Decision No. 6 of 11 April 2024 on Constitutional Case No. 15/2023
Referring Authority and Subject Matter of the Case
The case was initiated upon a request by a three-member panel of the Supreme Administrative Court. The subject matter of the case is the constitutionality of the provision of Article 55a, paragraph 2 of the Health Insurance Act, which provides that the National Health Insurance Fund shall not pay for medical and dental care provided by healthcare institutions in violation of the volumes and values specified in their contracts under Article 59, paragraph 1. In the request, the principal argument for unconstitutionality is the alleged contradiction of the provision with Article 52, paragraph 1 of the Constitution, which establishes that citizens have the right to health insurance ensuring access to medical care and to free use of medical services under conditions and procedures prescribed by law.
Summary of the Court’s Reasoning
The State regulates the expenditure of a limited public resource, namely the healthcare budget, but this must be done in accordance with the principle of proportionality.
Under this principle, a legal provision that restricts fundamental rights must be not only necessary but also suitable. A legal provision is suitable if it is capable of achieving the intended result. The measure adopted in the contested provision is an unsuitable means to achieve the objective of regulating the expenditure of the limited healthcare resource. Introducing limits for individual healthcare institutions cannot reduce the number of patients (and the costs of their treatment); it only redirects them from one institution that has exhausted its administratively determined limit to another that has not. Therefore, the limits imposed on the medical activities of healthcare providers do not constitute a measure that leads to a reduction of the expenditures of the National Health Insurance Fund or to their better planning.
The rule in Article 55a, paragraph 2 of the Health Insurance Act, which declares it legally impermissible to pay for medical care already received by a health-insured person, does not, by itself, contribute to achieving the intended objective - that the resources of the National Health Insurance Fund be sufficient for all health-insured persons in need throughout the calendar year. The cost of treating a specific individual carries the same weight from the perspective of the overall expenditure of the Fund’s budget, regardless of whether the individual was treated in a healthcare institution that exceeded the volumes and values specified in its contract under Article 59, paragraph 1 of the Health Insurance Act, or had to receive medical care from another hospital service provider with “available capacity.” Both legally and mathematically, the application of the absolute prohibition under Article 55a, paragraph 2 of the Health Insurance Act provides no concrete guarantee that more health-insured persons will be entitled to receive treatment financed from the Fund’s budget.
Grounds for the Ruling and Disposition
Pursuant to Article 149, paragraph 1, item 2 of the Constitution (competence to rule on requests for establishing the unconstitutionality of laws), the Constitutional Court declares unconstitutional the provision of Article 55a, paragraph 2 of the Health Insurance Act due to its contradiction with the right to health insurance under Article 52, paragraph 1 of the Constitution.
The decision was adopted with one opinion on the reasoning.
Председател: Павлина Панова