natgillin/translations-raw huggingface dataset:
In this context, some of the Brussels private hospitals have freely chosen to operate at several sites while others operate on just one site [227].
Komisija je proučila tudi trditev pritožnika v okviru zadeve pred Splošnim sodiščem (glej oddelek 4.2), da je treba lokalne zdravstvene potrebe obravnavati v okviru velikega števila javnih in zasebnih bolnišnic v regiji glavnega mesta Bruselj.
However, private hospitals can decide to regroup their beds and departments to one site at any time [228].
Kot je bilo pojasnjeno, se je v okviru mehanizma bolnišnične organizacije določilo največje število postelj v splošnih bolnišnicah v regiji glavnega mesta Bruselj, in sicer 7260, da bi se izognili preveliki ponudbi zdravstvenih storitev.
It is also worth noting that, within the limits set by the programming mechanism [229], private hospitals are also free to choose the types of care they offer which gives them the possibility to specialise in the most profitable types of healthcare [230].
To število postelj skupaj zagotavljajo javne in zasebne bolnišnice, da bi izpolnile potrebo po zdravstvenem varstvu v regiji glavnega mesta Bruselj.
The multi-site obligation incumbent on the IRIS-H
Vendar se v okviru mehanizma bolnišnične organizacije upoštevajo le zdravstvene potrebe na regionalni ravni, ne pa tudi socialne potrebe določene skupine prebivalcev in posebne socialne razmere na geografskem območju.
With regard to the IRIS-H, the municipalities and CPAS prioritised the maintenance of local care provision over the concentration of hospital beds.
Te socialne potrebe se ocenijo v okviru politike socialne pomoči CPAS (tj. na občinski ravni).
They specifically chose to offer a full range of basic treatments on all sites which due to the necessary duplication of infrastructure, equipment and activities led to higher costs.
Predhodnice bolnišnic IRIS so bile ustanovljene zaradi izpolnjevanja socialnih potreb, po prestrukturiranju pa so se različne lokacije bolnišnic IRIS ohranile, saj še naprej izpolnjujejo dejansko socialno potrebo (glej uvodne izjave od 82 do 84 in 91).
It is on that basis that in the 1995 Brussels hospital restructuring the CPAS and the municipalities deliberately chose to retain the existing multi-site local hospital services offering a full range of treatments, given the needs of the population.
Ker storitev splošnega gospodarskega pomena zagotavljanja socialnega zdravstvenega varstva opravljajo le bolnišnice IRIS, dejansko obstajata obveznost in potreba po več lokacijah.
They found that the local medico-social need prompting the initial creation of the public hospitals had not ceased to exist.
Za revne prebivalce regije glavnega mesta Bruselj ni pomembno le, da lahko obiščejo bolnišnico blizu svojega bivališča, ampak tudi, da so lahko prepričani, da bodo prejeli zdravljenje, tudi če ga ne bodo mogli plačati, in da lahko zaprosijo za podporo oddelka socialne službe.
In this context, it must be noted that most of the IRIS-H sites are located in the poorest municipalities of the Brussels Capital Region (see also recital 202).
Bruseljske občine in CPAS želijo s tem, ko so bolnišnice IRIS zavezali k ohranjanju različnih lokacij, zagotoviti, da se socialno zdravstveno varstvo zagotovi čim bližje lokacijam, kjer obstaja potreba po njem.
The public authorities hence willingly renounced efficiency gains, to the detriment of their purely financial interest, and chose to keep all existing hospital sites even though they knew that the federal hospital financing measures would not cover all the costs (e.g. due to duplication of infrastructure and operating costs, see also recital 203).
V zvezi s tem je treba poudariti, da je deset od enajstih lokacij bolnišnic IRIS v občinah, v katerih povprečni prihodek ne preseže mediane [246] za regijo glavnega mesta Bruselj.
This choice is reflected in the IRIS strategic plans and therefore obliges the IRIS-H to maintain all hospital sites so that patients can receive all basic treatments as close as possible to their homes.
