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Public Procurement Law and Health Care: From Theory to Practice

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Part of the book series: Legal Issues of Services of General Interest ((LEGAL))

Abstract

Recent literature explores the impact of EU Law on national health care systems through an analysis of the application of EU competition law, EU internal market law and EU state aid rules.

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Notes

  1. 1.

    See, among many, (a) for the impact of the internal market rules, Hatzopoulos (2002), pp. 683–729, and more recently, Hatzopoulos (2005), pp. 123–160; Davies (2002), pp. 27–40; Cabral (2004), pp. 673–685, and van der Mei (2002), pp. 289–215 and van der Mei (2004), pp. 57–67; Dawes (2006), pp. 167–182; (b) for state aid see Hatzopoulos (2009), pp. 761–804 and Hatzopoulos (2010, forthcoming); (c) for a full account of the relationships between EU and Health Law see Hervey and McHale (2004).

  2. 2.

    For example, ECJ, Case C-380/98 University of Cambridge [2000] ECR I-8035, para 16; ECJ, Case C-19/00 SIAC Construction [2001] ECR I-7725, para 32; Case C-92/00 Hl [2002] ECR I-5553, para 43; and ECJ, Case C-507/03 Commission v. Ireland (An Post) [2007] ECR I-9777, para 27.

  3. 3.

    European Commission working document: measurement of Indicators for the economic impact of public procurement policy of 27 April 2010. Available on: http://www.ec.europa.eu/internal_market/publicprocurement/index_en.htm.

  4. 4.

    Ibid.

  5. 5.

    See also Drijber and Stergiou (2009), pp. 805–846, in which the ‘specialist’ case law on public procurement is placed in the wider context of the ‘general’ case law on the free provision of services.

  6. 6.

    Ibid.

  7. 7.

    Article 1(9) Public Sector Directive.

  8. 8.

    ECJ, Case C-324/98 Telaustria [2000] ECR I-10745; ECJ, Case C-59/00 Vestergaard [2001] ECR I-9505; ECJ, Case C-231/03 Coname [2005] ECR I-7287; ECJ, Case C-264/03 Commission v. France (social housing) [2005] ECR I-8831; ECJ, Case C-458/03 Parking Brixen [2005] ECR I-8585; Commission v. Ireland (An Post), cited supra n. 2; ECJ, Case C-6/05 Medipac-Kazantzides [2007] ECR I-4557; ECJ, Case C-220/06 Asociación Profesional de Empresas de Reparto y Manipulado de Correspondencia v. Administración General del Estado (Correos) [2007] ECR I-12175; ECJ, Joined Cases C-147/06 & C-148/06 SECAP SpA and Santorso Soc. Coop. Arl v. Commune di Torino[2008] ECR I-3565.

  9. 9.

    Directive 2004/17/EC on the coordination of the procurement procedures of entities operating in the water, energy, transport and postal services sectors (OJ 2004, L 134/1).

  10. 10.

    Directive 2004/18/EC on the coordination of procedures for the award of public works contracts, public supply contracts and public service contracts ( OJ 2004, L 134/114).

  11. 11.

    In its Guide to the Community rules on public procurement of services, the Commission states: ‘Within the meaning of the EC Treaty services are considered to be services where they are normally provided for remuneration, insofar as they are not governed by the provisions relating to the freedom of movement for goods, capital and persons.’ See Guide to the Community rules on public procurement of services other than in the water, energy, transport and telecommunications sectors. Directive 92/50/EEC, p. 5. This approach is in line with settled case law of the ECJ, in which the Court has held that Article 56 TFEU (ex Article 49 EC) is applicable to services normally provided for remuneration. ECJ, Case 263/86 Humbel [1988] ECR 5365, para 17 and ECJ, Case C-157/99 Smits and Peerbooms [2001] ECR I-5473, para 58.

  12. 12.

    Article 1(2)(d) Public Sector Directive.

  13. 13.

