Case 1.240

Two merged cases challenged the constitutionality of a law on health sector reform. The law provided care for insured person under the Health Insurance Fund. However, to be an insured person required that the person has paid all dues, including retroactive payments, even if that meant paying for coverage when no services were provided. These payments, and any default fees, were obligatory for everyone except those excluded by statute.

In the case before the Cluj Tribunal, the tribunal held the provisions were a violation of Article 16 (on equality of rights) and 34 (on the right to protection of health) of the Constitution. However the Maramures Tribunal decided the unconstitutionality exceptions were unfounded.

The Constitutional Court found the provisions constitutional.

The Court found that the provisions did not violate Art. 16 on the equality of rights, Art. 22 on the right to life, physical integrity and mental integrity, or Art. 34 on the right to protection of health. The provisions established the citizens’ rights and their responsibilities. The law also articulated the groups of people exempted from paying the contribution to the fund. Persons who do not follow this obligation should have different access to the Health Insurance System than those who do. This system is not discriminatory, it does not affect a person’s physical and mental integrity, and it does not restrict the right to protection of health, and only treats those different who didn’t fulfil their obligation to contribute.

The Court also found that the provisions did not violate Art. 47 on living standards. The Court noted that in drafting the law, the legislature intended different legal treatment for those that don’t pay in order that the public medical system was not limited by a disproporationate contribution in relation to its income.

“[I]t should be noted that the law not only establishes the right of citizens to receive public health services, but it also stipulates their obligation to contribute to the Health Insurance Fund. Persons exempt from this contribution are set out in Art. 213 of Law no. 95/2006, so that, apart from them, all other citizens have the abovementioned obligation. Once this obligation arises and the policyholder pays the contribution, the law grants him the right to benefit from the medical services package provided in the public health system.” (Page 5)

“În acest sens,  Între această situaţie şi cea în care se află autorul excepţiei nu se poate pune însă un semn de egalitate. Astfel, în condiţiile în care persoana obligată să contribuie la sistemul de asigurări de sănătate ignoră această obligaţie, este firesc ca accesul la serviciile sistemului public de asigurări de sănătate să fie diferit de prima ipoteză. O asemenea soluţie nu este, prin urmare, discriminatorie, nu afectează integritatea fizică sau psihică a persoanei şi nici nu îngrădeşte dreptul la ocrotirea sănătăţii, ci îl reglementează diferit, având în vedere situaţia deosebită în care se găseşte persoana care nu a respectat obligaţia legală de a contribui la fondul de asigurări sociale de sănătate.” (Page 4)

 “…the Legislator sought to create a different legal treatment that takes into account the policyholder’s liability, so that access to medical services in the public system is not hindered by a disproportion between contributions and income.” (Page 5)

“…legiuitorul a urmarit crearea unui tratament juridic diferit, care sa tina cont de posibilitatile materiale ale

asiguratilor, astfel încât accesul la serviciile medicale în sistemul public sa nu fie împiedicat de o

contributie disproportionata în raport cu veniturile” (Page 4)