natgillin/translations-raw huggingface dataset:
The first step of the restructuring operation was taken on 19 May 1994 when the Belgian Federal Government, the Brussels Capital Region and the Brussels Commission Communautaire commune signed a cooperation agreement on hospital policy.
V zvezi s tem je v preambuli sporazuma o sodelovanju navedeno:
This agreement provided for the implementation of a restructuring agreement to ensure the continuity of public and local hospital services.
„Ker je finančni primanjkljaj javnih bolnišnic na območju regije glavnega mesta Bruselj dejansko dosegel zaskrbljujoče razsežnosti,
As stated in Article 2 of that cooperation agreement:
ker je kljub več načrtom prestrukturiranja finančno ravnovesje teh ustanov izjemno negotovo in temu ustrezno obremenjuje občinske proračune s strukturnim dolgom,
‘This restructuring agreement must satisfy the following conditions:
ker je v navedenih okoliščinah treba spodbuditi vzpostavitev mehanizmov za usklajevanje in sodelovanje med občinami in CPAS ter združenji, ustanovljenimi v skladu s Poglavjem XII [zakona o CPAS], ki so odgovorni za javne bolnišnice na območju regije glavnega mesta Bruselj,
to provide guarantees of the maintenance of, on the one hand, the specific character of public hospitals, inter alia, by the choice of legal structures and coordination ensuring predominance of the public sector in the management bodies and decision-making procedures, and, on the other hand, a local basis, through greater representation of directly elected members in the composition of the management bodies’ [20].
ker lahko taki mehanizmi za usklajevanje in sodelovanje zagotovijo kontinuiteto javnih bolnišnic s spodbujanjem sinergij na področju opreme in infrastrukture in s svojimi upravnimi in razvojnimi viri ter pomagajo pri zmanjšanju primanjkljaja v občinskih proračunih,
The preamble to the cooperation agreement states to that effect:
ker ta sporazum na noben način ne spreminja pravil za financiranje bolnišnic, ampak je namenjen le zmanjšanju strukturnega primanjkljaja, ki vpliva na CPAS in občine“ [21].
‘Whereas the financial deficit shown by the public hospitals in the territory of the Brussels Capital Region has in fact reached worrying proportions;
Na tej podlagi je Commission Communautaire commune sprejela Ordonnance z dne 22. decembra 1995, s katero se je Poglavje XIIa vključilo v različico zakona o CPAS, ki velja v regiji glavnega mesta Bruselj.
Despite several restructuring plans, the financial equilibrium of those institutions is extremely precarious and is accordingly burdening the municipal budgets with a structural debt;
Pripravljalno delo za to Ordonnance [22] se nanaša na sporazum o sodelovanju z dne 19. maja 1994 (glej uvodno izjavo 25), katerega glavni cilj je bil s predlaganim prestrukturiranjem zagotoviti kontinuiteto (pérennité) bruseljskih javnih bolnišnic [23].
Whereas it is necessary in those circumstances to encourage the establishment of mechanisms for coordination and cooperation between municipalities and the CPAS and associations set up in accordance with Chapter XII of the [Loi CPAS] with responsibility for public hospitals in the territory of the Brussels Capital Region;
Prestrukturiranje je obsegalo naslednje ključne elemente:
Whereas such coordination and cooperation mechanisms can ensure the continuity of public hospitals, by encouraging synergies in equipment and infrastructure and their management and development resources and help to offset the deficit in municipal budgets;
CPAS so neposredno upravljanje svojih javnih bolnišnic prepustili novoustanovljenim pravnim osebam (t. i. združenjem, ustanovljenim na podlagi Poglavja XII), ki so jih ustanovili (skupaj z zadevno občino ali občinami, združenjem, ki zastopa zdravnike, zaposlene v bolnišnicah, in, kjer je primerno, univerzo Université Libre de Bruxelles in/ali univerzo Vrije Universiteit Brussel).
Whereas this agreement in no way alters the rules for hospital financing, but is designed solely to offset the structural deficit affecting the CPAS and municipalities’ [21].
Pri tem so odstopili od svoje prvotne odločitve, da sami upravljajo svoje bolnišnice, kot so jih v preteklosti.
