in recitals 165-167, the Commission has come to the conclusion that the additional obligations of the IRIS-H are to be considered together with their basic hospital mission as de facto constituting one social healthcare SGEI.
Dejansko niti zakon LCH niti kazenski zakonik ne vsebujeta take obveznosti, za načelo nediskriminacije pa tudi ni mogoče šteti, da nalaga tako obveznost.
While the basic hospital mission has been defined above (see recital 164) the exact content of each of the additional SGEI obligations is defined in the remainder of this section.
Obveznost zagotavljanja nujne zdravstvene oskrbe migrantom brez dokumentov velja za CPAS in ne za bolnišnice, ki tako oskrbo zagotavljajo.
Furthermore, it is also pointed out how these additional SGEI obligations are linked with each other and how they contribute to the social healthcare SGEI.
Obveznost zagotavljanja splošnega zdravstvenega varstva, naložena bolnišnicam IRIS
I. Obligation to treat all patients in all circumstances regardless of their ability to pay (universal care obligation)
Vendar morajo bolnišnice IRIS [199] v nasprotju z zasebnimi bolnišnicami zdraviti vse paciente v vseh okoliščinah, tudi v nenujnih primerih, ne glede na plačilno sposobnost pacientov in/ali njihovo zavarovanje, in sicer na podlagi posebnih pravil, ki veljajo le za bolnišnice IRIS, tj. njihovih statutov in strateških načrtov združenja IRIS, kot je navedeno v nadaljevanju.
According to the Belgian authorities, the IRIS-H have the obligation to treat all patients, even if they are not able to pay and/or are uninsured, in all circumstances including situations where patients do not require urgent medical care.
Kot je bilo pojasnjeno (glej uvodno izjavo 24), so CPAS bolnišnice IRIS ustanovili, da bi lahko izpolnili svojo nalogo zagotavljanja socialne pomoči vsakomur, ki jo potrebuje.
The complainants put into doubt that such an obligation applies to the IRIS-H and claim that the Brussels private hospitals cannot refuse patients and in fact treat a large number of ‘social patients’.
CPAS morajo tako pomoč (vključno z zdravniško in socialno-zdravstveno oskrbo) zagotoviti vsem posameznikom in družinam, ki jo potrebujejo [200].
To support their claims, the complainants argue that the LCH entrusts all hospitals with the same hospital mission and, as stated in paragraph 150 of the annulment judgment of 7 November 2012, also refer to the general principle of non-discrimination which would prohibit them from selecting patients according to their ideological, philosophical or religious beliefs or their situation of poverty.
CPAS svoje storitve zagotavljajo brezplačno in so bili ustanovljeni zlasti za pomoč revnim in pomoči potrebnim.
According to them, public and private hospitals have the same obligation to treat patients in both emergency and ‘post-emergency’ circumstances.
V zvezi s tem je v členu 5 statutov bolnišnic IRIS navedeno:
First and foremost, the Commission observes that the LCH does not contain any wording that can be interpreted as obliging hospitals (whether public or private) to treat patients in all circumstances and regardless of their ability to pay.
Brez poseganja v pristojnosti krovne organizacije IRIS in pristojnosti IRIS-Achats [podružnice za javno naročanje] in katerega koli drugega organa, ki bi ga krovna organizacija morda ustanovila v skladu s členom 135j sistemskega zakona z dne 8. julija 1976 o javnih centrih za socialno pomoč, ter v skladu z zakoni in predpisi ima združenje pri opravljanju svoje bolnišnične naloge najširša pooblastila.
However, under Belgian law there exists a general obligation to assist persons in danger.
Navedeno nalogo opravlja z namenom zagotavljanja kakovostnega zdravstvenega varstva po optimalnih stroških za vse, ne glede na njihov prihodek, možnost zavarovanja, poreklo in filozofska prepričanja, in vzpostavitve vzdržnega finančnega ravnovesja združenja“ [201].
As pointed out by the Belgian authorities, under Article 422 ter of the Belgian Criminal Code, this obligation applies in emergency situations, and particularly in medical emergencies of a life-threatening nature.
Podobno je v uvodu k strateškim načrtom združenja IRIS za obdobje 1996–2001 navedeno:
Hospitals are therefore required to provide assistance in cases of medical emergency, according to their organisation and available expertise.
