Slovakia, District Court in Dunajská Streda, 7 September 2016 11C/303/2013

Identification of the case

• Health care (art. 35 CFREU)

• Regulation of the Ministry of Health of the Slovak Republic No 67/2005 for healthcare providers in the provision and payment of benefits in kind
• The Slovak Act on Insurance No 580/2004
• The Slovak Act on Healthcare and Services Relating to Healthcare No 576/2004
• The Slovak Act on Healthcare Providers, Healthcare Workers, Professional Organizations in Healthcare No 578/2004

• Regulation (EEC) No 1408/71 of the Council of 14 June 1971

Summary of the case

The Hospital with a Healthcare Centre in Dunajská Streda (the plaintiff) demanded the payment for urgent medical treatment of a European national, Mr. M.N. (the defendant). The defendant failed to identify himself with a valid European insurance card and failed to acquire a form certified by the patient’s domestic insurance company. However, he did acknowledge his debt. In cases when the obligation to notify has not been fulfilled by a patient undergoing urgent medical care, Article 9(3) of the Slovak Act on Insurance applies. The hospital was therefore required to claim such expenses at the largest Slovak insurance company. At the same time, according to Article 9(1) of Regulation No 67/2005, a Slovak insurance company shall reimburse the costs of healthcare provided to an EU national or resident who failed to identify himself with an E-health form only when he requests a form certified by the patient’s domestic insurance company. Simultaneously, based on Council Regulation (EEC) No 1408/71 and the EU Charter, every EU resident has an equal right to access healthcare services without discrimination based on his finances, residence, type of disease, or access to healthcare services. The main question of the ruling therefore was, which one of these claims applies first?

• Civil judicial enforcement

Before its reasoning, the Court stated that the ruling was based on the Slovak Act on Insurance; the Slovak Act on Healthcare and Services Relating to Healthcare; and the Slovak Act on Healthcare Providers. The District Court started by listing relevant healthcare provisions, and then it referred to Article 35 of the EU Charter, stating its translated definition.

The Court then stated evidence proving that the defendant pledged to recognise his debt in case he failed to submit his European insurance card within the following three weeks, meaning the urgent medical treatment would have been covered under Article 9(3) of the Slovak Act on Insurance, and thus by the largest Slovak insurance company. Accordingly, urgent medical treatment of a European citizen would have been equal to urgent medical treatment of a Slovak citizen and thus in accordance with the principle of non-discrimination under EU law.

The Court stated that the Ministry of Health made it clear that a healthcare provider should not bear the costs for urgent medical care merely because a patient has not fulfilled his duty to identify himself with a certified form/card, has not registered himself at a Slovak insurance company, or has no Slovak medical insurance card. The Court affirmed that Member States may maintain both the general conditions of eligibility and the regulatory/ administrative requirements, provided that these conditions are necessary and proportionate, not arbitrary or discriminatory. The Court then repeated the case L. Pasteur Hospital in Košice v Všeobecná Zdravotná poisťovňa a.s. (General Health Insurance Company) in stating that: “such requirements need to be applied objectively, transparently, and without discrimination, based mainly on medical considerations, without imposing additional burden on other Member States’ citizens”.

The Court recalled that reimbursement conditional on a document acquired before urgent medical treatment would constitute an obstacle to the free movement of services (see L. Pasteur Hospital in Košice v Všeobecná Zdravotná poisťovňa a.s. (General Health Insurance Company). However, the Court concluded that the defendant’s failure to submit his insurance card resulting in a legal title recognising his debt to the hospital was valid, as the defendant understood his given and informed approval, as all documents were provided in English. The defendant was therefore obliged to reimburse the hospital.

Role of the Charter and role of the general principles on enforcement

The national court emphasised that reimbursement conditional on a document acquired before urgent medical treatment of an EU national/resident would be in violation of Article 35, and would additionally constitute an obstacle to the freedom of services in the EU.

Additional notes on the decision