natgillin/translations-raw huggingface dataset:
Federal Public Service of Public Health's ranking of the hospitals based on the socioeconomic profile of their patients (*= IRIS-H, += private Brussels hospitals)
Bolnišnice IRIS so ocenile, da je leta 2010 njihov znesek odpisanega dolga povprečje, ki velja za javne bolnišnice v Belgiji, presegel za približno […] milijonov EUR.
No figures
V kontekst je treba umestiti tudi financiranje iz proračuna finančnih sredstev, zagotovljeno na podlagi oddelka B8, ki se dodeli bolnišnicam s pacienti z najšibkejšim socialno-ekonomskim položajem.
Ste Anne St Remi+
S tem omejenim zveznim financiranjem naj bi se nadomestil del stroškov, povezanih s „socialnimi pacienti“ (npr. ker taki pacienti v povprečju bivajo v bolnišnici dlje kot drugi pacienti), vendar to ni nadomestilo za obveznost zagotavljanja splošnega zdravstvenega varstva.
The complainant's reference to a February 2004 publication of the Mutualités Chrétiennes (see recital 72), which concerns only the year 2001 and which would show that the private hospitals treat more than 60 % of ‘social patients’ in the Brussels Capital Region, has to be put into context.
Financiranje na podlagi oddelka B8 ne nadomesti dejanskih stroškov, ki jih imajo bolnišnice zaradi zdravljenja socialnih pacientov (npr. neplačani računi socialnih pacientov, potreba po dodatnih socialnih delavcih).
The term ‘social patients’ may create the impression that it concerns patients who cannot pay for treatment and who would therefore all be in scope of the universal care obligation.
Namesto tega se na podlagi razvrstitve socialno-ekonomskega profila pacientov bolnišnic določi fiksni proračun (tj. približno 25 milijonov EUR letno za celotno Belgijo) (glej uvodno izjavo 185).
This is however not the case for the following reasons:
Prva tri mesta v tej razvrstitvi zasedajo bolnišnice IRIS, zato te bolnišnice prejmejo tudi večji delež financiranja na podlagi oddelka B8 v primerjavi z nižje uvrščenimi bolnišnicami (kot so bruseljske zasebne bolnišnice).
First and foremost, the publication's definition of ‘social patients’ [219] only concerns persons who are insured by the Belgian social security [220] and hence does not include those patients who cannot pay and are not covered by the social security.
Razlog, da so do tega financiranja načeloma upravičene javne in zasebne bolnišnice, je, da se lahko bolnišnice, tudi če zanje ne velja obveznost zagotavljanja splošnega zdravstvenega varstva, naložena bolnišnicam IRIS, še vedno prostovoljno odločijo za zdravljenje socialnih pacientov.
It is however the latter group that benefits most from the universal care obligation and that represents the largest financial burden for the IRIS-H (see also recitals 187-188).
To lahko storijo, ker niso vsi socialni pacienti plačilno nesposobni ali brez zavarovanja.
Based on the broad definition used in the publication, almost 20 % (respectively about 26 %) of the admissions in private (respectively public) hospitals in Brussels would have concerned ‘social patients’, and private hospitals would have treated almost 66 % of the total number of these patients in 2001.
Dejansko za socialne paciente, ki imajo socialno zavarovanje, pogosto veljajo nižje tarife in inštitut INAMI plača večji delež, zato se finančno tveganje za bolnišnice zmanjša.
Second, even the ‘precarious patients’ [221], which the publication defines as a subgroup of the ‘social patients’, are covered by the social security and there is no reason to assume that they cannot pay their own contribution.
Dejstvo je tudi, da se niso vsi CPAS v Belgiji odločili za ustanovitev lastne bolnišnice.
However, it could be argued that such ‘precarious patients’ may have a higher likelihood of not being able to pay the own contribution to the hospital.
Zato lahko CPAS, da bi izpolnili svojo obveznost zagotavljanja socialne pomoči, uporabijo zasebne bolnišnice.
The publication shows that public hospitals treat about 48 % of ‘precarious patients’, compared to 52 % being treated by private Brussels hospitals.