„Da bi lahko javne bolnišnice omrežja IRIS kadar koli izpolnile svojo socialno nalogo, bodo nudile številne storitve, ki vsem zagotavljajo najkakovostnejšo oskrbo po na splošno sprejemljivih finančnih pogojih za vse in bodo dostopne vsem pacientom, ne glede na njihov prihodek, možnost zavarovanja, poreklo in ideološka prepričanja“ [202].(177) V tem istem uvodu je v nadaljevanju navedeno:
There is hence no doubt that the Brussels public and private hospitals are obliged to treat patients in emergency situations regardless of their ability to pay.
„Glavni cilj načrta združenja IRIS je ohranjati okrepljeno omrežje javnih bolnišnic v Bruslju, ki je dostopno vsem pacientom, ne glede na njihov prihodek, možnost zavarovanja, poreklo ter ideološka in filozofska prepričanja“ [203].
In a similar vein, the deontology code that applies to doctors explicitly allows them to refuse patients with the exception of emergency situations [192].
(178) V drugem oddelku tega načrta je navedeno, da listina o pacientovih pravicah združenja IRIS zagotavlja:
Second, the complainants referred to a judgment by the Brussels Court of First Instance [193], to justify that there is no difference between public hospitals and private hospitals with regard to the treatment of ‘social patients’, whether in an ‘emergency’ or ‘post emergency’ situation.
„dostop vsem pacientom, brez razlikovanja glede na njihovo poreklo, prihodek, filozofska in ideološka prepričanja ter možnost zavarovanja“ [204].(179) Poleg tega je v strateškem načrtu združenja IRIS za obdobje 1996–2001 v pododdelku 2.5.4 z naslovom „Prise en charge et traitement de toute personne se présentant dans un des hôpitaux du réseau iris“ navedeno:
This judgment concerns a very specific case of urgent medical aid which the CPAS have to provide on the basis of Article 57(2) Loi CPAS.
„Osnovni namen javnih bolnišnic [tj. bolnišnic IRIS] je zagotavljanje socialne medicine; v skladu z njim morajo izpolniti zahteve socialnih nalog, in sicer tudi, če ta funkcija ni priznana v zakonodajnem in regulativnem okviru, ki ureja sektor bolnišnic.
The Brussels Court of First Instance noted that the urgent medical aid is in fact never provided by the CPAS itself but by specialised medical services and that nothing can justify making a distinction whether this service is public or private.
Vloga javnih bolnišnic je sprejetje in zdravljenje vseh pacientov, ne glede na njihovo poreklo, okoliščine, kulture, prepričanja in patologije.
Nevertheless, the Commission notes that the obligation to provide urgent medical aid applies to the CPAS and not to the hospitals who deliver the care.
Ker so naše bolnišnice javne, morajo upoštevati načela univerzalnosti, enakosti, kontinuitete in spremembe.
In the case at hand, an undocumented migrant was urgently admitted by a Brussels private psychiatric hospital which requested the CPAS to pay for this urgent medical aid due to the migrant's manifest state of poverty.
Načelo univerzalnosti določa, da je treba sprejeti vse paciente, ne glede na to, kdo so.
The Brussels Court concluded that if a CPAS does not provide the urgent medical aid in a hospital it manages it must pay the costs of care provided by a private hospital where the emergency services due to the urgency had decided to take the patient to a private hospital.
Bolnišnica mora zato zagotavljati zdravljenje na najvišji možni ravni, da bi lahko izpolnila potrebe vseh.
This judgment clearly concerns an exceptional situation which derogates from the normal framework for social assistance in which the CPAS relies on its own (public) hospitals.
V skladu z načelom enakosti, ki je ustavna pravica, je treba sprejeti vsakogar brez kakršne koli diskriminacije.
In the case at hand, this derogation was due to the fact that the public IRIS-H do not provide psychiatric care which was needed in that case.
Iz navedenega je jasno, da se plačilna sposobnost pacientov in njihovo zavarovanje ne upoštevata pri sprejemanju pacientov v bolnišnice IRIS, tako da je dostop do zdravstvenega varstva zagotovljen vsem, tudi v nenujnih primerih.
Furthermore, the Brussels Court pointed out that ‘if this aid is typically more often provided in an establishment dependent on the relevant CPAS or with which it has concluded an agreement, the person may be admitted to another establishment, owing to the urgency resulting from the situation of the person to be admitted to hospital’.
Več elementov v strateškem načrtu združenja IRIS za obdobje 1996–2001 dokazuje tudi socialno naravo bolnišnične oskrbe, ki jo zagotavljajo bolnišnice IRIS (npr. „da se zdravstvo še naprej zagotavlja brez kakršne koli tržne logike“ [206]), in močno željo po nudenju kakovostne oskrbe vsem slojem bruseljskega prebivalstva, zlasti najrevnejšim [207].