Nasprotno je pet od enajstih zasebnih bolnišnic v občinah, v katerih je povprečni prihodek višji od te mediane [247].
In particular, the structuring axes section of the 1996-2001 IRIS strategic plan refers to:
Iz zemljevida [248] (glej sliko 3) je razvidno tudi, da v regiji glavnega mesta Bruselj ni bistvenega geografskega pokrivanja med javnimi (krogi s črtkano črto) ter zasebnimi splošnimi in univerzitetnimi bolnišnicami (krogi s polno črto).
‘Maintaining a decentralised hospital activity and a large outpatient coverage.
To pomeni, da veliko število bolnišnic, dejavnih v regiji glavnega mesta Bruselj, ne zadošča za zagotavljanje dostopa do bolnišnične oskrbe vsem prebivalcem.
The activity will be maintained on the nine sites’ [231] [232].[…]
Poleg tega so bolnišnice IRIS, kot je bilo pojasnjeno, edine bolnišnice v regiji glavnega mesta Bruselj, ki opravljajo storitev splošnega gospodarskega pomena zagotavljanja socialnega zdravstvenega varstva, zato zasebnih bolnišnic ni mogoče šteti za enakovredne, kar zadeva izpolnjevanje socialnih potreb lokalnega prebivalstva.
‘Maintaining the core activity on the different sites.
Komisija na podlagi navedenega ugotavlja, da zaradi prisotnosti več zasebnih bolnišnic v regiji glavnega mesta Bruselj ni treba dvomiti, da ima obveznost nudenja storitev na več lokacijah, ki velja za bolnišnice IRIS in ne za bruseljske javne bolnišnice, dejansko naravo storitev splošnega gospodarskega pomena, zlasti ob upoštevanju storitev splošnega gospodarskega pomena zagotavljanja socialnega zdravstvenega varstva.
Patients, especially elderly patients, can hence continue to receive hospital care at a reasonable distance from their home’ [233].(195) The 1996-2001 strategic plan also emphasises that the IRIS-H mainly treat patients who live in their near vicinity and are hence referred to as ‘proximity hospitals’ [234].
Slika 3
In addition, the IRIS-H want ‘to increase the adequacy of [their] services to the needs of the city's population, […] and strengthen [their] accessibility to all sections of the population, in particular the less advantaged’ [235].
Zemljevid bolnišnic v regiji glavnega mesta Bruselj
The 2002-2014 strategic plan adds to the above the following:
Hôpitaux psihiatriques
‘Iris adopts the principle of a patient-centred organisation, enclosed in a public network of institutions working together between them in order to ensure the provision of proximity and specialised care’ [236].(197) This strategic plan continues with respect to proximity care as follows:
Dejanski učinek obveznosti nudenja storitev na več lokacijah na bolnišnice IRIS
‘Taking into account the geographical distribution of the IRIS sites, their impact on the general population coverage, sometimes in social destitution, the first developed objective is to ensure at each site quality proximity medicine that is effective and accessible.
Obveznost nudenja storitev na več lokacijah se lahko šteje tudi za breme bolnišnic IRIS, saj morajo podvajati nekatero infrastrukturo, pomeni pa tudi višje operativne stroške.
The IRIS hospitals — apart from the Institut Bordet and the Queen Fabiola Children's University Hospital (HUDERF) [237] which are mono-specialised reference hospitals — have as their primary vocation to offer proximity medicine responding to a local demand by patients living in neighbouring municipalities’ [238].(198) The 2002-2014 IRIS strategic plan also specifies that beyond proximity medicine relating to basic care, the IRIS-H also provide specialised care (i.e. a wider and/or more developed range of treatments) [239].
Ti stroški so povezani zlasti s potrebo po zagotavljanju storitev na vsaki lokaciji, kot so služba za nujno pomoč, služba za sterilizacijo, službe za spremljanje in varnost ter lastna uprava.
Such care is however not provided on all sites (although it is usually offered on more than one site) and is subject to planning at the level of the IRIS network [240].