    New thresholds entered into force on 1 January 2010. See Regulation (EC) No 1177/2009, amending Directives 2004/17/EC and 2004/18/EC in respect of their application thresholds for the procedures for the award of contracts (OJ 2009, L 314/64).

  14. 14.

    Article 7(b) first indent Public Sector Directive.

  15. 15.

    Council Directive 92/50/EEC of 18 June 1992 relating to the coordination of procedures for the award of public service contracts as amended by Directive 97/52/EC.

  16. 16.

    In its review of the procurement Directive on public service contracts 92/50/EEC under Article 43 of that Directive, the Commission was obliged within three years of adoption to consider applying all the provisions of the Directive to Part B-services and make proposals for adapting the Directive. But no changes had been made since the adoption of Directive 92/50. During the legislative process of the new Directives no revision took place and no proposals were made. According to an EU Commission official, Member States were at that time reluctant to discuss a more ‘liberalised’ regime of Part B-services.

  17. 17.

    Annex II A of the Directive covers, inter alia, maintenance and repair of equipment and vehicles, some transport services, financial services, computer services, research and development for the authority’s own purpose, accounting services, management consultancy, computer services, architectural and planning services, advertising, building cleaning and property management, publishing and printing and sewerage and sanitation services.

  18. 18.

    Guide to the Community rules on public procurement of services, supra n. 11, p. 7.

  19. 19.

    Recital 21 of Services Directive 92/50/EEC. See also Arrowsmith (2005), p. 314, para 6.44.

  20. 20.

    Article 21 Public Sector Directive.

  21. 21.

    Annex II B to the Directive lists 11 categories of public services, which are subject to a ‘light’ procurement regime. The following services are currently included in Annex II B: hotel and restaurant services, rail and transport services, water transport services, supporting and auxiliary transport services, legal services, personal replacement and supply services, except employment contracts, investigation and security services, except armoured car services, education and vocational education services, health and social services, recreational, cultural and sporting services and other services, except contracts for the acquisition, development, production or co-production of programmes by broadcasting organisations and contracts for broadcasting time. A service falls in the last category ‘other services’ only in the exceptional case where it is not possible to place it in any of the categories of Annex IIA or Annex IIB.

  22. 22.

    See Guide to the Community rules on public procurement of services, supra n. 11, p. 9.

  23. 23.

    http://simap.europa.eu/codes-and-nomenclatures/codes-cpv/codes-cpv_en.htm.

  24. 24.

    Article 7(a)(b) Public Sector Directive.

  25. 25.

    Article 9(3) of the Public Sector Directive prohibits the artificial splitting of contracts for the purpose of avoiding the application of the Directive.

  26. 26.

    See Guide to the Community rules on public procurement of services, supra n. 11, p. 12.

  27. 27.

    Trepte (2007), pp. 230–231, para 4.98.

  28. 28.

    ECJ, Case C-76/97 Walter Tögel v. Niederösterreichische Gebietskrankenkasse [1998] ECR I-5357.

  29. 29.

    Arrowsmith (2005), p. 315, para 6.47.

  30. 30.

    ECJ, Case C-411/00 Felix Swoboda GmbH v. Österreichische Nationalbank [2002] ECR I-10567.

  31. 31.

    By the same token, recital 2 of the Directive states that ‘the award of contracts concluded in the Member States on behalf of the State, regional or local authorities and other bodies governed by public law entities, is subject to the principles of the Treaty and in particular to the principle of freedom of movement of goods, the principle of freedom of establishment and the principle of freedom to provide services and to the principles deriving there from, such as the principle of equal treatment, the principle of non-discrimination, the principle of mutual recognition, the principle of proportionality and the principle of transparency.’ Furthermore, Article 2 of the Public Sector Directive stipulates that operators can benefit from opportunities in other Member States by stating that Member States have to comply with the principles of non-discrimination and transparency when awarding public contracts.

  32. 32.

