natgillin/translations-raw huggingface dataset:
Their costs are, in addition to the particular activities they carry out, also influenced by their status as public hospitals which entails a number of constraints that do not apply to private hospitals.
„Brez poseganja v člen 109 [zakona LCH] se rezultat poslovnega leta razdeli med partnerje, ki imajo vsaj petino glasov v generalni skupščini, in sicer s sklepom generalne skupščine“ [48].Na podlagi tega morajo občine in CPAS v celoti pokriti vsak primanjkljaj bolnišnic IRIS, kot je naveden v njihovih računovodskih izkazih.
In particular, the operating costs incurred by the IRIS-H in the provision of their services of general economic interest (hereinafter ‘SGEI’) and ancillary activities are among others increased by factors such as:
Poleg tega morajo občine v skladu s členom 106 zakona o CPAS kriti vsak primanjkljaj, ki ga ustvari njihov CPAS (glej uvodno izjavo 22).
the requirement to pay mandatory language bonuses [40] that have to be awarded to bilingual employees with an estimated yearly cost [41] to be borne by the IRIS-H of approx.
Zato občine (neposredno in na podlagi svoje obveznosti financiranja zadevnega CPAS) na koncu zagotovijo kontinuiteto bolnišnic IRIS, tako da v celoti pokrijejo vsak primanjkljaj, ki ga te bolnišnice morda ustvarijo.
EUR […] [42] million,
Koliko morajo občine in CPAS posredovati, da bi morebitni primanjkljaj, ki ga ustvarijo bolnišnice IRIS, pokrili na podlagi člena 46 njihovih zadevnih statutov, je seveda odvisno od tega, v kolikšnem obsegu lahko bolnišnice IRIS svoje stroške krijejo iz drugih virov financiranja.
the pension scheme that applies to statutory employees [43] (i.e. civil servants) which is more generous than the one applying to private sector employees and for which the IRIS-H have to contribute an estimated amount of EUR […] million per year,the costs related to long-term illnesses of statutory employees [44] that have to be borne by the IRIS-H (instead of by the social security system) for an estimated yearly amount of EUR […] million,pay scale increases imposed on the IRIS-H by the Brussels Capital Region [45] which sets the pay scales for employees of the municipalities, the CPAS and the IRIS-H and which only pays for 60 % of these increases leaving an annual cost of approx.
V zakonu LCH je opisanih pet virov financiranja, ki so enako na voljo javnim in zasebnim bolnišnicam.
EUR […] million for the IRIS-H, and
Operativni stroški belgijskih bolnišnic se večinoma krijejo iz prvih treh virov financiranja [49], četrti in peti vir pa sta povezana s stroški bolnišnic za naložbe.
the mandatory contributions by the IRIS-H to the cost of the IRIS umbrella organisation [46] for an estimated annual cost of EUR […] million.(43) These residual costs have to be borne by the IRIS-H and are not covered by other public financing sources (such as for instance the BMF, see recital 46(a)).
Prvi vir financiranja je budget des moyens financiers (v nadaljnjem besedilu: proračun finančnih sredstev) [50], ki ga določi zvezni minister za javno zdravje, v njegovem okviru pa se upoštevajo le dejavnosti zdravstvenega varstva, ki jih krije socialno zavarovanje.
The financing and accounting mechanisms of the IRIS-H
Proračun finančnih sredstev se določi za vsako bolnišnico v okviru skupnega proračuna zvezne države.
Financing mechanisms
Razpoložljivi zvezni proračun se razdeli med vse bolnišnice in ni nujno, da krije vse njihove upravičene stroške.
The fundamental principle according to which the IRIS-H are funded is enshrined in Article 46 [47] of the bylaws of each of the five local hospital associations (see recitals 28-29), which stipulate that:
Od leta 2002 se proračun finančnih sredstev za vsako bolnišnico določi zlasti glede na število dni zdravljenja, ki jih je posamezna bolnišnica zagotovila v prejšnjem letu.