It was on that basis that the Brussels Commission Communautaire commune adopted the Ordonnance of 22 December 1995 which inserted a Chapter XII bis in the version of the Loi CPAS that applies in the Brussels Capital Region.
Kot omogočata člen 60(6) in člen 118 zakona o CPAS (glej uvodno izjavo 19), so se CPAS odločili za ustanovitev združenja, prek katerega lahko skupnosti zagotovijo zdravniško in zdravstveno-socialno pomoč.
The preparatory work for this Ordonnance [22] refers to the cooperation agreement of 19 May 1994 (see recital 25) of which the main objective was to guarantee, through the proposed restructuring, the continuity (pérennité) of the Brussels public hospitals [23].
Zato so bile obstoječe bruseljske javne bolnišnice likvidirane, njihove dejavnosti pa prenesene na osem lokalnih združenj bolnišnic, ustanovljenih na podlagi Poglavja XII zakona o CPAS.
The restructuring consisted of the following key elements:
Tako so bolnišnice IRIS 1. januarja 1996 pridobile pravno in finančno neodvisnost [24].
In doing so, the CPAS departed from their original choice of managing their own hospitals themselves as they did in the past.
Teh osem bolnišnic je bilo nato prerazporejenih v sedanjih pet bolnišnic IRIS, pri čemer so se ohranile vse lokacije.
As allowed by Articles 60(6) and 118 of the Loi CPAS (see recital 19), the CPAS chose to set up an association through which they can provide medical and medico-social assistance to the community.
Istega dne so se CH Etterbeek-Ixelles, CH Baron Lambert, CH Bracops in CH Molière združile v južne bolnišnice IRIS (ISH).
As a result, the existing Brussels public hospitals were liquidated and their activities were transferred to eight local hospital associations established on the basis of Chapter XII of the Loi CPAS.
Če ni navedeno drugače, se sklici na „bolnišnice IRIS“ v tem sklepu nanašajo na teh sedanjih pet lokalnih združenj javnih bolnišnic [25].
In this way, the IRIS-H obtained legal and financial independence [24] on 1 January 1996.
Ustanovljeno je bilo krovno omrežje, imenovano IRIS (na podlagi poglavja XIIa zakona o CPAS), da bo usklajevalo in nadzorovalo bolnišnične dejavnosti vsakega posameznega združenja, ustanovljenega na podlagi Poglavja XII [26].
The following eight hospital associations were created: the CHU Brugmann — HUDERF, the CH Brien, the CHU Saint-Pierre (CHU-SP), the CH Etterbeek-Ixelles, the CH Baron Lambert, the CH Bracops, the CH Molière, and the Institut Bordet (IB).
Njegov glavni cilj je doseči vzdržno finančno ravnovesje na področju bolnišničnih dejavnosti, ki jih opravljajo bolnišnice IRIS.
These eight hospitals were then further regrouped, while retaining all hospital sites, into the current five IRIS-H as follows.
Njegove glavne naloge so usklajevanje dejavnosti bolnišnic IRIS, določanje strateškega načrta za omrežje IRIS, izboljšanje kakovosti nudenih storitev in spremljanje proračuna omrežja.(29) V skladu s Poglavjem XII zakona o CPAS je vsako lokalno združenje bolnišnic ustanovljeno na podlagi statuta, v katerem so med drugim določeni namen, pravice in obveznosti članov ter organi odločanja združenja [27].
The CHU Brugmann (CHU-B) and Queen Fabiola Children's University Hospital (HUDERF) were split into two separate legal entities on 1 January 1997.
Na tej podlagi ima vsako združenje generalno skupščino in upravni svet, v katerih so zastopane stranke, ki so ustanovile združenje (glej uvodno izjavo 28), vendar v teh organih odločanja večino sedežev vedno zasedajo predstavniki vlade (tj. občine in CPAS) [28].
On 1 July 1999, the CHU Brugmann and the CH Brien became one entity named CHU Brugmann.
Zato je jasno, da vsako od bolnišnic IRIS nadzorujejo javni organi.
On that same date, the CH Etterbeek-Ixelles, the CH Baron Lambert, the CH Bracops, the CH Molière merged into the Iris South Hospitals (ISH).