    The equal treatment principle in relation to public procurement was first mentioned in ECJ, Case C-243/89 Commission v. Denmark (Storebaelt) [1993] ECR I-3353, para 33. It was further developed in ECJ, Case C-21/03 Fabricom v. Belgian State [2005] ECR I-1559, para 14. The principle of equal treatment entails an obligation of transparency. See, for the first time, ECJ, Case C-275/98 Unitron Scandinavia and 3-S [1999] ECR I-8921, para 31. See for general literature on the transparency case law: Arrowsmith (2005), p. 354; Arrowsmith (2006), p. 344; McGowan (2007), pp. 274–283 and Brown (2007), p. 1.

  33. 33.

    Telaustria, para 62, Coname and Parking Brixen, supra n. 8.

  34. 34.

    See for literature on the transparency principle and service concessions: Neergaard (2007), pp. 387–409 and Stergiou (2009), pp. 159–184.

  35. 35.

    Telaustria, supra n. 8, para 62.

  36. 36.

    Arrowsmith (2005), p. 366.

  37. 37.

    Coname, supra n. 8.

  38. 38.

    Parking Brixen, supra n. 8, para 50.

  39. 39.

    Public authorities had expressed a need for clarification of the obligations deriving from the principle of openness, since the application of this principle is subject to interpretation. The vagueness of the obligations on how to act had been experienced problematic. See Social Services of General Interest: Feedback Report to the 2006 questionnaire of the Social Protection Committee, pp. 10–12, available at: http://ec.europa.eu/employment_social/spsi/docs/social_protection/2008/feedback_report_final_en_OnlinePDF.pdf.

  40. 40.

    Interpretative Communication on the Community law applicable to contract awards not or not fully subject to the provisions of the directives (OJ 2006, C 179/2).

  41. 41.

    See also McGowan (2007). The Commission has been criticised by several Member States and the European Parliament for creating new rules on tendering, which go beyond the current obligations under Community law. Germany challenged the legality of the Communication (Case T-258/06, OJ 2006, Ruling of 20 May 2010, C 294/52).

  42. 42.

    See also Interpretative communication on the application of Community law on Public Procurement and Concessions to institutionalised PPP (IPPP) (OJ 2008 C 91/02), in which the Commission emphasises the application of ‘the principle of equal treatment and the specific expressions of that principle, namely the prohibition of discrimination on grounds of nationality and Articles 43 TEC on freedom of establishment and 49 TEC on freedom to provide services’ when choosing a third party for the supply of economic activities. See also Communication on Mobilising private and public investment for recovery and long-term structural change: developing Public Private Partnerships, COM (2009) 615 final, p. 5, para 3.1.

  43. 43.

    An Post, supra n. 2. In a similar infringement procedure between the Commission and Ireland, the Court was asked to assess whether Ireland had failed to fulfil its obligations on the principle of transparency. The Dublin City Council (DCC) had awarded a Part B-service contract to provide emergency ambulance services to the Eastern Regional Health Authority without undertaking any prior advertising, ECJ, Case C-532/03 Commission v. Ireland (ambulance services) [2007] ECR I-11353. See for a case note, Browne (2008), pp. 92–95.

  44. 44.

    An Post, supra n. 2 at para 33: ‘According to settled case law, it is the Commission’s responsibility to provide the Court with the evidence necessary to enable it to establish that an obligation has not been fulfilled and, in so doing, the Commission may not rely on any presumption.’

  45. 45.

    The ECJ applied the same reasoning to contracts whose value falls below the thresholds of the Directive. Case C-412/04 Commission v. Italy [2008] ECR I-619.

  46. 46.

    SECAP SpA and Santorso Soc. Coop. Arl v. Commune di Torino, cited supra n. 8.

  47. 47.

    Ibid., para 24.

  48. 48.

    Ibid., para 24.

  49. 49.

    See also Drijber and Stergiou (2009), pp. 809–815.

  50. 50.

    Due to the mobility of service providers and service recipients active in these markets, the dynamics of this service market has changed and they are considered to be, from a service recipient perspective, increasingly of cross-border interest. The case law on patient’s rights to cross-border health care shows that patients are willing to travel in order to undergo treatment in another Member State. See for example ECJ, Case C-444/05 Stamatelaki [2007] ECR I-3185 and ECJ, Case C-372/04 Watts [2006] ECR I-4325.