‘Without prejudice to Article 109 [LCH], the result of the financial year shall be allocated between partners holding at least one fifth of the votes in the General Assembly by decision of the General Assembly’ [48].On this basis, the municipalities and the CPAS are required to fully absorb any deficit incurred by the IRIS-H as reported in their financial accounts.
Ta posebni znesek se nato posamezni bolnišnici izplača na dva načina.
In addition, according to Article 106 of the Loi CPAS, the municipalities have to cover any deficit generated by their CPAS (see recital 22).
Natančneje, približno 85 % (fiksni del) tega zneska se bolnišnicam izplačuje mesečno, preostalih 15 % (spremenljivi del) pa se izplača na podlagi dejanskih sprejemov in dni zdravljenj v bolnišnici med letom.
In consequence, the municipalities (directly and via their funding obligation towards their respective CPAS) ultimately ensure the continuity of the IRIS-H by fully covering any deficit these hospitals may generate.
Ob koncu vsakega leta se proračun finančnih sredstev preračuna na podlagi dejanskih podatkov za zadevno leto in glede na rezultat bolnišnica prejme določen znesek ali pa ga mora vrniti.
The extent to which the municipalities and the CPAS have to intervene to cover any deficit generated by the IRIS-H on the basis of Article 46 of their respective bylaws naturally depends on the degree to which the IRIS-H can cover their costs from other financing sources.
Proračun finančnih sredstev podrobneje ureja kraljevi odlok z dne 25. aprila 2002, v katerem so opredeljeni pogoji in pravila za določanje proračuna finančnih sredstev, dodeljenega bolnišnicam.
The LCH describes five financing sources that are available equally for public and private hospitals.
Kraljevi odlok zlasti določa, kako se določi proračun finančnih sredstev, katere vrste stroški se lahko krijejo z državnim financiranjem in katera merila veljajo v zvezi s tem [51].
The operating costs of Belgian hospitals are mainly covered by the first three financing sources [49] while the fourth and fifth sources are related to hospitals' investments costs.
Poudariti je treba, da proračun finančnih sredstev ni vzpostavljen zaradi kritja dejanskih stroškov, ki jih ima posamezna bolnišnica, ampak je v glavnem urejen kot pavšalno financiranje na podlagi njenih povprečnih dejanskih preteklih stroškov.
The first financing source is the budget des moyens financiers (hereinafter ‘BMF’) [50], which is established by the Federal Minister responsible for public health, and only takes into account healthcare activities that are covered by the social security.
Zato proračun finančnih sredstev morda ne zadošča pri močno povišanih stroških ali drugih dogodkih v organizacijski in stroškovni strukturi bolnišnice.
The BMF is determined for each hospital within the boundaries of the global Federal State budget.
Drugi vir financiranja so prispevki za socialno varnost, ki jih Institut National d'Assurance Maladie-Invalidité (v nadaljnjem besedilu: inštitut INAMI) bolnišnicam izplača za zdravljenje, ki so ga nudile pacientom.
The available Federal budget is allocated among all hospitals and may not necessarily cover all of their eligible costs.
To financiranje temelji na zakonu Loi Assurance Maladie-Invalidité [52] oziroma njegovi konsolidirani različici iz zakona z dne 14. julija 1994 [53], ki vzpostavlja belgijski sistem socialne varnosti za bolezni in invalidnost ter določa zdravstvene storitve in zdravila, ki so upravičena do nadomestila iz naslova socialnega varstva.
Since 2002, the BMF for each hospital is mainly determined on the basis of the number of days of treatment provided by each hospital during the previous year.
Bolnišnice del plačil zdravnikom in stroškov zdravljenja pacientov neposredno zaračunajo inštitutu INAMI.
This specific amount is then paid out to each of the hospitals in two different ways.
Vendar ta plačila ne krijejo vseh stroškov, ki jih imajo bolnišnice pri zagotavljanju svojih zdravstvenih dejavnosti.
In particular, about 85 % (the fixed part) of this amount is being paid to the hospitals on a monthly basis, while the remaining 15 % (the variable part) is paid on the basis of the actual admissions and days of treatment in the hospital during the year.
Zato bolnišnice, ki nimajo zadostnih drugih virov prihodkov, tvegajo, da bodo imele izgubo.