Dejansko se financiranje iz proračuna finančnih sredstev (glej uvodno izjavo 46(a)) dodeli le za eno tako storitev za posamezno bolnišnico, ne glede na to, na koliko lokacijah deluje.
The goal is always to guarantee to the Brussels population the accessibility for all at the optimal level of care provision (via proximity medicine or via specialised care) [241].
Operativni stroški, povezani z različnimi področji (vzdrževanje, gretje, čiščenje itd.), se prištejejo navedenim dodatnim stroškom za infrastrukturo in opremo.
This strategic plan also contains detailed tables which specify the types of basic care and specialised care that are offered on each of the IRIS-H sites.
Na podlagi študije, ki jo je krovna organizacija IRIS izvedla leta 2009, so bili stroški te obveznosti nudenja storitev na več lokacijah, ki jih financiranje iz proračuna finančnih sredstev ni krilo, za vseh pet bolnišnic IRIS skupaj ocenjeni na […] milijonov EUR za leto 2008 in […] milijonov EUR za leto 2009.
Basic care activities are labelled as ‘level 1 — proximity level’ while the specialised care activities are marked as ‘level 2 — specialisation level’ and ‘level 3 — reference level’ [242].
Sklepne ugotovitve o obveznosti nudenja storitev na več lokacijah bolnišnic IRIS
It is hence very clear for the IRIS-H which types of care they have to provide at each of their sites.
Komisija ugotavlja, da je na podlagi strateških načrtov združenja IRIS bolnišnicam IRIS naložena jasna obveznost (1) ohranjanja vseh bolnišnic zaradi izpolnjevanja zdravstveno-socialnih potreb zadevnega lokalnega prebivalstva in (2) zagotavljanja vseh dejavnosti osnovne oskrbe na vseh teh lokacijah.
In order to ensure that each IRIS-H is fully aware of and managed in the light of the medico-social needs of the local population, the creation of the IRIS-H was also specifically linked to the maintenance of a ‘local basis’ for the public hospital services.
V strateškem načrtu združenja IRIS so zlasti določene vrste dejavnosti, ki se štejejo za osnovno oskrbo oziroma specializirano oskrbo, in za vsako od bolnišnic IRIS je navedeno, katere vrste oskrbe mora nuditi.
This is reflected in the restructuring agreement backed by the cooperation agreement of 19 May 1994 [243] and also in the composition of the management bodies of the IRIS-H [244].
Poleg tega določbe statutov bolnišnic IRIS in zakona o CPAS zagotavljajo, da bolnišnice IRIS v celoti upoštevajo zdravstveno-socialne potrebe lokalnega prebivalstva in se v skladu z njimi tudi upravljajo.
More particular, in accordance with Article 11 of the bylaws, the majority of the members of the General Assembly of the IRIS-H associations are elected by the municipal council and the Social Services Council (organised at municipal level) while the Mayor and the Chair of the CPAS are appointed as ex-officio members.
Poleg tega obveznost nudenja storitev na več lokacijah presega zahteve zakona LCH in mehanizma bolnišnične organizacije, saj slednji ne upošteva socialnih potreb določenega prebivalstva in posebnih socialnih razmer na geografskem območju.
Likewise, 10 of the 14 members of the Administrative Council are appointed by members of the public authorities' delegation to the General Assembly (as required by Article 27 of the bylaws).
Zasebnim bolnišnicam ni treba delovati na več lokacijah ali zagotavljati vseh vrst osnovne oskrbe na vsaki lokaciji (če se odločijo za delovanje na več lokacijah).
The intention to manage the IRIS-H in the light of the medico-social needs of the local population was confirmed by the IRIS network's Administrative Council meeting on 20 November 1996, at which an amendment to the 1996-2001 strategic plan was adopted, explicitly stating in that connection:
Kot je pojasnjeno v prejšnji uvodni izjavi, imajo bolnišnice IRIS zaradi obveznosti nudenja storitev na več lokacijah precejšnje stroške, ki jih proračun finančnih sredstev ne krije, in zato prispevajo k primanjkljaju bolnišnic IRIS.