Podobno imajo občine in CPAS veliko večino v generalni skupščini in upravnem svetu krovnega omrežja IRIS.
Unless indicated otherwise, where the decision at hand refers to the ‘IRIS-H’ this concerns these current five local public hospital associations [25].
Poglavje XIIa zakona o CPAS med drugim določa pravila glede nadzora in upravnega pregleda, ki veljajo za lokalna združenja bolnišnic.
Creating an umbrella structure called IRIS (on the basis of Chapter XII bis of the Loi CPAS) to coordinate and supervise the hospital activities of each of the Chapter XII associations [26].
Natančneje, krovna organizacija IRIS mora pripraviti strateški načrt, ki je zavezujoč za združenja, ustanovljena na podlagi Poglavja XII.
The main objective of the IRIS umbrella is to reach a sustainable financial equilibrium for the hospital activities performed by the IRIS-H.
Na podlagi tega načrta mora vsako lokalno združenje bolnišnic pripraviti načrt upravljanja in finančni načrt ter ju v odobritev predložiti krovni organizaciji (glej člen 135d zakona o CPAS).
The main tasks of IRIS are to coordinate the activities of the IRIS-H, determining the strategic plan for the IRIS network, improving the quality of the services offered, and monitoring the budget of the network.(29) In line with Chapter XII of the Loi CPAS, each of the local hospital associations is established on the basis of bylaws which among others determine the purpose, the rights and obligations of the members, and the decision-making bodies of the association [27].
Lokalna združenja bolnišnic morajo pred sprejetjem nekaterih pomembnih odločitev pridobiti soglasje krovne organizacije IRIS (glej člen 135e), ta pa jih spremlja vsako četrtletje (glej člen 135g).
On this basis, each association has a General Assembly and Administrative Council in which the parties that established the association (see recital 28) are represented; but the representatives of the government (i.e. the municipality and the CPAS) always occupy a majority of the seats in these decision-making bodies [28].
Združenje IRIS v vsako lokalno združenje bolnišnic tudi imenuje predstavnika, ki se udeležuje srečanj organov odločanja teh združenj in lahko vloži veto na odločitve, ki niso v skladu z odločitvami združenja IRIS (glej člen 135h).
As a result, it is clear that each of the IRIS-H is controlled by the public authorities.
Kot je pojasnjeno v uvodnih izjavah 31 in 32 sklepa o začetku postopka, je prestrukturiranje bruseljskih javnih bolnišnic, ki jih je nadzoroval in upravljal CPAS, obsegalo tudi finančni del.
Likewise, the municipalities, the CPAS have a large majority in the General Assembly and the Administrative Council of the IRIS umbrella structure.
Natančneje, regija glavnega mesta Bruselj je prek sklada Fonds Régional Bruxellois de Refinancement des Trésoreries Communales (v nadaljnjem besedilu: sklad FRBRTC) občinam, ki so upravljale javno bolnišnico (prek zadevnega CPAS), za obdobje 20 let dodelila posojilo v višini 4 milijard belgijskih frankov (približno 100 milijonov EUR) [29].
Chapter XII bis of the Loi CPAS determines, among others, the rules with respect to control and administrative oversight that apply to the local hospital associations.
Nato so občine ta sredstva dodelile svojim javnim bolnišnicam, da bi pokrile del njihovih finančnih obveznosti [30].
More specifically, the IRIS umbrella organisation is required to draw up a strategic plan which is binding on the local Chapter XII associations.
Regija glavnega mesta Bruselj se je 6. junija 1996 odločila, da ne bo zahtevala vračila posojila in obresti, če se bodo v celoti spoštovali sporazumi o prestrukturiranju bolnišnic in finančni načrti.
On the basis of this plan, each local hospital association has to draw up management and financial plans and submit these to IRIS for approval (see Article 135 quinquies Loi CPAS).
Regulativni okvir, ki se uporablja za bolnišnice IRIS
The local hospital associations are also required to ask the permission of IRIS before taking certain major decisions (see Article 135 sexies) and are monitored by IRIS on a quarterly basis (see Article 135 octies).