V takih primerih bi zasebna bolnišnica seveda zdravila številne socialne paciente in bi tudi lahko bila upravičena do financiranja na podlagi oddelka B8, ki ga predvideva proračun finančnih sredstev.
However, proportionally, the public hospitals treat many more of such patients than would be expected based on their market share (in terms of beds and number of admissions).
Vendar lahko CPAS v regiji glavnega mesta Bruselj uporabijo javne bolnišnice IRIS, zato je jasno, zakaj je iz razvrstitve iz uvodne izjave 185 razvidno, da je povprečni socialno-ekonomski profil pacientov bruseljskih zasebnih bolnišnic precej boljši od profila bolnišnic IRIS.
Indeed, ‘precarious patients’ would make up 9,5 % of the admissions in public hospitals compared to only 4,1 % in private hospitals.
Zaradi vseh teh razlogov financiranja iz proračuna finančnih sredstev na podlagi oddelka B8 ni mogoče obravnavati kot znak obstoja obveznosti zagotavljanja splošnega zdravstvenega varstva za vse belgijske bolnišnice.
Third, in any case, the observation that in 2001 Brussels private hospitals would have treated 52 % (respectively 66 %) of ‘precarious’ (respectively ‘social’) patients cannot change the conclusion that only the IRIS-H have a universal care obligation.
Sklepne ugotovitve o obveznosti zagotavljanja splošnega zdravstvenega varstva bolnišnic IRIS
Indeed, in the absence of any legal obligation for private hospitals to treat all patients regardless of their ability to pay and their insurance status, any possible decision of private hospitals to provide care to ‘precarious’ or ‘social’ patients in non-emergency situations would be purely voluntary and could thus be reversed at any moment.
Komisija na podlagi navedenega ugotavlja, da obveznost zagotavljanja splošnega zdravstvenega varstva velja le za bolnišnice IRIS, da je jasno naložena ter opredeljena s statuti bolnišnic IRIS in strateškimi načrti združenja IRIS v skladu z zahtevami iz zakona o CPAS (glej uvodni izjavi 29 in 30) in da je razvidna tudi iz razvrstitve socialno-ekonomskega profila pacientov bolnišnic (glej uvodno izjavo 185).
Furthermore, the most vulnerable group of patients, i.e. those who are not covered by the social security or any other insurance, are not included in the publication's statistics.
Ta obveznost zagotavlja, da revni v regiji glavnega mesta Bruselj prejmejo ustrezno zdravljenje tudi v nenujnih primerih, čeprav ga ne morejo plačati.
This also explains the apparent divergence between the publication's figures for 2001 and the Federal Public Service for Public Health's ranking (see recital 185) for the period 2007-2013.
Tako bolnišnice IRIS zagotavljajo socialno zdravstveno varstvo in izpolnjujejo potrebe lokalnega prebivalstva.
While this Public Service's ranking takes into account the proportion of patients who are not covered by the social security, the publication's statistics only include patients with social security cover.
Kot je pojasnjeno v prejšnji uvodni izjavi, se neposredno krije le del bremena te obveznosti (npr. CPAS povrnejo stroške zdravljenja).
For all of the above reasons, the Commission considers that the publication of the Mutualités Chrétiennes with statistics for the year 2001 cannot be taken as evidence that the IRIS-H would not have a universal care obligation or that the Brussels private hospitals would have a comparable obligation.
Preostalo breme se nato krije z nadomestilom primanjkljaja, ki se obravnava v tem sklepu.
The universal care obligation that is entrusted to the IRIS-H ensures that patients facing extreme financial hardship, political refugees, illegal immigrants, etc. receive treatment in all circumstances.
Obveznost nudenja vseh osnovnih bolnišničnih storitev na več lokacijah
If these patients cannot pay for their treatment and have no insurance cover (neither via the social security nor through private health insurance) the CPAS will only cover these patients' costs provided that certain conditions are met.
Belgijski organi menijo, da imajo bolnišnice IRIS tudi posebno obveznost nudenja vseh osnovnih bolnišničnih storitev na več lokacijah v regiji glavnega mesta Bruselj.