‘That series of constraints, necessitating restructuring, must be addressed in the wider context of our strategic objectives, which may be stated as follows:
Obveznost zagotavljanja obsežnih socialnih storitev
the IRIS public hospitals network must be a key element in the future of the Brussels healthcare system,
Belgijski organi menijo, da morajo bolnišnice IRIS pacientom in njihovim družinam zagotavljati obsežne socialne storitve.
our hospitals must adapt to changes in the needs of the Brussels population,
Po navedbah pritožnikov obveznost očitno obsega le večji obseg socialnih storitev, kot ga zagotavljajo druge bolnišnice.
the network must be restructured for and around patients,
V zvezi s tem je treba poudariti, da niti zakon LCH niti pogoji za izdajo dovoljenj bolnišnicam (na podlagi zveznega odloka z dne 23. oktobra 1964) ne nalagajo splošne obveznosti zagotavljanja socialnih storitev v bolnišnici.
the modernisation of the network must be based on a new momentum for the hospital community generally and the medical community in particular.’
Potrebo po posredovanju socialnih delavcev določa le nekaj posameznih pravil o posebnih bolnišničnih storitvah (tj. za geriatrični in psihiatrični oddelek [249]).
This amendment goes on to state:
Poleg tega posebno pravilo za univerzitetne bolnišnice določa le, da mora biti na vsakih 2000 sprejemov prisoten en socialni delavec [250].
‘In that context, the restructuring must guarantee:
Razen v teh posebnih primerih zasebnim bolnišnicam ni treba zagotavljati socialnih storitev vsem svojim pacientom.
the continuation of medical and treatment activities at each hospital site, consistent with our mission to provide local medical services,
Nasprotno morajo imeti bolnišnice IRIS na podlagi strateških načrtov združenja IRIS socialno službo, ki pomaga vsem pacientom, ki jo potrebujejo.
the pursuit of financial equilibrium aims,
Obveznost zagotavljanja obsežnih socialnih storitev, naložena bolnišnicam IRIS
harmonious development of the network in order to balance the general and specific interests of each entity,
Strateški načrt združenja IRIS za obdobje 1996–2001 določa splošni okvir za splošno zdravljenje pacientov v bolnišnicah IRIS, vključno s psihosocialnimi in okoljskimi vidiki:
greater coordination and collaboration between entities in the network,
„Celovita oskrba pacientov: pacienta ni mogoče obravnavati le z vidika zdravstvenega stanja, zaradi katerega potrebuje oskrbo.
accessibility of the network and maintenance of its public character,
Zlasti nekatere kategorije pacientov potrebujejo celovito oskrbo, ki ne zajema le izključno zdravstvenih vidikov, ampak tudi psihosocialne in okoljske vidike: to velja za geriatrične, pediatrične, neozdravljivo bolne, psihiatrične, socialno prikrajšane in druge paciente“ [251].(207) V tem načrtu so nato opisane vloga socialnih služb in njihove glavne naloge:
Genuine SGEI nature of the multi-site obligation on the IRIS-H
„Bolnišnice [IRIS] morajo imeti socialne službe, katerih glavna vloga je prispevati k dobrobiti pacientov, kakovosti zdravstvenega varstva in optimalnemu delovanju ustanove.
The Commission also considered the complainant's argument in the context of the case before the GC (see Section 4.2) that the local healthcare needs have to be seen in the context of the large number of public and private hospitals present in the Brussels Capital Region.
Socialna služba je sodelavka upravitelja bolnišnice in partnerka vseh oddelkov bolnišnice.
As explained above, the hospital programming mechanism set the maximum number of general hospital beds in the Brussels Capital Region at 7260 with the objective to avoid excess supply of medical services.
Odgovorna je za humanizacijo pogojev pacientovega bivanja v bolnišnici.
This number of beds is provided jointly by public and private hospitals to meet the need for hospital care in the Brussels Capital Region.
