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Súhlas s poskytnutím zdravotnej starostlivosti na území iného členského štátu


 | 2.9.2013 | komentárov: 384

Tento týždeň sme v sekcii judikatúra pridali rozhodnutie Súdneho dvora Európskej únie vo veci C-173/09, ktoré sa týka poskytovania zdravotnej starostlivosti na území iného členského štátu.

Georgi Ivanov Elčinovje bulharským občanom trpiaci závažnou chorobou, kvôli ktorej chcel podstúpiť najmodernejšiu liečbu v Nemecku, keďže táto sa v Bulharsku nevykonávala. Predtým však musel požiadať svoju zdravotnú poisťovňu Nacionalnazdravnoosiguritelna kasa (Národná zdravotná poisťovňa, ďalej len „NZOK“) o vydanie formulára E 12 potrebného pre uskutočnenie tohto zámeru. Krátko na to odcestoval do Nemecka, pričom súhlas mu ešte nebol udelený. NZOK odmietlo nakoniec súhlas udeliť, keďže liečba, ktorú chcel navrhovateľ podstúpiť v Nemecku nebola na zozname výkonov, ktoré NZOK prepláca a neboli podľa nej splnené podmienky pre jeho udelenie podľa bulharského právneho poriadku. G.I. Elčinov podal proti tomuto rozhodnutiu žalobu na Správny súd v Sofii. Ten zrušil rozhodnutie NZOK, keďže podľa neho boli splnené podmienky stanovené právnymi predpismi. NZOK sa proti rozsudku odvolalo na Najvyšší správny súd, ktorý zrušil napadnuté rozhodnutie a vrátil vec na rozhodnutie prvostupňovému Správnemu súdu v Sofii. Tento prerušil konanie pred ním a položil Súdnemu dvoru EÚ sedem prejudiciálnych otázok:

„1.      Má sa článok 22 ods. 2 druhý pododsek nariadenia … č. 1408/71 … vykladať v tom zmysle, že v prípade, ak v bulharskom zdravotníckom zariadení nemôže byť poskytnutá konkrétna liečba, v súvislosti s ktorou sa žiada o vystavenie formulára E 112, platí domnienka, že liečba sa neprepláca z rozpočtu [NZOK] alebo Ministerstva zdravotníctva, a naopak, v prípade, ak sa táto liečba prepláca z rozpočtu NZOK alebo Ministerstva zdravotníctva, platí domnienka, že môže byť poskytnutá v bulharskom zdravotníckom zariadení?

2.      Má sa slovné spojenie ‚takáto starostlivosť nemôže byť dotknutej osobe poskytnutá na území členského štátu, kde má bydlisko‘, ktoré sa uvádza v článku 22 ods. 2 druhom pododseku nariadenia … č. 1408/71, vykladať v tom zmysle, že zahŕňa také prípady, kedy liečba, ktorá sa poskytuje na území členského štátu, v ktorom má poistená osoba bydlisko, je ako druh zdravotného výkonu oveľa menej účinná a radikálnejšia než liečba, ktorá sa poskytuje v inom členskom štáte, alebo zahŕňa len také prípady, kedy nemožno dotknutej osobe poskytnúť starostlivosť včas?

3.      Má vnútroštátny súd, pri rešpektovaní zásady procesnej autonómie, povinnosť podriadiť sa záväzným pokynom, ktoré mu dal súd vyššieho stupňa v rámci zrušenia jeho rozhodnutia a vrátenia veci na nové rozhodnutie, keď je tu dôvod domnievať sa, že tieto pokyny sú v rozpore s právom Spoločenstva?

4.      V prípade, že predmetná starostlivosť nemôže byť poskytnutá na území členského štátu, v ktorom má poistená osoba bydlisko, postačuje na to, aby tento členský štát mal povinnosť udeliť povolenie na poskytnutie starostlivosti v inom členskom štáte podľa článku 22 ods. 1 písm. c) nariadenia č. ... 1408/71, skutočnosť, že predmetný druh liečby patrí medzi zdravotné výkony stanovené právnou úpravou členského štátu bydliska, aj keď táto právna úprava neuvádza výslovne konkrétnu metódu liečby?

