C‑243/19, A [2020]

Context: This case involves Article 56 TFEU (Free Movement of Services) in the realm of cross-border healthcare and the implications of religious beliefs on access to medical treatment.

• Facts: A Latvian boy, who is a Jehovah's Witness, requires open-heart surgery. The surgery cannot be performed in Latvia due to his religious beliefs, as it involves blood transfusions which the family cannot accept. The type of surgery needed is available in Poland. The key issues are whether the family can claim reimbursement for the surgery performed in Poland and whether the national health service must accommodate religious objections.

• Outcome: The European Court of Justice (ECJ) held that the boy could not claim reimbursement for the surgery performed in Poland.

• Key Points:

◦ Religious Objections: The case highlighted the intersection of religious beliefs and healthcare services. AG Hogan suggested that the state must adapt healthcare to personal circumstances, particularly when it involves minors. He argued that the refusal of reimbursement could amount to indirect discrimination.

◦ Regulation 883/2004 and Directive 2011/24:

▪ Social Security Regulation: Does not require reimbursement if the treatment is not deemed necessary medically in the home state.

▪ Patients' Rights Directive: Requires prior authorisation for cross-border healthcare but considers this a restriction on rights, which must be justified.

◦ Justifications:

▪ Financial Stability: Latvia argued that reimbursing the costs of treatment abroad would threaten the financial stability of its social security system. This reasoning was rejected as the Directive includes a reimbursement cap, limiting additional costs.

▪ Treatment Capacity: Latvia argued that keeping treatment within the country helps maintain medical competence and capacity. However, the ECJ ruled that if forcing the boy to stay in Latvia restricts his religious beliefs, it could constitute indirect discrimination.

• Impact and Analysis:

◦ The ruling reflects the balance between accommodating individual religious beliefs and maintaining the integrity and financial stability of national healthcare systems.

◦ It underscores the need for national courts to assess whether restrictions are justified and proportionate, particularly when they might indirectly discriminate against individuals based on their beliefs.

◦ The case reaffirms that while national systems have a degree of discretion, there are limits when it comes to ensuring fundamental rights are respected, including those related to religious freedoms.