  51. 51.

    Bovis (2007), p. 192.

  52. 52.

    Article 1(9) Public Sector Directive.

  53. 53.

    ECJ, Case C-44/96 Mannesmann Anlagenbau Austria AG and Others v. Strohal Rotationsdruck GmbH [1998] ECR I-73.

  54. 54.

    Arrowsmith (2005), pp. 264–265, para 5.10.

  55. 55.

    Ibid., p. 266, para 5.11.

  56. 56.

    ECJ, Case C-323/96 Vlaamse Raad [1998] ECR I-5063, paras 50–51 and ECJ, Joined Cases C-223/99 and C-260/99 Agorà Srl and Excelsior Snc di Pedrotti Bruna & C. v. Ente Autonomo Fiera Internazionale di Milano and Ciftat Soc. Coop. arl [2001] ECR 3606, para 37.

  57. 57.

    ECJ, Case C-360/96 Gemeente Arnhem and Gemeente Rheden v. BFI Holding BV [1998] ECR I-6821.

  58. 58.

    ECJ, Case C-373/00 Adolf Truley GmbH v. Bestattung Wien GmbH [2003] ECR I-1931.

  59. 59.

    Arrowsmith (2005), p. 269, para 5.14.

  60. 60.

    ECJ, Case C-214/00 Commission v. Spain [2003] ECR I-4667; ECJ, Case C-283/00 Commission v. Spain [2003] ECR I-11697; Case C-84/03 Commission v. Spain [2005] ECR I-139. See for an analysis of these cases: Trepte (2007), pp. 119–121, paras 2.56–2.59.

  61. 61.

    University of Cambridge, supra n. 2, para 30. See also Article 2 of Directive 2006/111/EC on the transparency of financial relations between Member States and public undertakings (Transparency Directive), OJ L 318.

  62. 62.

    ECJ, Case C-337/06 Bayerischer Rundfunk and Others [2007] ECR I-11173, paras 34 and 49. See also Arrowsmith (2005), p. 257, para 5.6.

  63. 63.

    ECJ, Case C-237/99 Commission v. France (social housing) [2001] ECR I-939.

  64. 64.

    Adolf Truley supra n. 58, paras 71–74.

  65. 65.

    Commission v. France (social housing), supra n. 63, para 59.

  66. 66.

    Mannesmann supra n. 53, para 20 and University of Cambridge, supra n. 2, para 74.

  67. 67.

    ECJ, Case C-300/07 Hans and Christophorus Oymanns, judgment of 11 June 2009, ECR I-0000 (n.y.r.).

  68. 68.

    Ibid., para 59.

  69. 69.

    Ibid., para 52.

  70. 70.

    University of Cambridge, supra n. 2, para 74.

  71. 71.

    Oymannssupra n. 67, para 53.

  72. 72.

    Ibid., paras 54–58.

  73. 73.

    http://ec.europa.eu/internal_market/publicprocurement/authorities_en.htm.

  74. 74.

    Oymannssupra n. 67, para 46.

  75. 75.

    http://europa.eu/rapid/pressReleasesAction.do?reference=IP/08/1971&format=HTML&aged=0&language=EN&guiLanguage=en.

  76. 76.

    Commission Decision of 9 December 2008 amending the Annexes to Directives 2004/17/EC and 2004/18/EC of the European Parliament and of the Council on public procurement procedures, as regards their lists of contracting entities and contracting authorities. 2008/963/EC.

  77. 77.

    See also Hatzopoulos (2008), pp. 177–178 [on file with the author].

  78. 78.

    Available on http://ec.europa.eu/internal_market/publicprocurement/authorities_en.htm.

  79. 79.

    http://www.nvz-ziekenhuizen.nl/Actueel/NVZ_Nieuws/Archief/2005/Maart/Nummer_12_d_d_17_maart_2005.

  80. 80.

    Tögel, supra n. 28.

