The Norms that do not Envisage Covering the Costs of Home Birth from the State Budget Resources are Compatible with the Satversm
On 12 February 2015 the Constitutional Court passed the judgement in Case No. 2014-08-03 “On the Compliance of Para 555 of Annex 16 “Tariffs of Health Care Services for Preventive, Diagnostic, Treatment and Rehabilitation Services” to the Cabinet of Ministers Regulation of 17 December 2013 No. 1529 “The Procedure for Organising and Financing Health Care”, insofar it does not Envisage a Tariff for Scheduled Birth outside Inpatient Facilities, with the First Sentence of Article 91 of the Satversme of the Republic of Latvia”.
The State has ensured the existence and accessibility of obstetric services free of charge, and it does not have the obligation to guarantee this service in another place and form desirable to a person or outside the system of health care services paid for by the State.
The Contested Norms
The contested norm included in the Cabinet of Ministers Regulation of 17 December 2013 No. 1529 “The Procedure for Organising and Financing Health Care” (hereinafter – Regulation No. 1529) establishes a tariff of payment for physiological labour. This norm does not envisage a tariff for scheduled childbirth outside inpatient facilities, since this kind of assistance is not provided in facilities referred to in Para 7 of this Regulation. Thus, during the hearing of the case, the Constitutional Court, taking into account the close link between the norms, the opinions expressed by parties to the case and the summoned persons, as well the need to abide by the principles of the proceedings before the Constitutional Court, decided to broaden the claim by examining also the constitutionality of Para 7 of Regulation No. 1529. [9]
The aforementioned paragraph provides: “Health care services that are paid for from the State budget resources allocated for health care shall be provided by those medical facilities that have concluded a contract with the [National Health] Service, as well as institutions of public administration that provide health care services in accordance with the Statute.”
Norm of Higher Legal Force
The first sentence of Article 91 of the Satversme: “All human beings in Latvia shall be equal before the law and the courts.”
The Facts
The case was initiated having regard to the application submitted by the Ombudsman of the Republic of Latvia, expressing the opinion that a norm that did not envisage covering the costs of scheduled labour outside inpatient facilities (home birth) from the State budget was incompatible with the principle of equality. The State allegedly covers the cost of obstetric assistance only if the scheduled labour takes place in an inpatient facility. However, the women, who receive the obstetric assistance at an inpatient facility, and women, who receive the obstetric assistance at home, are in similar and comparable circumstances, therefore the regulation on funding the obstetric services should apply to them equally.
The Court Findings and Ruling
On the scope of examining the contested norms
The Constitutional Court recognised that the compliance of the contested norms with Article 91 of the Satversme should be examined in interconnection with Article 111 of the Satversme (“The State shall protect human health and guarantee a basic level of medical assistance for everyone.”) [10]
On the obligations of the State in the field of health care
The Constitutional Court noted that the obligation of the State to implement measures to protect human health, inter alia, to ensure existence and accessibility of health care services follows from the right to health care. However, this does not mean that every person shall always have the right to receive any medical services free of charge. The State has broad discretion to choose the way in which persons can exercise their right to receive health care services [11.1]
On the action by the State in ensuring obstetric assistance
In case of physiological labour, the health care service, in concrete scope, is ensured by the State free of charge with the mediation of medical facilities referred to in Para 7 of Regulation No. 1529. The Constitutional Court recognised that the legislator had established a system of health care services paid for by the State, in the framework of which all women could receive health care services free of charge in case of physiological labour. [11.3]
In the particular field the State has ensured to all women existing and accessible health care service, and it does not have the obligation to guarantee this service in another place and form desirable to a person or outside the system of health care services paid for by the State.
The women to whom in case of physiological labour obstetric care is provided within the system of funding of the health care system ensured by the State, and women, who receive such assistance outside the aforementioned system, are in different circumstances, and these groups are not comparable. [13]
It follows from the case law of the Constitutional Court that comparison of the groups of persons would be possible, if the health care service ensured within the system established by the State to any of them would not be accessible at all or would be accessible in a different quality. [13]
Hence, the Constitutional Court recognised the contested norms as being compatible with the first sentence of Article 91 of the Satversme.
The Constitutional Court noted that the State, within the limits of its economic possibilities, might choose to expand the range of health care services it paid for, including the field of sexual and reproductive health. [14]
The Judgement by the Constitutional Court is final and not subject to appeal, it shall enter into force on the day of its official publication.
Linked case: 2014-08-03