At the end of each year, the BMF is recalculated on the basis of the actual figures for the year and depending on the outcome the hospital either receives or has to repay an amount.
Tretji vir financiranja so plačila, ki jih bolnišnicam neposredno plača pacient ali njegova zasebna zavarovalnica.
The BMF is regulated in more detail by the Royal Decree of 25 April 2002 which defines the conditions and rules for setting the BMF granted to hospitals.
Ta plačila so potrebna, ker sistem socialne varnosti ne krije celotnega plačila zdravnikov ali zdravil in drugih medicinskih pripomočkov (npr. vsadkov).
In particular, the Royal Decree determines how the BMF is set, which type of costs are accepted for coverage by State funding and what criteria apply in this regard [51].
Poleg tega se lahko poleg običajne cene za hospitalizacijo in običajnega plačila za zdravnika zaračunajo dodatki, če se pacienti na primer odločijo za zasebno sobo (tj. za zdravljenje se lahko zaračuna znesek, višji od standardne cene).
It is important to point out that the BMF is not set up to cover the actual costs incurred by each hospital but is instead mainly arranged as flat rate financing based on their average actual historical costs.
Pacientom se lahko zaračuna tudi uporaba dodatnih storitev (npr. najem televizorja, uporaba parkirišča bolnišnice itd.).
As a result, the BMF may be insufficient in case of significant cost increases, or other evolutions in the organisation and cost structure of a hospital.
Vsa plačila, ki jih pacienti ali tretje osebe plačajo za nadomestilo bolnišničnim zdravnikom za zdravljenje hospitaliziranih pacientov, mora centralno pobrati bolnišnica [54].
The second source of financing are the social security payments, i.e. made by the Institut National d'Assurance Maladie-Invalidité (hereinafter ‘INAMI’), to the hospitals for the treatments they offered to their patients.
Bolnišnice in njihovi zdravniki sklenejo dogovore, v katerih so določeni odstotki plačil, ki jih bolnišnice lahko zadržijo za kritje stroškov pobiranja in drugih stroškov, ki se ne financirajo iz proračuna finančnih sredstev [55].
This financing is based on the Loi Assurance Maladie-Invalidité [52], respectively its consolidated version laid down in the Law of 14 July 1994 [53], which sets up the Belgian social security system with regard to sickness and invalidity and specifies the medical services and medication that are eligible for compensation by the social security.
Podobno kot velja za običajna plačila zdravnikom, lahko bolnišnica del navedenih dodatkov zadrži za kritje dela svojih stroškov (spet v skladu z dogovorom med bolnišnico in njenimi zdravniki).
The hospitals directly charge part of the doctor's fees and the cost of the patients' medication to the INAMI.
Del plačila zdravnikom torej ni plačilo, ki ga dobijo zdravniki, ampak se uporabi za kritje operativnih stroškov bolnišnic.(d) Četrti vir financiranja je posebej namenjen kritju stroškov bolnišnic za naložbe.
These payments however do not cover the full costs that the hospitals incur when providing their healthcare activities.
Naložbe bolnišnic v glavnem krije država (zvezna vlada in regije plačajo vsaka svoj del), preostali del pa bolnišnice plačajo iz lastnih sredstev in z bančnimi posojili.
As a result, hospitals that have insufficient other sources of revenues risk becoming loss-making.
Državno financiranje je namenjeno kritju stroškov gradnje ali prenove bolnišnice ali bolnišničnega oddelka ter stroškov prvega nakupa opreme in medicinskih pripomočkov [56].
A third source of financing are payments made directly by the patient or by their private health insurers to the hospitals.
Subvencije za naložbe so omejene (npr. fiksni znesek na kvadratni meter ali enoto).
These payments are necessary because the social security does not cover 100 % of doctors' fees nor of medication and other medical supplies (e.g. implants).
Peti splošni vir javnega financiranja je povezan z naložbami in je namenjen odškodninam za študije, razvoju gradbenih projektov in kritju stroškov, ki nastanejo zaradi zaprtja ali neuporabe bolnišnice ali bolnišničnega oddelka [57].
