Case 185645, 185675, 185693, 185695

C.E., n°185645, 185675, 185693, 185695, 27 April 1998
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French government issued a decree on 19 December 1996 which, according to article L.162-5-3 of the Social Security Code, requires doctors to pay back social security payment if they do not meet their expected health expenses. Doctors’ trade unions challenged this decree, on the ground that it creates a sanction towards doctors whereas they are a freelance profession. They also contested the repayment of social security payment for self-employed doctors that are not covered by the national system. The trade unions observe that doctors have the freedom of prescription, and that the patients have the freedom to choose their doctor.

The French Supreme Administrative Court refers to article 38 of the French Constitution to explain the Government’s power to reform social security. Indeed, article 34 enumerates social security as domain of the law. It refers to the Preamble of the French Constitution of 1946 which mentions a right to protection of health. It also refers to article 12 of the International covenant on economic, social and cultural rights (1966) which guarantees protection of health. The last international convention it refers to is the European convention for the protection of human rights and fundamental freedoms: article 2 on the right to live, article 4 on forced labor, article 8 on private life. It contests the reference to its articles 6 and 7 protecting rights to a fair trial.

The French Supreme Administrative Court found that the repayment was just an adjustment, not a sanction.

The French Supreme Administrative Court also found that the repayment by individuals who had not honored their professional objectives was proportionate, considering that the final aim of this disposition was to keep the French health system sustainable, and the entire Nation’s economy sustainable, too.

The French Supreme Administrative Court found therefore that the decree was not to be removed concerning doctors linked to the French social security system. Though, it found that the decree could not apply to doctors that were not part of the social security system.

The French Supreme Administrative Court lastly found that the right to a fair trial was not endangered, considering that the decree held no dispositions on repayment procedures.

“Considering that neither the principle of free exercise of medicine nor the principle of freedom of prescription nor the free choice of doctors by patients were challenging the government’s power to […] legally fix the repayment of medical expenses in order to contend their increase regarding the Nation’s economic situation.”
Considérant que ni le principe de libre exercice de la profession de médecin, ni les principes de liberté de prescription et de libre choix du médecin par le malade ne faisaient obstacle à ce que le gouvernement agissant dans le cadre d'une habilitation donnée en application de l'article 38 de la Constitution, pût légalement fixer des règles d'ajustement des dépenses médicales destinées à contenir leur progression dans des limites acceptables au regard de la situation économique de la Nation ;

“Considering that the repayment for doctors linked to the social security system is a mechanism of adjustment and not a sanction […].”
Considérant que le reversement exigible des médecins conventionnés en cas de non-respect de l'objectif prévisionnel d'évolution des dépenses médicales constitue un mécanisme d'ajustement de ces dépenses et ne revêt pas le caractère d'une sanction ; que, par suite, les moyens tirés de la violation des principes de nécessité des peines et de non-cumul des peines pour une même faute doivent être écartés comme inopérants ;

“Considering that the difference of situation between doctors linked to the social security and doctors who are not allows to exempt independent doctors of this repayment. Yet this situation does not allow that the repayment is used to compensate independent doctors expenses […].”
« Que, si la différence de situation existant entre médecins conventionnés et médecins non conventionnés permet de ne faire supporter la charge du reversement que par les seuls médecins conventionnés, elle ne saurait, en revanche, justifier que ce reversement comprenne des dépenses occasionnées par l'activité des médecins non conventionnés ; que les requérants sont, par suite, fondés à soutenir que le décret a méconnu sur ce point les dispositions précitées de l'article L. 162-5-3 du code de la sécurité sociale ; »

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