Iz prejšnjega oddelka je jasno, da so bolnišnice IRIS ustanovljene na podlagi zakona o CPAS, da bi CPAS omogočile izpolnitev obveznosti zagotavljanja socialne pomoči.
IRIS also appoints a representative in each local hospital association who attends the meetings of the decision-making bodies of these associations and who can veto decisions that are not in line with those of IRIS itself (see Article 135 novies).
Delovanje teh bolnišnic torej ureja zlasti zakon o CPAS.
Finally, as explained in recitals 31 and 32 of the opening decision, the restructuring of the Brussels public hospitals that were supervised and managed by the CPAS also consisted of a financial part.
Vendar zanje kot bolnišnice velja tudi zakon z dne 7. avgusta 1987 (Loi coordonnée sur les hôpitaux, v nadaljnjem besedilu: zakon LCH) [31], v členu 147 tega zakona (zdaj členu 163 zakona LCH iz različice zakona z dne 10. julija 2008) [32] pa je navedeno:
More specifically, via the Fonds Régional Bruxellois de Refinancement des Trésoreries Communales (hereinafter ‘FRBRTC’) the Brussels Capital Region granted a loan of 4 billion Belgian francs (about 100 million EUR) over a period of 20 years to those municipalities that managed a public hospital (via their respective CPAS) [29].
„Za bolnišnice, ki jih upravlja CPAS, in zdravnike, ki so zaposleni v teh bolnišnicah, določbe tega usklajenega zakona dopolnjujejo zakon o CPAS z dne 8. julija 1976 in zlasti člene 48, 51, 52, 53,54, 55, 56 in 94 tega zakona.“
In turn, the municipalities awarded these funds to their public hospitals to cover part of their financial liabilities [30].
Zakon LCH med drugim določa vrste bolnišnic, ki so lahko uradno pooblaščene [33], pogoje upravljanja bolnišnice in strukturo zdravniških dejavnosti [34], bolnišnično organizacijo [35], pravila in pogoje za izdajo dovoljenj bolnišnicam in za opravljanje bolnišničnih storitev [36], pravno razmerje med bolnišnico in zdravniki, zaposlenimi v bolnišnici, finančni statut zdravnikov, zaposlenih v bolnišnici, ki med drugim vključuje pobiranje in določanje plačil, kaj plačila zajemajo in razdelitev centralno pobranih plačil [37].
On 6 June 1996, the Brussels Capital Region decided not to demand repayment of the loan and interests, on the condition that the hospital restructuring agreements were fully implemented and the financial plans respected.
Poleg tega za bolnišnice IRIS veljajo pravila iz statutov lokalnih združenj bolnišnic, ki med drugim določajo namen bolnišnic IRIS ter pravice in obveznosti članov združenj (glej tudi uvodno izjavo 29).
The regulatory framework applying to the IRIS-H
Lokalna združenja bolnišnic delujejo pod nadzorom krovne organizacije IRIS, ki omejuje njihovo zmožnost samostojnega sprejemanja nekaterih finančnih in upravnih odločitev (glej tudi uvodno izjavo 30).
From the previous section it is clear that the IRIS-H have been established on the basis of the Loi CPAS to enable the CPAS to fulfil their obligation to provide social aid.
Bistveno je, da krovna organizacija IRIS sprejme večletne strateške načrte, ki so za lokalna združenja bolnišnic zavezujoča v skladu s členom 135d zakona o CPAS.
These hospitals are therefore governed primarily on the basis of the Loi CPAS.
Regulativni okvir, v katerem bolnišnice IRIS delujejo, torej sestavljajo zakon o CPAS, zakon LCH, statuti lokalnih združenj bolnišnic in zavezujoči strateški načrti, ki jih sprejme krovna organizacija IRIS.
However, as hospitals, they are also subject to the Law of 7 August 1987 (Loi coordonnée sur les hôpitaux, hereinafter ‘LCH’) [31] Article 147 (now Article 163 of the LCH in the version of the Law of 10 July 2008) [32] of which specifies:
Glavne dejavnosti bolnišnic IRIS
‘In the case of hospitals managed by a CPAS and the doctors working in those hospitals, the provisions of this Coordinated Law supplement the Loi CPAS.’