  81. 81.

    ECJ, Case C-475/99 Ambulanz Glöckner [2001] ECR I-8089. See the chapter by Welti in this book.

  82. 82.

    ECJ, Case C-234/03 Contse [2005] ECR I-9315.

  83. 83.

    Medipac-Kazantzidis, supra n. 8, confirmed in ECJ, Case C-489/06 Commission v. Greece [2009] ECR I-1797.

  84. 84.

    ECJ, Case C-119/06 Commission v. Italy (health care transport services) [2007] ECR I-4557.

  85. 85.

    An Post,supra n. 2, Ambulance services, supra n. 43.

  86. 86.

    ECJ, Case 2/74 Reyners v. Belgium [1974] ECR 63. Official authority is that which arises from the sovereignty and majesty of the State; for him who exercises it, it implies the power of enjoying the prerogatives outside the general law, privileges of official power and powers of coercion over citizens.

  87. 87.

    For example, ECJ, Case C-19/92 Kraus [1993] ECR I-1663, para 32; ECJ, Case C-55/94 Gebhard [1995] ECR I-4165, para 37; and ECJ, Case C-243/01 Gambelli [2003] ECR I-13031, paras 64–65.

  88. 88.

    Ambulance services, supra n. 43.

  89. 89.

    Ibid., Opinion of the Advocate General, paras 86 et seq. The Court concluded that there was no public contract. It therefore did not need to address the issues discussed here.

  90. 90.

    ECJ, Case C-260/04 Commission v. Italy (service concessions for horse-betting) [2007] ECR I-4165, para 15.

  91. 91.

    See, in particular, ECJ, Joined Cases C-338/04, C-359/04 & C-360/04 Placanica [2007] ECR I-1891.

  92. 92.

    Commission v. Italy, supra n. 90, paras 34–35.

  93. 93.

    Medipac-Kazantzidis, supra n. 8.

  94. 94.

    See ECJ, Case 120/78 Rewe-Zentral [1979] ECR 649 (Cassis de Dijon), para 8; ECJ, Case C-270/02 Commission v. Italy [2004] ECR I-1559, paras 21 and 22; and ECJ, Joined Cases C-158/04 and Case C-159/04 Alfa Vita Vassilopoulos and Carrefour-Marinopoulos [2006] ECR I-8135, paras 20–23.

  95. 95.

    Medipac-Kazantzidis, supra n. 8, paras 60–62.

  96. 96.

    On the concept of SGEIs and its implications on EU law, especially after the entry into force of the Lisbon Treaty, see, among many, the contributions contained in Neergaard et al. (2009); Krajewski et al. (2009); van de Gronden (2009).

  97. 97.

    In CFI, Case T-289/03 BUPA [2005] ECR II-741, the CFI recognised explicitly that Member States have a wide discretion in defining what services on their territory are to be considered as SGEI. The Commission nonetheless scrupulously examines whether a Member State has committed ‘a manifest error’ when defining a certain service as SGEI. It does so in particular in State aid cases.

  98. 98.

    ECJ, Case 10/71 Port of Mertert [1971] ECR 730, para 11.

  99. 99.

    ECJ, Case 41/83 Italy v. Commission [1985] ECR 888, paras 29–33.

  100. 100.

    ECJ, Case 155/73 Sacchi [1974] ECR 409.

  101. 101.

    ECJ, Case 66/86 Ahmed Saeed [1989] ECR 853, para 55.

  102. 102.

    ECJ, Case C-41/90 Höfner [1991] ECR I-2017, para 24.

  103. 103.

    ECJ, Case C-320/91Corbeau [1993] ECR I-2568, para 15.

  104. 104.

    Ambulanz Glöckner, supra n. 81.

  105. 105.

    In all these cases the Court accepted the argument that the exclusive right protected the undertaking in question against the risk of cream skimming, leaving them with the least profitable services. See Corbeau, supra n. 103; ECJ, Case C-67/96 Albany [1999] ECR I-5751; ECJ, Case C-209/98 Deutsche Post [2000] ECR I-3743.

