This Won’t Hurt a Bit : The Commission’s Approach to Services of General Economic Interest and State Aid to Hospitals

Where the provision of healthcare services involves undertakings (entities engaged in the provision of goods and/or services on a market) these are subject to the EU state aid rules. State aid questions are raised in particular regarding the compensation for public service provision, which may qualify for exemption as services of general economic interest (SGEI). In the Altmark Case of 2003 the Court of Justice provided criteria for establishing whether aid is in fact involved or not. Where aid exists, this may still be declared compatible with the internal market by the European Commission based on a further set of SGEI criteria that it spelled out in its legislative packages of 2005 and recently in 2011. This paper first looks at the relevant tests in general and then focuses on the main substantive Commission state aid decision with regard to hospital care, involving the public hospitals in the Brussels capital region in 2009. This shows that the Commission leaves considerable leeway for the compensation of public service provision by hospitals. However a more formal approach by the Member States clarifying the scope of their SGEI would help in securing the safe harbour for these services that is provided by the 2011 framework