Glavna dejavnost bolnišnic IRIS je zagotavljanje bolnišničnih storitev pacientom v regiji glavnega mesta Bruselj.
The LCH sets out, inter alia, the types of hospitals that can be formally authorised [33], the conditions for the management of a hospital and the structure of the medical activity [34], the hospital programming [35], the conditions for authorisation of hospitals and hospital services [36], the legal relationship between a hospital and the hospital doctors, the financial statute of the hospital doctors including among others the collecting and setting of the fees, what the fees cover, and the allocation of the centrally collected fees [37].
Skupaj imajo skoraj 10000 zaposlenih, letno opravijo več kot milijon zdravniških pregledov in so največja belgijska služba za pomoč.
In addition, the IRIS-H are also subject to the rules laid down in the bylaws of the local hospital associations, specifying among others the purpose of the IRIS-H as well as the rights and obligations of members of the association (see also recital 29).
Nudijo popolne zdravstvene storitve na vseh pomembnih zdravstvenih področjih, dve pa sta specializirani na posebnih področjih (Fabiola Children's University Hospital je specializirana za pediatrijo, Institut Bordet pa za onkologijo).
Finally, the local hospital associations operate under the oversight of the IRIS umbrella organisation, restricting their ability to autonomously take certain financial and management decisions (see also recital 30).
Bolnišnice IRIS poleg zdravstvenih storitev opravljajo številne povezane socialne dejavnosti.
Significantly, the IRIS umbrella organisation adopts multi-annual strategic plans which are binding for the local hospital associations as determined by Article 135 quinquies Loi CPAS.
Socialni delavci, zaposleni v teh bolnišnicah, zlasti pomagajo prikrajšanim pacientom in njihovim družinam pri reševanju in obvladovanju finančnih, upravnih, medosebnih in socialnih težav.
In conclusion, the regulatory framework in which the IRIS-H operate is made up of the Loi CPAS, the LCH, the bylaws of the local hospital associations, and the binding strategic plans adopted by the IRIS umbrella organisation.
Pet bolnišnic IRIS svoje zdravstvene in povezane socialne storitve trenutno opravlja v omrežju enajstih lokacij v Bruslju.
The primary activity of the IRIS-H is the provision of hospital services to patients in the Brussels Capital Region.
Na podlagi razvrstitve zvezne javne službe za javno zdravje (za preglednico s to razvrstitvijo glej uvodno izjavo 185) so tri velike bolnišnice IRIS, ki nudijo popolno bolnišnično oskrbo (CHU Saint-Pierre, CHU Brugmann in južne bolnišnice IRIS), tudi tri bolnišnice s pacienti z najšibkejšim socialno-ekonomskim položajem v Belgiji.
The IRIS-H together employ nearly 10000 staff, provide over 1 million consultations per year, and constitute Belgium's largest emergency service.
To je razvidno tudi iz dejstva, da leta 2012 skoraj 11 % vseh sprejetih pacientov v CHU Saint-Pierre in CHU Brugmann ni imelo obveznega belgijskega zdravstvenega zavarovanja in ni moglo plačati zdravljenja, 15 % pacientov teh bolnišnic pa je bilo odvisnih (tudi) od podpore CPAS.
The IRIS-H offer comprehensive medical services across all major medical fields, with two of them specialising in particular disciplines (in particular Queen Fabiola Children's University Hospital specialises in paediatrics, while the Institut Bordet specialises in oncology).
Bolnišnice IRIS imajo tudi številne pomožne dejavnosti (npr. prevoz pacientov med bolnišnicami z reševalnim vozilom, vrtec za otroke zaposlenih, negovalne domove in domove za starejše občane, šole za medicinske sestre, raziskave, pomoč pri samostojnem življenju, psihiatrične ustanove, majhno trgovino za paciente in obiskovalce, najem televizorjev za paciente, najem sob za tretje osebe, gostinski obrat in parkirišča).
In addition to medical services, the IRIS-H also engage in a series of related social activities.
Te pomožne dejavnosti obsegajo le zelo majhen odstotek vseh dejavnosti bolnišnic IRIS, kot je razvidno iz njihovega malega deleža skupnega prihodka bolnišnic IRIS (tj. v povprečju manj kot 2 %).
