2015/11/4 - 32 Cdo 2051/2013 (summary)

Judgement of the Supreme Court dated 4 November 2015, file number 32 Cdo 2051/2013
(invalidity of legal proceedings, conciliation procedure related to payments for medical care)

The judgement factually related to payments for medical care provided. The health insurance company and the provider of medical services had made a contract on payments for medical care, and subsequently a few amendments were made setting limits of total payments for the given period to amount really paid in the preceding period. Medical care provided by the sued medical institution exceeded the agreed limit. Merit of the case was the question whether amendments to the general contract limiting amount of the payments (within the parties’ freedom of contract) were valid or whether the parties were obliged to act strictly within the limits set by the general agreement, and the amendments were invalid. The court of first instance based its decision on the principle of autonomous volition of the parties and the fact that the amendments limiting the payments were valid. The appellate court stated that the requirement to follow the general meeting based on the conciliation procedure was an example of legal regulation of peremptory nature. In the application for appellate review of the decision the plaintiff namely argued that necessity to follow result of the conciliation procedure did not relate to a specific agreement on amount of payments for provision of the medical services, and the method of determining conditions and amount of the payments, as it was decided by the appellate court, contradicted to prohibition of state aid in accordance with para. 1 of Art. 107 of TFEU and the judgement of the Court of Justice dated 24 July 2003, in case C-280/00, Altmark.

The Supreme Court stated that public health insurance was governed by the legal regulation that, considering public interest in its proper functioning, was based on the provisions governed by public law, limiting the parties’ freedom of contract. The list of medical operations with point values, amount of a point value, etc. resulted from the conciliation procedure. Public interest in quality and accessibility of medical care as well as financial stability of the system related not only to the contract on provision and payment of medical care, but also to the connected legal facts making its particular content complete. As relates to conflict with the Union law, the Supreme Court stated that it wasn’t a conflict with the interior market, because the problem related to legal norm that subsequently related to the others in the same way, and that’s why the plaintiff wouldn’t have been given preferential treatment if compared with the other medical care providers, or no other condition would have been fulfilled so that it would have represented the conflict with the interior market within the intention of paragraph 1 of Art. 107 SFEU and within the framework of the decision made by the Court of Justice in the case of Altmark, because the trade between the member states of the European Union wouldn’t have been affected.