To lay down the rules that apply for such reimbursement, the IRIS-H and 17 of the 19 CPAS in the Brussels Capital Region have concluded so-called multilateral ‘domicile de secours’ conventions.
Vendar po navedbah pritožnikov ni jasno, kaj obveznost nudenja popolnih dejavnosti osnovne bolnišnične oskrbe „na več lokacijah“ obsega ali kolikšna dodatna bremena nalaga bolnišnicam IRIS.
For non-urgent care, the CPAS refer persons to the IRIS-H and provide a written commitment (a so-called réquisitoire) that the CPAS will cover the cost of treatment.
Vendar pritožniki ne trdijo, da imajo bruseljske zasebne bolnišnice tako obveznost.
If patients show this document (réquisitoire) the IRIS-H send the invoice directly to the CPAS.
Komisija ugotavlja, da zakon LCH od bolnišnic (javnih ali zasebnih) ne zahteva, naj delujejo na več lokacijah.
For urgent care this procedure can of course not be followed.
Namesto tega mehanizem bolnišnične organizacije določa največje število bolnišničnih postelj, ki so lahko na voljo v posamezni belgijski regiji.
Instead, the reimbursement by the CPAS is conditional on (i) a medical certificate confirming the need for urgent admission or immediate treatment of the person; and (ii) the person's state of poverty as confirmed by the CPAS using the information collected by the hospital to complete a social inquiry.
Za regijo glavnega mesta Bruselj je število postelj v (splošni) bolnišnici omejeno na približno 7260 in vsaka bolnišnica v Bruslju lahko upravlja število postelj v okviru te omejitve.
Collecting the required information is an important task for the social services departments of the IRIS-H (see also recitals 210-211) [222].
Če je zmogljivost bolnišnice odobrena v okviru sistema organizacije, se lahko bolnišnica sama odloči, ali in v kolikšni meri bo te postelje razporedila na eno lokacijo ali pa jih razdelila na več lokacij v zadevni regiji.
Provided that the abovementioned conditions are met (i.e. a réquisitoire for non-urgent care and a medical certificate and social inquiry for urgent care), the CPAS reimburses the IRIS-H for the treatment costs of patients who cannot pay for their treatment and have no insurance cover.
Podobno se lahko odloči, ali bo podvojila nekatere oddelke ali namesto tega nudila le različne vrste oskrbe na vsaki od svojih zadevnih lokacij.
However, this does not relieve the IRIS-H from the entire burden of the universal care obligation.
V zvezi s tem so se nekatere bruseljske bolnišnice prostovoljno odločile za delovanje na več lokacijah, medtem ko druge delujejo le na eni lokaciji [227].
Indeed, in order to obtain reimbursement by the CPAS, the IRIS-H need to collect information for the social inquiry (which they did for 25749 cases in 2012).
Vendar se lahko zasebne bolnišnice kadar koli odločijo za prerazporeditev svojih postelj in oddelkov na eno lokacijo [228].
This is one of the reasons why the IRIS-H employ more than twice as many social workers as e.g. university hospitals (see recital 213).
Opozoriti je treba tudi, da lahko zasebne bolnišnice v okviru omejitev, določenih z mehanizmom bolnišnične organizacije [229], prostovoljno izberejo vrste oskrbe, ki jih nudijo, zato se lahko specializirajo za najdonosnejše vrste zdravstvenega varstva [230].
The CPAS however do not reimburse the IRIS-H for the cost of collecting the information for the social inquiries [223].
Obveznost nudenja storitev na več lokacijah, naložena bolnišnicam IRIS
Furthermore, the CPAS have longer payment delays (sometimes exceeding one year) than the mutuelles and insurance companies (both paying within one to two months after receipt of the invoice).
Kar zadeva bolnišnice IRIS, so občine in CPAS nadaljnjemu zagotavljanju oskrbe na lokalni ravni dali prednost pred koncentracijo bolnišničnih postelj.
As a result, the IRIS-H have to pre-finance these costs for a longer period than for ‘regular’ patients.
Posebej so se odločili za nudenje vseh osnovnih zdravljenj na vseh lokacijah, zaradi potrebnega podvajanja infrastrukture, opreme in dejavnosti pa so nastali višji stroški.