Poskrbeti mora za socialne težave pacientov še pred začetkom bivanja v bolnišnici, če je to mogoče, pa tudi med bivanjem in ob odpustu iz bolnišnice.
However, the programming mechanism only takes into consideration the medical needs at regional level and does not take into account the social needs of a particular population and the specific social conditions in a geographical area.
Je posebna povezava med bolnišnico in pacientom, njegovo družino in okoljem.
Those social needs are assessed under the social aid policy of the CPAS (i.e. at municipal level).
Da bi lahko uresničila navedeno, mora:
The predecessors of the IRIS-H were established to meet social needs and following the restructuring the different sites of the IRIS-H were maintained because they continue to fulfil a genuine social need (see recitals 82-84 and 91).
imeti čas in biti strokovno usposobljena, da lahko skupaj s pacientom, njegovo družino in spremstvom ter zdravniškimi skupinami oceni njegove potrebe in z njim razvije ustrezne odzive,
Indeed, it is because only the IRIS-H perform the social healthcare SGEI that there is also the necessity and obligation to have multiple sites.
imeti dostop do dokumentacije o sprejemu in zdravju pacienta, ki lahko vključuje socialne podatke, ki lahko prispevajo h kakovosti oskrbe,
For poor inhabitants of the Brussels Capital Region it is not only important to be able to go to a hospital close to his or her home but also to be sure that they will receive treatment even if they cannot pay and to be able to request support from the social services department.
biti pravočasno obveščena o datumu premestitve ali odpusta, da stori vse potrebno,
By obliging the IRIS-H to maintain their different sites, the Brussels municipalities and CPAS want to ensure that social healthcare is provided as close as possible to where there is a need.
podati mnenje o pacientih z zapletenimi profili in boleznimi,
In this context, it is worth pointing out that ten of the eleven IRIS-H sites are located in municipalities where the average income does not exceed the median [246] for the Brussels Capital Region.
skupaj s finančnimi službami določiti pravne ureditve, saj omejitve njenega posredovanja določa poklicna etika v pacienta usmerjenega odnosa v vseh njegovih vidikih,
On the contrary, five of the eleven private hospital sites are located in municipalities where the average income is higher than this median [247].
se usklajevati s CPAS,
From the map below [248] (see Figure 3) there also appears to be no significant geographical overlap between the public (dashed line circles) and private general and university hospitals (full line circles) in the Brussels Capital Region.
poznati vzpostavljene zdravstvene in socialne mreže,
This suggests that the pure fact that there is a large number of hospitals active in the Brussels Capital Region is not sufficient to ensure accessibility to hospital care for all inhabitants.
predlagati izboljšave v delovanju bolnišnice,
Furthermore, as explained above, the IRIS-H are the only hospitals in the Brussels Capital Region that provide a social healthcare SGEI and the private hospitals can hence not be seen as equivalent when it concerns catering to the social needs of the local population.
imeti infrastrukturo, ki zagotavlja zaupnost izmenjav in podatkov.
On the basis of the above, the Commission concludes that the presence of several private hospitals in the Brussels Capital Region is no reason to put into doubt the genuine SGEI nature of the multiple sites obligation that applies to the IRIS-H and not to the Brussels private hospitals, especially in the light of the social healthcare SGEI.
Naloga socialne medicine, ki je poslanstvo javnih bolnišnic, pomeni, da imajo usklajevalno vlogo med deležniki v sektorju zdravstvene nege, da sodelujejo v zdravstvenih in socialnih mrežah ali take mreže celo vzpostavijo, in da neposredno sodelujejo pri oblikovanju pomožnih storitev združenja IRIS, ki so potrebne zaradi izpolnjevanja potreb prebivalstva (hotel de soins, hotel des familles, paliativna oskrba na domu, oskrba odvisnikov od drog, oskrba brezposelnih, storitve domačega varstva itd.).