In addition, if patients choose to have a single room, then supplements can be charged on top of the normal hospitalisation price and on top of the normal doctor's fee (i.e. more than the standard rates that apply per treatment).
V praksi se to financiranje ne dodeli zelo pogosto.
Finally, patients may also be charged for the use of additional services (e.g. rent for a TV, use of the hospital parking, etc.).
Člen 109 zakona LCH (zdaj člen 125 zakona LCH iz različice zakona z dne 10. julija 2008 [58]) določa šesti mehanizem financiranja, ki ga lahko koristijo le javne bolnišnice (kot so bolnišnice IRIS).
All payments made by patients or third parties to compensate hospital doctors for their treatment of hospitalised patients, have to be collected centrally by the hospital [54].
V skladu s to določbo morajo primanjkljaj javnih bolnišnic, ki izvira iz njihovih bolnišničnih dejavnosti, kriti občine, ki jih nadzirajo (npr. prek CPAS ali centralne strukture, kot je združenje IRIS).
The hospitals and their doctors conclude agreements that determine the percentages of the fees that the hospitals can keep to cover their collection costs and other costs that are not financed by the BMF [55].
Načelo, da ta primanjkljaj (delno) krijejo občine, je bilo vključeno že v zakon z dne 23. decembra 1963 [59], ki je veljal pred zakonom LCH, in potrjeno s členom 34 zakona z dne 28. decembra 1973 [60].
Similarly as for the normal doctors' fees, part of the abovementioned supplements can also be retained by the hospital to cover part of its costs (again conditional on an agreement between the hospital and its doctors).
Merila za izračun primanjkljajev, ki jih morajo kriti občine, so določena v kraljevem odloku [61].
Part of the doctors' fees are hence not a payment going to the doctors but instead are used to cover the operating costs of the hospitals.(d) The fourth source of financing is specifically meant to cover investment costs incurred by the hospitals.
Na podlagi tega zvezni minister za javno zdravje vsako leto določi primanjkljaj, ki ga je treba kriti za posamezno javno bolnišnico.
The investments of hospitals are mainly covered by the State (the Federal government and the Regions each pay a part) and the remaining part is paid from the hospitals' own resources combined with bank loans.
V praksi primanjkljaj na podlagi člena 109 zakona LCH, ki ga je treba kriti, kot določi minister, ni popolnoma enak primanjkljaju iz računovodskih izkazov bolnišnice, saj so nekateri stroškovni elementi (npr. rezultat nebolnišničnih dejavnosti, ki so v primeru bolnišnic IRIS v celoti pomožne bolnišnične dejavnosti, kot bo pojasnjeno v uvodni izjavi 155) [62], ki so vključeni v primanjkljaj iz računovodskih izkazov, izključeni iz primanjkljaja na podlagi člena 109 zakona LCH.
The State financing is aimed at the costs of building or renovating a hospital or hospital ward and the costs of the first acquisition of equipment and medical devices [56].
Bolnišnice IRIS imajo torej na voljo celovit mehanizem financiranja, ki zagotavlja kritje vsakega primanjkljaja, ki ga morda ustvarijo.
Investment subsidies are capped (e.g. a fixed amount per square metre or per unit).
Pet splošnih ukrepov financiranja, predvidenih v zakonu LCH (glej uvodno izjavo 46), krije večino operativnih stroškov bolnišnic in naložbe.
The fifth general source of public financing is related to investments and concerns damages payments for studies, the development of building projects, but also costs resulting from the closure or non-usage of a hospital or hospital ward [57].
Če ti viri ne zadoščajo za kritje stroškov, nastalih pri opravljanju dejavnosti bolnišnic, morajo občine v skladu s členom 46 statutov bolnišnic IRIS v celoti kriti vsak primanjkljaj, ki ga ustvarijo bolnišnice IRIS (glej uvodni izjavi 44 in 45).
In practice, this type of financing is not very commonly awarded.