On 31 December 2010, the Brussels CPAS owed the IRIS-H almost EUR 35 million (of which about 71 % concerned invoices for 2010, 12 % for 2009 and approx.
Zato so se CPAS in občine pri prestrukturiranju bruseljskih bolnišnic leta 1995 namerno odločili, da glede na potrebe prebivalstva ohranijo obstoječe lokalne bolnišnične storitve na več lokacijah, ki nudijo vsa zdravljenja.
13 % for earlier years).
Ugotovili so, da še vedno obstaja lokalna zdravstveno-socialna potreba, zaradi katere so bile bolnišnice prvotno ustanovljene.
Using a nominal annual interest rate of 2 %, the IRIS-H estimated that the cost of the longer payment delays amounted to almost EUR 700000 at that time [224].
V zvezi s tem je treba opozoriti, da je večina lokacij, na katerih delujejo bolnišnice IRIS, v najrevnejših občinah regije glavnega mesta Bruselj (glej tudi uvodno izjavo 202).
Finally, not all persons who may experience difficulties to pay their bill are eligible for CPAS cover [225].
Javni organi so se zato prostovoljno odpovedali povečanju učinkovitosti na škodo svojim izključno finančnim interesom in se odločili, da ohranijo vse obstoječe bolnišnice, čeprav so vedeli, da zvezni ukrepi za financiranje bolnišnic ne bi pokrili vseh stroškov (npr. zaradi podvajanja infrastrukture in operativnih stroškov, glej tudi uvodno izjavo 203).
On the basis of their universal care obligation, the IRIS-H nevertheless treat patients for which they do not have the commitment that the CPAS will pay the costs.
Ta izbira je razvidna iz strateških načrtov združenja IRIS in zato bolnišnice IRIS zavezuje k ohranjanju vseh lokacij, da lahko pacienti vsa osnovna zdravljenja prejmejo čim bližje svojim bivališčem.
In such a situation, the IRIS-H send an invoice to patients who in some cases will not be able to pay.
Zlasti oddelek o strukturnih oseh strateškega načrta združenja IRIS za obdobje 1996–2001 navaja:
The result is that the IRIS-H have to deal with a level of irrecoverable debt which is much higher than that of other public hospitals and of private hospitals in Belgium [226].
„Ohranjanje decentralizirane bolnišnične dejavnosti in velike ambulantne pokritosti.
The IRIS-H estimated that in 2010 their amount of debt written off exceeded the average applicable for public hospitals in Belgium by approx.
Dejavnost se bo ohranila na devetih lokacijah“ [231] [232].[…]
EUR […] million.
„Ohranjanje temeljne dejavnosti na različnih lokacijah.
Finally, it is important to put into context the funding provided under Section B8 of the BMF which is awarded to hospitals with a weak socioeconomic patient profile.
Pacienti, zlasti starejši, so tako lahko še naprej deležni bolnišnične oskrbe na razumni oddaljenosti od bivališča“ [233].(195) V strateškem načrtu za obdobje 1996–2001 je poudarjeno tudi, da bolnišnice IRIS zdravijo zlasti paciente, ki živijo v bližini, zato se imenujejo „bolnišnice v bližini“ [234].
This limited Federal financing is meant to compensate some of the costs related to ‘social patients’ (e.g. due to the fact that on average such patients stay longer in the hospital than other patients) but is not compensation for a universal care obligation.
Poleg tega si bolnišnice IRIS prizadevajo „povečati učinkovitost [svojih] storitev, da bodo izpolnile potrebe mestnega prebivalstva, […] in povečati [svojo] dostopnost vsem skupinam prebivalstva, zlasti prikrajšanim“ [235].
The Section B8 financing does not compensate the actual costs incurred by hospitals for the treatment of social patients (e.g. the non-paid invoices by social patients, the need to have additional social workers).
V strateškem načrtu za obdobje 2002–2014 je poleg tega navedeno tudi:
Instead, a fixed budget (i.e. approx.