5.      Odporuje článku 49 ES a článku 22 nariadenia Rady ... č. 1408/71 také vnútroštátne ustanovenie, akým je § 36 ods. 1 zákona o zdravotnom poistení, podľa ktorého osoby povinne poistené majú nárok na čiastočnú alebo úplnú náhradu nákladov na lekársku pomoc v zahraničí len vtedy, keď im bolo v tomto zmysle udelené predchádzajúce povolenie?

6.      Musí vnútroštátny súd uložiť príslušnej inštitúcii štátu, v ktorom je dotknutá osoba zdravotne poistená, povinnosť vydať dokument na účely poskytnutia zdravotnej starostlivosti v zahraničí (formulár E 112), ak považuje odmietnutie vydať taký dokument za protiprávne, v prípade, že žiadosť o vydanie dokumentu bola podaná pred vykonaním liečby v zahraničí, pričom liečba bola ukončená v čase vydania súdneho rozhodnutia?

7.      V prípade kladnej odpovede na predchádzajúcu otázku a v prípade, že súd bude považovať odmietnutie udeliť povolenie na liečbu v zahraničí za protiprávne, akým spôsobom sa majú nahradiť náklady, ktoré poistená osoba vynaložila na účely svojej liečby:
a)      priamo štátom, v ktorom je daná osoba poistená, alebo štátom, v ktorom bola liečba poskytnutá, po predložení povolenia na liečbu v zahraničí?
b)      v akom rozsahu, v prípade, že sa suma za zdravotné výkony stanovené právnou úpravou členského štátu bydliska líši od sumy za zdravotné výkony, ktoré stanovuje právna úprava členského štátu, v ktorom bola liečba poskytnutá; vzhľadom na článok 49 ES, ktorý zakazuje obmedzenia slobodného poskytovania služieb?“

Po právnom posúdení všetkých položených otázok rozhodol Súdny dvor, že právo Únie bráni, aby vnútroštátna právna úprava podmieňovala poskytnutie náhrady nákladov za zdravotnú starostlivosti v inom členskom štáte predchádzajúcim súhlasom domáceho členského štátu osoby, ktorej sa zdravotná starostlivosť poskytuje v každom prípade. Súdny dvor zároveň vymedzil aj prípady, v ktorých nie je možné odmietnuť poskytnutie súhlasu s poskytnutím zdravotnej starostlivosti na území iného členského štátu: „ak – v prípade, že výkony stanovené vnútroštátnou právnou úpravou sa nachádzajú na zozname, na ktorom sa výslovne a konkrétne neuvádza metóda uplatňovanej liečby, ale uvádza sa len druh liečby, ktorú prepláca príslušná inštitúcia, – sa pri uplatnení obvyklých zásad výkladu a na základe posúdenia založeného na objektívnych a nediskriminačných kritériách, pri zohľadnení príslušných lekárskych prvkov a dostupných vedeckých údajov preukáže, že táto metóda liečby zodpovedá druhom liečebných postupov uvedeným na tomto zozname, alebo ak nemožno v členskom štáte, na území ktorého má poistená osoba bydlisko, vykonať včas alternatívnu liečbu, ktorá je rovnako účinná.”
V prípade ak by vnútroštátny orgán, kompetentný na udeľovanie takéhoto súhlasu, ho odmietol udeliť neodôvodnene a aj napriek tomu by došlo k poskytnutiu zdravotnej starostlivosti, je stanovená povinnosť pre vnútroštátny súd zaviazať tento vnútroštátny orgán nahradiť náklady, ktoré vznikli poistenej osobe.Výška sumy náhrady nákladov je pritom „rovnaká ako suma stanovená na základe ustanovení právnej úpravy, ktorá je pre inštitúciu členského štátu, na území ktorého bola poskytnutá nemocničná starostlivosť, záväzná.V prípade, ak je táto suma nižšia ako suma, ktorá by vyplývala z uplatnenia právnej úpravy účinnej v členskom štáte bydliska v prípade nemocničnej starostlivosti v tomto členskom štáte bydliska, je príslušná inštitúcia povinná poskytnúť poistenej osobe dodatočnú náhradu nákladov zodpovedajúcu tomuto rozdielu, a to v rozsahu skutočne vynaložených nákladov.”

Zdroj: http://curia.europa.eu/juris/document/document.jsf?docid=81396&mode=req&pageIndex=2&dir=&occ=first&part=1&text=pacient&doclang=SK&cid=2615441#ctx1

Spracovala:
Ľudmila Moľová




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