Računovodski primanjkljaj, ki ga obravnava člen 46 statutov, nujno zajema „primanjkljaj na podlagi člena 109“ [63] (glej uvodno izjavo 47), s popolnim kritjem računovodskega primanjkljaja pa občine izpolnijo tudi svojo obveznost na podlagi člena 109 zakona LCH.
Article 109 of the LCH (now Article 125 of the LCH in the version of the Law of 10 July 2008 [58]) sets out a sixth financing mechanism of which only public hospitals (such as the IRIS-H) can benefit.
Načini plačevanja iz tega mehanizma za nadomestilo primanjkljaja bodo opisani v nadaljevanju (glej oddelek 7.3.5).
According to this provision, public hospitals' deficits arising from their hospital activities have to be covered by the municipalities that control them (i.e. via their CPAS or via a central structure such as IRIS).
Računovodske zahteve
The principle of this (partial) deficit cover by the municipalities was already included in the Law of 23 December 1963 [59], which preceded the LCH, and was confirmed by Article 34 of the Law of 28 December 1973 [60].
Za vse bolnišnice (tj. javne in zasebne) veljajo računovodske zahteve in zahteve glede preglednosti.
The criteria to calculate the deficits that the municipalities are obliged to cover are determined in a Royal Decree [61].
Vsaka bolnišnica mora zlasti voditi več računovodskih evidenc, na podlagi katerih se lahko določijo stroški posamezne storitve in ki upoštevajo nekatere elemente zakona z dne 17. julija 1975 [64] o računovodstvu [65].
On this basis, the Federal Minister responsible for public health each year determines the deficit that must be covered for each public hospital.
Vodenje ločenih računovodskih evidenc nebolnišničnih dejavnostih je obvezno.
In practice, the Article 109 LCH deficit that must be covered as determined by the Minister is not exactly equal to the deficit reported in the financial accounts of the hospital, since certain cost elements (e.g., the result of the non-hospital activities which in the case of the IRIS-H are purely ancillary to the hospital activities as will be explained in recital 155) [62] contained in the deficit reported in the financial accounts are excluded from the Article 109 LCH deficit.
Bolnišnice morajo tudi imenovati revizorja, ki potrdi računovodske evidence in izkaze bolnišnice [66].
In conclusion, the IRIS-H thus enjoy a comprehensive financing mechanism that ensures coverage of any deficit they may generate.
Bolnišnice morajo tudi predložiti nekatere (finančne) informacije zveznemu ministru za javno zdravje [67], njegova zvezna javna služba pa spremlja skladnost z zakonom LCH [68].
The five general financing measures foreseen by the LCH (see recital 46) cover the majority of the hospitals' operating and investment costs.
OPIS UKREPOV, NA KATERE SE NANAŠA PRITOŽBA
To the extent that these sources are insufficient to cover the costs arising from the hospitals' activities, Article 46 of the bylaws of the IRIS-H obliges the municipalities to fully cover any deficit generated by the IRIS-H (see recitals 44-45).
Po navedbah pritožnikov se je regija glavnega mesta Bruselj odločila, da dejansko prevzame vlogo zadevnih bruseljskih občin pri nadomestilu za primanjkljaje bolnišnic IRIS.
The accounting deficit addressed by Article 46 of the bylaws necessarily includes the ‘Article 109 LCH deficit’ [63] (see recital 47) and by fully covering the accounting deficit, the municipalities also fulfil their obligation under Article 109 LCH.
V pritožbi so zlasti navedeni ukrepi sklada Fonds Régional Bruxellois de Refinancement des Trésoreries Communales (ali sklada FRBRTC), ki ga je ustanovila regija glavnega mesta Bruselj [69].
The payment modalities of this deficit compensation mechanism will be described below (see Section 7.3.5).
Poleg tega je v pritožbi navedeno, da naj bi regija glavnega mesta Bruselj občinam od leta 2003 tudi sama dodeljevala posebne subvencije [70] (tj. v višini do 10 milijonov EUR letno), ki naj bi se kot pomoč prenesle na bolnišnice IRIS.