„Združenje IRIS sprejema načelo organizacije, usmerjene v paciente, obkrožene z javnim omrežjem ustanov, ki medsebojno sodelujejo, da bi zagotovile bližino in specializirano oskrbo“ [236].(197) V tem strateškem načrtu je v zvezi z oskrbo v bližini nadalje navedeno:
EUR 25 million per year for Belgium as a whole) is allocated on the basis of the ranking of the hospitals' socioeconomic patient profile (see recital 185).
„Ob upoštevanju geografske razporeditve bolnišnic IRIS in njihovega vpliva na pokritost splošnega prebivalstva, ki ponekod živi v socialni revščini, je prvi cilj na vsaki lokaciji zagotoviti kakovostno zdravstvo v bližini, ki je učinkovito in dostopno.
Since the top three positions in this ranking are occupied by the IRIS-H these hospitals also receive a larger proportion of the Section B8 financing in comparison to lower-ranked hospitals (such as the Brussels private hospitals).
Glavna naloga bolnišnic IRIS, razen bolnišnic Institut Bordet in Queen Fabiola Children's University Hospital [HUDERF] [237], ki sta referenčni bolnišnici, specializirani za eno področje, je nuditi zdravstvo v bližini, ki se odziva na lokalne potrebe pacientov, ki živijo v sosednjih občinah“ [238].(198) V strateškem načrtu združenja IRIS za obdobje 2002–2014 je določeno tudi, da bolnišnice IRIS poleg zdravstva v bližini, ki je povezano z osnovno oskrbo, nudijo tudi specializirano oskrbo (tj. širši in/ali bolj razvit obseg zdravljenja) [239].
The reason why both public and private hospitals are in principle eligible for this financing is that even in the absence of a universal care obligation like the one entrusted to the IRIS-H, hospitals can freely choose to treat social patients.
Vendar se taka oskrba ne zagotavlja na vseh lokacijah (čeprav se običajno nudi na več kot eni lokaciji), načrtuje pa se na ravni omrežja IRIS [240].
They may do so because not all social patients are unable to pay or are uninsured.
Cilj je prebivalcem Bruslja vedno zagotoviti dostopnost vsem na optimalni ravni zagotavljanja oskrbe (z zdravstvom v bližini ali specializirano oskrbo) [241].
In fact, for social patients that are covered by the social security often lower tariffs apply and the INAMI pays a larger share which reduces the financial risk for the hospital.
Ta strateški načrt vsebuje tudi podrobne preglednice, v katerih so navedene vrste osnovne oskrbe in specializirane oskrbe, ki so na voljo na posamezni lokaciji bolnišnic IRIS.
It is also the case that not every CPAS in Belgium has chosen to establish their own hospital.
Dejavnosti osnovne oskrbe so označene kot „raven 1 – raven bližine“, dejavnosti specializirane oskrbe pa so označene kot „raven 2 – raven specializacije“ in „raven 3 – referenčna raven“ [242].
Therefore, in order to fulfil their social aid obligation, the CPAS can rely on private hospitals.
Zato je zelo jasno, katere vrste oskrbe morajo bolnišnice IRIS zagotavljati na vsaki od lokacij.
In such situations, a private hospital would naturally treat a number of social patients and could also be eligible for the Section B8 financing foreseen by the BMF.
Za zagotovitev, da bolnišnice IRIS v celoti upoštevajo zdravstveno-socialne potrebe lokalnega prebivalstva in se v skladu z njimi tudi upravljajo, je bila ustanovitev bolnišnic IRIS povezana zlasti z ohranjanjem „lokalne podlage“ storitev javnih bolnišnic.
However, in the Brussels Capital Region the CPAS can rely on the public IRIS-H which explains why the ranking in recital 185 shows that the average socioeconomic profile of the Brussels private hospitals' patients is significantly better than that of the IRIS-H.
To je razvidno iz sporazuma o prestrukturiranju in potrjeno v sporazumu o sodelovanju z dne 19. maja 1994 [243], pa tudi iz sestave organov upravljanja bolnišnic IRIS [244].
For all these reasons, the Section B8 BMF funding cannot be interpreted as an indication of the existence of a universal care obligation for all Belgian hospitals.