Figure 3
Izvajajo akreditacijo organov, s katerimi bodo sodelovale“ [252].(208) V skladu s tem strateškim načrtom ima socialna služba pomembno vlogo tudi pri sprejemu pacientov:
Map of hospital sites in the Brussels Capital Region
„Prihod pacienta v bolnišnico je treba obravnavati različno glede na to, ali pride zaradi nujnega primera, pregleda ali sprejema; ob prihodu je treba pacientom vedno zagotoviti diskretnost in udobje ter odpraviti njihove pomisleke in pomisleke njihove družine.
Hôpitaux psihiatrique
Socialne službe naših bolnišnic imajo pri tem pomembno vlogo“ [253].(209) V strateškem načrtu združenja IRIS za obdobje 2002–2014 je poleg navedenega dodano:
Practical impact of the multi-site obligation on the IRIS-H
„Socialne storitve so v javnih bolnišnicah bistvene zaradi podpore bolnišničnim in ambulantnim pacientom.
The multiple sites obligation can also be considered as a burden for the IRIS-H as it requires them to duplicate certain infrastructure and brings higher operating costs.
Vključujejo pomoč pacientom in njihovim družinam pri reševanju in obvladovanju upravnih, finančnih, medosebnih in socialnih težav, povezanih z boleznijo, bivanjem v bolnišnici in zdravljenjem ter novo prognozo in okoliščinami.
These costs relate mainly to the need to provide each site with services such as an emergency service, a sterilisation service, a monitoring and security service and its own administration.
Socialna služba:
In fact, the BMF financing (see recital 46(a)) is granted for only one such service for each hospital, irrespective of the number of its sites.
spremlja paciente pri njihovi samostojnosti in neodvisnosti,
The operating costs related to the various areas (maintenance, heating, cleaning, etc.) are added to those additional infrastructure and equipment costs.
zagotovi, da se v splošno oskrbo vključijo pacientove norme, vrednote in kultura, zato se osredotoča na upravno pomoč, psihosocialno podporo in vlogo v zvezi z obveščanjem, preprečevanjem, ozaveščanjem, sodelovanjem in usklajevanjem.
Based on a study made by the IRIS umbrella organisation in 2009, the costs of the multi-site obligation that were not covered by the BMF financing were estimated at EUR […] million for 2008 and EUR […] million for 2009 for the five IRIS-H together.
Socialna služba torej deluje na različnih ravneh glede na to, ali pacienti potrebujejo socialno-materialno, psiho-socialno ali socialno-upravno podporo,
Conclusion on the multi-site obligation of the IRIS-H
zahteva tehnične in medosebne veščine, ki so hkrati konceptualne in tehnične, pa tudi osebne in medosebne lastnosti.
The Commission concludes that on the basis of the IRIS strategic plans the IRIS-H are entrusted with the clear obligation to (1) maintain all their hospital sites in order to meet the medico-social needs of the respective local populations; and (2) to provide a full range of basic care activities on all these sites.
Socialne službe imajo več različnih odgovornosti:
In particular, the IRIS strategic plan lays down the types of activities that are considered as basic care respectively specialised care and indicates for each of the IRIS-H sites what types of care have to be offered.
organizacija sprejema pacienta v bolnišnico in čim boljša priprava vsega potrebnega za njihov odpust v ustrezno oskrbo,
Furthermore, the provisions in the IRIS-H bylaws and the Loi CPAS ensure that the IRIS-H are fully aware of and managed in the light of the medico-social needs of the local population.
pomoč pacientom pri urejanju socialnega zavarovanja, da bodo lahko poravnali zdravstvene stroške.
In addition, the multiple sites obligation goes beyond the requirements of the LCH and the programming mechanisms as the latter does not take into account the social needs of a particular population and the specific social conditions in a geographical area.
„Socialna služba pripravi elektronsko datoteko, s katero lahko spremlja paciente v celotnem omrežju [IRIS].
Private hospitals hence neither are obliged to operate on several sites nor are they required to provide a full range of basic care on each site (in case they choose to have multiple sites).
Preveri tudi finančno zmogljivost [pacientov] ter izpolni oznake „V“ RCM [255] in druge evidence, ki jih zahtevajo predpisi.