Geraets-Smits v Stichting Ziekenfonds

Geraets-Smits v Stichting Ziekenfonds (Case C-157/99) is a landmark decision by the European Court of Justice (ECJ) concerning the European Union law on the free movement of goods and services. This case is particularly significant in the context of healthcare services within the EU, as it addresses the issue of cross-border healthcare and the reimbursement of medical expenses by health insurance schemes.

Background

The case involved two Dutch nationals, Peerbooms (Geraets-Smits) and Dekker, who sought medical treatment in another Member State of the EU, outside their own country, the Netherlands. Their health insurance provider, Stichting Ziekenfonds VGZ, refused to cover the costs of their treatment abroad. The refusal was based on the Dutch health insurance system's requirement that for the costs of treatment abroad to be reimbursed, the treatment must be deemed necessary and it must not be possible to receive equivalent treatment in the Netherlands within a reasonable time.

Geraets-Smits had sought treatment in Germany for a condition that was not effectively treatable in the Netherlands, while Dekker had undergone a special form of therapy in Austria. Both argued that the refusal to reimburse their treatment costs constituted a restriction on the free movement of services as provided for in the Treaty Establishing the European Community (TEC), now the Treaty on the Functioning of the European Union (TFEU).

Judgment

The ECJ held that the provision of medical services for remuneration falls within the scope of the freedom to provide services under the TEC. The Court found that the Dutch health insurance scheme's restrictions on the reimbursement of costs for treatment received in another Member State could hinder the freedom to provide services. However, the Court also recognized that such restrictions could be justified by overriding reasons of general interest, such as the protection of public health and the maintenance of a balanced medical and hospital service open to all.

The ECJ established criteria for assessing whether the refusal to grant authorization for treatment abroad was justified. It stated that the decision must be based on objective, non-discriminatory criteria which are known in advance. The national court was tasked with determining whether the treatment in question could be obtained without undue delay within the national health system, taking into account the patient's medical condition and the clinical needs.

Impact

The Geraets-Smits v Stichting Ziekenfonds case has had a profound impact on the provision of cross-border healthcare within the EU. It clarified that while Member States have the right to organize their own social security systems, including health insurance schemes, they must do so in a manner that does not infringe upon the fundamental freedoms guaranteed by EU law, particularly the freedom to provide services.

Following this judgment, the EU has taken steps to further facilitate cross-border healthcare, culminating in the adoption of the Directive 2011/24/EU on the application of patients' rights in cross-border healthcare. This directive aims to ensure clearer rules on the reimbursement of costs for patients seeking treatment in another Member State, promoting greater access to safe and high-quality healthcare across the EU.

See Also

• European Court of Justice
• Free movement of services
• Healthcare in the European Union
• Directive 2011/24/EU