Natančneje, v skladu s členom 11 statutov večino članov generalne skupščine združenj bolnišnic IRIS izvolita občinski svet in svet za socialne storitve (organiziran na občinski ravni), župan in predsednik CPAS pa sta imenovana po uradni dolžnosti.
Conclusion on the universal care obligation of the IRIS-H
Podobno deset od štirinajstih članov upravnega sveta imenujejo člani delegacije javnih organov pri generalni skupščini (v skladu s členom 27 statutov).
Based on the above, the Commission concludes that the universal care obligation only applies to the IRIS-H, is clearly entrusted and defined by the IRIS-H bylaws and the IRIS strategic plans in line with the requirements of the Loi CPAS (see recitals 29-30), and is also reflected in the ranking of the hospitals' socioeconomic patient profile (see recital 185).
Namen, da bi se morale bolnišnice IRIS upravljati ob upoštevanju zdravstveno-socialnih potreb lokalnega prebivalstva, je bil potrjen na seji upravnega sveta omrežja IRIS dne 20. novembra 1996, na kateri je bila sprejeta sprememba strateškega načrta za obdobje 1996–2001, v kateri je bilo izrecno navedeno:
This obligation ensures that poor people in the Brussels Capital Region receive adequate medical treatment even if they cannot pay including in non-emergency situations.
„Te omejitve, zaradi katerih je potrebno prestrukturiranje, je treba obravnavati v širšem okviru naših strateških ciljev, ki se lahko navedejo, kot sledi:
In this way, the IRIS-H provide social healthcare fulfilling the needs of the local population.
omrežje javnih bolnišnic IRIS mora biti ključni element prihodnjega bruseljskega sistema zdravstvenega varstva,
As explained in the previous recital, only part of the burden of this obligation is covered directly (e.g. via reimbursement of treatment costs by the CPAS).
naše bolnišnice se morajo prilagoditi spremenjenim potrebam bruseljskega prebivalstva,
The remaining burden is therefore covered via the deficit compensation at issue in this decision.
omrežje je treba prestrukturirati za paciente in ob upoštevanju pacientov,
Obligation to offer a full range of basic hospital services at multiple sites
posodobitev omrežja mora temeljiti na novem zagonu za bolnišnično skupnost na splošno in zlasti medicinsko skupnost.“
The Belgian authorities consider that the IRIS-H also have the specific obligation to offer a full range of basic hospital services at multiple sites in the Brussels Capital Region.
V tej spremembi je poleg tega navedeno:
According to the complainants it is however not clear what the obligation to offer complete ‘multi-site’ basic hospital care activities comprises, nor to what extent this obligation imposes additional burdens on the IRIS-H.
„V tem okviru je treba s prestrukturiranjem zagotoviti:
The complainants however do not claim that the Brussels private hospitals have such an obligation.
nadaljnje zagotavljanje zdravstvenih dejavnosti in zdravljenja v vsaki bolnišnici v skladu z našo nalogo zagotavljanja lokalnih zdravstvenih storitev,
The Commission notes that the LCH does not require hospitals (public or private) to operate on multiple sites.
prizadevanje za cilje finančnega ravnovesja,
Instead, the hospital programming mechanism determines the maximum number of hospital beds that can be offered in each Region of Belgium.
usklajen razvoj omrežja, da se uravnovesijo splošni in posebni interesi posameznega subjekta,
For the Brussels Capital Region, the number of (general) hospital beds is limited to approximately 7260 and each hospital in Brussels has the permission to operate a number of beds within this limit.
večje usklajevanje in sodelovanje med subjekti v omrežju,
In principle, if a hospital's capacity has been approved under the programming system, the hospital can decide freely whether and to what extent to group these beds on one site or to distribute them over multiple sites in that particular region.
dostopnost omrežja in ohranjanje njegove javne narave,
Likewise, it can decide whether or not to duplicate certain departments or instead to only offer distinct types of care at each of its respective sites.
Obveznost nudenja storitev na več lokacijah, naložena bolnišnicam IRIS, in njena dejanska narava storitev splošnega gospodarskega pomena