Accounting requirements
Pritožniki niso izrazili pomislekov glede pristojnosti regije glavnega mesta Bruselj v primerjavi s temi občinami, vendar menijo, da sredstva, ki so jih opredelili kot regionalno financiranje bolnišnic IRIS, presegajo sredstva, predvidena za kritje primanjkljaja v skladu s členom 109 zakona LCH (glej tudi uvodno izjavo 47).
All hospitals (i.e. public and private) are subject to accounting and transparency requirements.
Pritožniki trdijo, da so imele bolnišnice IRIS precejšnjo korist od regionalnega financiranja, ki je bilo dodeljeno občinam, v katerih so te bolnišnice, in da tega financiranja ni mogoče utemeljiti na podlagi določb zakona LCH.
In particular, each hospital must keep a set of accounts that allow determining the cost of each service and that respect certain elements of the Law of 17 July 1975 [64] on accounting [65].
Obveznosti glede kritja primanjkljaja iz člena 46 statutov bolnišnic IRIS niso omenili.
It is mandatory to record non-hospital activities on separate accounts.
Poleg tega so navedli približno 100 milijonov EUR, ki so bili dodeljeni iz sklada FRBRTC v okviru prestrukturiranja bruseljskih javnih bolnišnic, s katerim so bile ustanovljene bolnišnice IRIS (glej tudi oddelek 2.2).
Hospitals are also obliged to appoint an auditor who certifies the hospital's accounts and financial statements [66].
Pritožniki trdijo, da naj bi zaradi tega ukrepa bolnišnice IRIS prejele previsoko nadomestilo.
Finally, hospitals are required to submit certain (financial) information to the Federal Minister responsible for public health [67] and its Federal Public Service also monitors compliance with the LCH [68].
RAZLOGI ZA ZAČETEK POSTOPKA
DESCRIPTION OF THE MEASURES TARGETED BY THE COMPLAINT
Odločba Komisije iz leta 2009
According to the complainants, the Brussels Capital Region has chosen to de facto take up the role of the relevant Brussels municipalities for the compensation of the deficits of the IRIS-H.
Kot je bilo navedeno (glej uvodno izjavo 5), je Komisija 28. oktobra 2009 sprejela odločbo o nenasprotovanju [71], v kateri je sklenila, da javno financiranje bolnišnic IRIS v regiji glavnega mesta Bruselj pomeni državno pomoč, ki je združljiva z notranjim trgom kot nadomestilo za opravljanje storitev splošnega gospodarskega pomena.
In particular, the complaint mentions interventions by the Fonds Régional Bruxellois de Refinancement des Trésoreries Communales (or FRBRTC) which was created by the Brussels Capital Region [69].
Ta odločitev Komisije je temeljila na odločbi o storitvah splošnega gospodarskega pomena iz leta 2005 in neposredno na členu 86(2) Pogodbe ES (zdaj člen 106(2) PDEU).
In addition, the complaint adds that since 2003 the Brussels Capital Region itself also allegedly granted special subsidies to the municipalities [70] (i.e. up to EUR 10 million annually), which were allegedly intended to be passed on as aid for the IRIS-H.
Komisija je v odločbi menila, da so bile bolnišnicam IRIS naložene tri bolnišnične naloge javne službe, in sicer splošna bolnišnična naloga vseh bolnišnic (javnih in zasebnih) na podlagi zakona LCH [72], obveznost zdravljenja vsakega pacienta v vseh okoliščinah, vključno s posturgentnim zdravljenjem [73] in obveznost omogočanja popolne večstranske bolnišnične oskrbe [74].
While the complainants do not put into doubt the competence of the Brussels Capital Region towards these municipalities they consider that what they qualify as regional financing of the IRIS-H goes beyond what is envisaged by the deficit cover as specified by Article 109 of the LCH (see also recital 47).
Poleg tega je ugotovila, da je bila bolnišnicam IRIS naložena nebolnišnična naloga javne službe omogočanja socialne pomoči skupaj z zdravstvenim varstvom [75].
The complainants argue that the IRIS-H benefited significantly from regional financing awarded to the municipalities in which they are located and that this financing cannot be justified on the basis of the provisions of the LCH.
Nazadnje je bila navedena tudi obveznost dvojezičnosti [76].