Luxembourg, 24/04/2007 (Agence Europe) - With its judgement of 19 April 2007 relating to Case C-444/05, the European Court of Justice confirms the recent line taken when it comes to medical treatment received abroad. Upon referral from the Dioikitiko Protodikeio Athinon (the Administrative Court of First Instance, Athens) concerning the right of a Greek citizen to receive reimbursement for costs occasioned by medical treatment in the United Kingdom, the Court of Justice ruled that the Greek restrictions on such reimbursements run counter to the free provision of services.
In 1998, Mr Dimitrios Stamatelakis was treated twice at London Bridge Hospital, a private hospital in the United Kingdom. He paid the sum of £13,600 to cover the cost of treatment. His insurance company, Organismos Asfaliseos Eleftheron Epangelmation (an insurance institution for the liberal professions, hereafter to be known as OAEE), the successor of the Tameio Asfalisesos Emboron (Mercants' Insurance Fund), refused to reimburse the costs claimed by Mr Stamatelakis and, after his death in 2000, by his widow, Ms Aikaterini Stamatelaki. To explain its refusal, the insurance company cited the Greek regulation whereby costs incurred when a person is admitted to a private hospital abroad are only reimbursed when treatment relates to children under 14 years of age (Decree No 35/1385/1999 of the Ministry of Labour and Social Insurance, Article 15,2,a). After this refusal, Ms Stamatelaki appealed against the decision at the administrative court, Dioikitiko Protodikeio Athinon, which then passed on a reference for a preliminary ruling to the European Court of Justice.
The EU Court ruled that the Greek system runs counter to the free provision of services as set out in Article 49 of the EC Treaty. Its appraisal is based on the fact that OAEE discriminated between Greek hospitals (where treatment to insured persons is reimbursed) and hospitals not linked to the national health system (and which therefore do not have an agreement with the insurer) in other member states. The cost incurred for treatment abroad is therefore not reimbursed. This discourages Greek patients from travelling to another member state for treatment, and is therefore an obstacle to the free provision of services. There are, however, conditions in which restrictive measures may be tolerated by Community law, in particular when this is to protect the health service system, but the Court did not acknowledge this argument in the case in hand - all the more as the judgment mentions several possible methods, such as a ceiling placed on reimbursements, to protect the insurance firm against excessive financial loss.
The Court's judgement is fully in keeping with several recent decisions in the same field, in favour of the right of citizens to receive medical treatment in another member state, in comparable conditions. Thus, the Court supported the request made by British national Yvonne Watts in 2006 who had claimed reimbursement for hip replacement treatment received in France, given the very long waiting list at the British hospital where she would otherwise have received treatment. Going back a little further in time, there are other similar cases, including that of “Müller-Fauré and van Riet” in 2002 (C-385/99) and that of “Smits (wife of Geraets) and Peerbooms” in 2001 (C-157/99). It is not possible to lodge an appeal against these decisions of the Court of Justice, and applicability is not limited to the national court which referred the question to the EU Court but extends to all member state courts. One can therefore expect continued adoption of Article 49 EC by the medical care services sector, whether they like it or not. (cd)