In particular, social workers employed by the IRIS-H assist disadvantaged patients and their families in solving and managing financial, administrative, interpersonal and social difficulties.
Vse te dejavnosti pomenijo stroške in prihodke bolnišnic IRIS.
The five IRIS-H currently provide their medical and related social services across a network of eleven sites in Brussels.
Na njihove stroške poleg posebnih dejavnosti, ki jih opravljajo, vpliva tudi njihov status javnih bolnišnic, ki vključuje številne omejitve, ki ne veljajo za zasebne bolnišnice.
These sites are spread over six municipalities (i.e. Anderlecht, la Ville de Bruxelles, Etterbeek, Forest, Ixelles, and Schaerbeek).
Zlasti operativni stroški, ki jih imajo bolnišnice IRIS pri opravljanju svojih storitev splošnega gospodarskega pomena in pomožnih dejavnosti, se med drugim povečajo zaradi dejavnikov, kot so:
The IRIS-H consider it as their mission to be ‘in the service of one and all, at all moments of their existence, from cradle to grave, and irrespective of their medical problems’ [38].
zahteva za plačilo obveznih jezikovnih bonusov [40], ki jih je treba dodeliti dvojezičnim zaposlenim, po ocenah pa ti stroški [41] za bolnišnice IRIS letno znašajo približno […] [42] milijonov EUR,
Ten of the eleven IRIS-H sites are located in municipalities where the average income does not exceed the median [39] for the Brussels Capital Region.
pokojninska shema, ki velja za stalne uslužbence [43] (tj. javne uslužbence), ki je bolj velikodušna od tiste, ki se uporablja za zaposlene v zasebnem sektorju in za katero morajo bolnišnice IRIS po ocenah prispevati […] milijonov EUR letno,stroški, povezani z dolgotrajno boleznijo stalnih uslužbencev [44], ki jih morajo kriti bolnišnice IRIS (namesto sistema socialne varnosti), ki po ocenah letno znašajo […] milijonov EUR,zvišanja plačilne lestvice, ki jih bolnišnicam IRIS naloži regija glavnega mesta Bruselj [45], ki določi plačilne lestvice za zaposlene v občinah, CPAS in bolnišnicah IRIS, plača pa le 60 % tega zvišanja, zato imajo bolnišnice IRIS letno stroške v višini približno […] milijonov EUR, in
On the basis of a ranking by the Federal Public Service for Public Health (see recital 185 for the table with this ranking), the three large comprehensive IRIS-H (CHU Saint-Pierre, CHU Brugmann, ISH) are the three hospitals whose patient profile in socioeconomic terms is the weakest in Belgium.
obvezni prispevki bolnišnic IRIS k stroškom krovne organizacije IRIS [46], ki po ocenah letno znašajo […] milijonov EUR.
This is further illustrated by the fact that in 2012 almost 11 % of the total number of admitted patients in CHU Saint-Pierre and CHU Brugmann were not covered by the mandatory Belgian sickness insurance and could not pay for treatment, while 15 % of these hospitals' patients were (also) dependent on CPAS support.
(43) Te preostale stroške morajo nositi bolnišnice IRIS in se ne krijejo iz drugih javnih virov financiranja (kot je na primer proračun finančnih sredstev, glej uvodno izjavo 46(a)).
Finally, the IRIS-H also have a number of ancillary activities (e.g. ambulance transport of patients between hospitals; a nursery for the children of staff members; nursing and elderly homes; nursing schools; research; assisted living; and psychiatric care institutions; a little shop for patients and visitors; renting of TVs to patients, renting of rooms to third parties; a canteen and parking facilities).
Mehanizmi financiranja in računovodski mehanizmi bolnišnic IRIS
These ancillary activities represent only a very limited percentage of the IRIS-H's total activities, as reflected by their small share (i.e. on average less than 2 %) of the IRIS-H's total revenues.
Mehanizmi financiranja
The totality of these activities account for the IRIS-H costs and revenues.
Temeljno načelo, v skladu s katerim se financirajo bolnišnice IRIS, je določeno v členu 46 [47] statuta vsakega od petih lokalnih združenj bolnišnic (glej uvodni izjavi 28 in 29), ki določa: