Press and Information Division
PRESS RELEASE No 32/2001
12 July 2001
Case C-157/99
B.S.M. Geraets-Smits v Stichting Ziekenfonds
and
H.T.M. Peerbooms v Stichting CZ Groep Zorgverzekeringen
THE CONDITIONS FOR OBTAINING PRIOR AUTHORISATION TO RECEIVE
HOSPITAL TREATMENT IN ANOTHER MEMBER STATE MUST NOT GIVE
RISE TO AN ARBITRARY REFUSAL
The Court recognises that a system of prior authorisation constitutes an obstacle to freedom
to provide hospital medical services. However, overriding reasons connected with the
financial balance of social security systems and the maintenance of hospital services
available to all justify that restriction.
The Court circumscribes the criteria governing authorisation to receive hospital treatment in
another Member State and defines the normal and necessary nature of the proposed treatment
laid down in Netherlands legislation.
Mr Peerbooms, who is of Netherlands nationality, fell into a coma following a road accident. He received special intensive therapy in an Austrian clinic, which proved beneficial. Mr Peerbooms did not satisfy the requirements for admission to two Netherlands establishments offering the same medical technique on an experimental basis (as this technique was available in the Netherlands only to persons under the age of 25 years). Mr Peerbooms was also refused reimbursement by his Netherlands sickness insurance fund of the costs incurred, since, according to the authority dealing with his claim, the treatment given to the comatose patient in Austria had no advantage over the treatment available in the Netherlands.
Under the Netherlands social security legislation, a patient can receive medical treatment,
either in the Netherlands or abroad, at an establishment which has not entered into agreement
with his sickness insurance fund only after obtaining prior authorisation.
The Netherlands court hearing the disputes between the persons concerned and their sickness
insurance funds has asked the Court of Justice whether legislation of that type is compatible
with the principle of freedom to provide services.
The Court observes that Member States are free to organise their social security systems.
In the absence of harmonisation at Community level, it is for the legislation of each Member
State to determine the conditions concerning the right or duty to be insured with a social
security scheme and the conditions for entitlement to benefits.
Nevertheless, the Member States must comply with Community law and in particular with the
principle of freedom to provide services. Medical activities, even taking into consideration
the particular nature of the services concerned (benefits in kind, for which the hospital
establishment is paid by the fund with which the person concerned is insured), do indeed fall
within the scope of freedom to provide services.
The Court then considers whether the effect of the rules in question is to restrict freedom to
provide services. By subjecting reimbursement of costs to authorisation, which is granted
only where two conditions are satisfied (the treatment must be regarded as normal in the
professional circles concerned; and the treatment abroad must be necessary), the rules in
question constitute an obstacle to freedom to provide services.
Is there any justification for that obstacle?
The Court recalls that a risk of seriously undermining a social system's financial balance and
the maintenance of a balanced medical and hospital service open to all constitute financial and
public-health requirements capable of justifying an obstacle to freedom to provide services.
In the Court's view, the need to have resort to a system of prior authorisation, in the context of
a system of agreements to provide health care, makes it possible to ensure that there is
sufficient and permanent access to a balanced range of high-quality hospital treatment on the
national territory, to ensure that costs are controlled and to prevent any wastage of financial,
technical and human resources. None the less, any conditions, such as those applied in the
Netherlands, which must be satisfied in order to obtain prior authorisation must be justified
and must satisfy the principle of proportionality.
Thus, the condition that the proposed hospital treatment in another Member State must be
regarded as normal is acceptable only in so far as it refers to what is sufficiently tried and
tested by international medical science.
The second condition, namely the necessity of the proposed treatment, that is to say the
requirement that the insured person receive treatment in a foreign establishment owing to his
medical state, must mean that authorisation can be refused only if the patient can receive the
same or equally effective treatment without undue delay from an establishment with which his
sickness insurance fund has contractual arrangements.
Available in all languages.
For the full text of the judgment, please consult our Internet page www.curia.eu.int
For further information please contact Fionnuala Connolly:
Tel: (00 352) 4303 3355; Fax: (00 352) 4303 2731 |