Region: Europe
Year: 2001
Court: Cour d'arbitrage [Constitutional Court of Belgium]
Health Topics: Health systems and financing
Human Rights: Freedom from discrimination, Right to due process/fair trial
Tags: Health funding, Health insurance, Health regulation, Out-of-pocket expenditures, Reimbursement, Subsidies
The National Institute for Health and Disability Insurance’s Medical Control Service asked the Court of Arbitration a preliminary question on articles 141, 146 and 156 of the Law relating to mandatory healthcare and benefits insurance (“Law”), concerning their potential violation of articles 10 and 11 of the Belgian Constitution, and correspondingly, of article 6 of the Convention for the Protection of Human Rights and Fundamental Freedoms [European Convention on Human Rights]and of article 14.1 of the International Covenant on Civil and Political Rights.
Under the Law’s provisions, an administrative body within the National Institute was charged with handling contestations about a prohibition to intervene in the cost of healthcare and the ensuing investigation and findings. On the other hand, disputes between the National Institute and an insured person or a healthcare provider were submitted to ordinary courts. The Appeal Commission was asking the Court to rule on the possible discrimination resulting from this difference in treatment for contestations/disputes, considering the judicial guarantees afforded to parties before a court.
The Court found that articles 141, 146 and 156 of the Law relating to mandatory healthcare and benefits insurance did not violate articles 10 and 11 of the Constitution. The Court held that contestations related to the prohibition to intervene in the cost of healthcare were of a political rights nature, and thus, the delegation to administrative bodies was not discriminatory (paragraphs B.6.1. to B.6.4.).
The Court also found that the difference in treatment from a case before an ordinary court and an administrative body does not “result in a disproportionate limitation of the rights of the interested parties” in the case of such contestations (paragraphs B.7.1 to B.7.3.).
« B.6.3. L’objet des contestations en cause concerne donc l’appréciation du respect, par le dispensateur de soins, de ses obligations en tant qu’il collabore à un service public. Lorsque la commission d’appel statue sur un tel objet, elle agit dans l’exercice d’une fonction qui se trouve dans un rapport tel avec les prérogatives de puissance publique de l’Etat qu’elle se situe en dehors de la sphère des litiges de nature civile au sens de l’article 144 de la Constitution. Il s’ensuit qu’une contestation portant sur l’interdiction d’intervention dans le coût des prestations de santé est une contestation portant sur un droit politique.
Le législateur pouvait donc, en application de la possibilité que lui offre l’article 145 de la Constitution, confier le contentieux relatif à un tel droit politique à une juridiction administrative disposant en la matière d’une compétence de pleine juridiction, créée en application de l’article 146 de la Constitution.
B.6.4. Compte tenu de l’article 145 de la Constitution, le fait d’attribuer la connaissance de litiges portant sur des droits politiques à une juridiction administrative plutôt que de confier ce contentieux à une juridiction de l’ordre judiciaire ne peut constituer une violation du principe d’égalité et de non-discrimination. »
“B.6.3. The object of the contestations in question thus relate to the evaluation of the care provider’s respect of its obligations as a person collaborating to a public service. When the Appeal Commission rules on such an object, it acts in the exercise of a function that is in such a relation to the prerogatives of the State’s public powers that it is located outside of the sphere of civil disputes as provided by article 144 of the Constitution. Therefore, a contestation relating to a prohibition to intervene in the cost of health benefits is a contestation on a political right.
The legislator could thus, pursuant to the possibility offered by article 145 of the Constitution, delegate the dispute relating to a political right to an administrative jurisdiction that has full jurisdiction in the matter, created pursuant to article 146 of the Constitution.
B.6.4. Considering article 145 of the Constitution, the delegation of the evaluation of disputes on political rights to an administrative jurisdiction rather than delegating these disputes to a judiciary jurisdiction cannot constitute a violation of the equality and non-discrimination principle.”
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« B.7.2. La différence de traitement entre certaines catégories de personnes qui résulte de l’application de procédures différentes devant des juridictions différentes et dans des circonstances au moins partiellement différentes n’est pas discriminatoire en soi. Il ne pourrait y avoir de discrimination que si la différence de traitement résultant de l’application de ces procédures entraînait une limitation disproportionnée des droits des parties concernées.
B.7.3. En vertu de l’article 155, § 6, de la loi relative à l’assurance obligatoire soins de santé et indemnités, coordonnée le 14 juillet 1994, les commissions d’appel sont composées de trois magistrats et, avec voix consultative, de trois membres qui appartiennent à la même catégorie professionnelle que le dispensateur de soins à charge duquel les constatations ont été faites. Le simple fait que des non-magistrats siègent dans un organe juridictionnel en raison de leur compétence ne porte pas, en lui-même, atteinte à l’indépendance et à l’impartialité de cet organe.
Aux termes de l’article 156, alinéa 6, de la loi coordonnée, les intéressés peuvent se faire assister par une personne de leur choix, devant les commissions d’appel. […]
L’absence d’intervention d’un auditorat indépendant ne permet pas de conclure qu’il aurait été porté atteinte de manière disproportionnée aux droits des personnes concernées.
L’absence d’un tel auditorat, qui n’existe d’ailleurs pas davantage auprès des chambres civiles des tribunaux de l’ordre judiciaire, n’empêche pas les parties de se défendre librement et de contester le contenu des enquêtes et des constatations qui leur sont opposées. »
“B.7.2. The difference in treatment between some categories of persons resulting from the implementation of the different procedures before different jurisdictions and in circumstances at least partially different is not discriminatory in itself. There could only be discrimination if the difference in treatment resulting from the implementation of such procedures would result in a disproportionate limitation of the rights of the interested parties.
B.7.3. Pursuant to article 155, § 6, of the Law relating to mandatory health and benefits insurance, coordinated on 14 July 1994, the appeal commissions are constituted of three magistrates and, entitled to a consultative voice, three members belonging to the same professional group as the care provider about whom the findings have been made. The simple fact that persons who are not magistrates are parties to a judicial body due to their qualifications does not violate in itself the independence and impartiality of this body.
Pursuant to article 156, paragraph 6, of the coordinated law, the interested parties can be assisted by a person of their choice, before the appeal commissions.[…]
The absence of an independent auditeur’s office does not lead to the conclusion that there would have been a violation of the interested persons’ rights in a disproportionate manner.
The absence of such an auditeur’s office, which moreover do not exist within civil chambers of the tribunals of the judiciary, does not prevent the parties to freely defend themselves and to contest the content of the investigations and the findings that are presented against them.”