  106. 106.

    Ambulanz Glöckner, supra n. 81.

  107. 107.

    Ibid., para 61.

  108. 108.

    Article 1(2)(a) Public Sector Directive.

  109. 109.

    Commission v. Italy (health care transport services), supra n. 84.

  110. 110.

    ECJ, Case C-399/98, Ordine degli Architetti delle province de Milano e Lodi v. Comune di Milano [2001] ECR I-5409. In this ruling, the city of Milan had given developers permission for a development scheme to build the exterior of the world-known theatre. The Court ruled that there was a contract, although the agreement was governed by public law and involved the exercise of public law powers. Advocate General Léger had reasoned that if something is provided without benefit to the provider there is no potential for the favouritism that the Directives seek to prevent.

  111. 111.

    The Commission interprets the definition of the contracting parties obligations also very widely. ‘All forms of consideration moving from the contracting authority and capable of valuation in money terms satisfy the requirement of pecuniary consideration’, according to the Commission in its Guide to the Community rules on public procurement of services, supra n. 11, pp. 11–12.

  112. 112.

    Commission v Italy, supra n. 84, para 47.

  113. 113.

    Ibid., para 48.

  114. 114.

    Ibid., para 50: ‘Dans les circonstances précises de l’espèce, la méthode de paiement prévue par l’accord-cadre de 2004 dépasse donc le simple remboursement des frais encourus. Dans cette mesure, il convient de considérer que cet accord-cadre prévoit une contrepartie des services de transport sanitaire qu’il vise’.

  115. 115.

    Ambulance Services, supra n. 43.

  116. 116.

    Ibid., para 32.

  117. 117.

    Ibid., para 35.

  118. 118.

    Ibid., para 37.

  119. 119.

    Social Services of General Interest: Feedback Report to the 2006 questionnaire of the Social Protection Committee, pp. 10–12, available at: http://ec.europa.eu/employment_social/spsi/docs/social_protection/2008/feedback_report_final_en_OnlinePDF.pdf. Despite the fact that the title of this report only refers to social services, this Report includes health care services.

  120. 120.

    Ibid., p. 10.

  121. 121.

    Ibid., p. 11.

  122. 122.

    Ibid., p. 13.

  123. 123.

    Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions. Services of general interest, including social services of general interest: a new European commitment. 20.11.2007 COM (2007) 725 final, p. 11.

  124. 124.

    Commission staff working document. ‘Frequently asked questions concerning the application of public procurement rules to social services of general interest.’ SEC (2007)1514 of 20.11.2007.

  125. 125.

    Prior to 2006, a dual system of private a public insurance existed. People with earnings above approximately €30,000 per year and their dependants (around 35% of the population) were excluded from statutory coverage provided by public sickness funds and could purchase cover from private health insurers. See also the chapter by Sauter in this book.

  126. 126.

    Statutory coverage includes: care by general practitioners (GPs), hospitals and midwives; hospitalisation; dental care (up to the age of 18; coverage from age 18 is confined to specialist dental care and dentures); medical aids; medicines (not all medicines; sleeping pills nor, for example, are not covered); maternity care; ambulance and patient transport services; paramedical care (limited physiotherapy/remedial therapy, speech therapy, occupational therapy and dietary advice).

  127. 127.

    The income-related contribution is set at 6,5% of the first € 30.000 of annual taxable income. Employers reimburse their employees for this contribution and employees pay tax on this reimbursement. The Dutch insured pay a flat-rate premium (set by insurers) to their private health insurer. The Dutch government has created a safety net for low-income citizens if the average flat-rate premium exceeds 5% of their household income. Furthermore, the Dutch government pays for the premiums of children up to 18 years of age.

  128. 128.

    http://english.minvws.nl/en/themes/health-insurance-system/default.asp.

  129. 129.

    Diagnosis and Treatment Combinations (Diagnosebehandelingcombinaties, DBC’s, in Dutch) are Dutch health care codes that define and describe all characteristics of particular treatments. See http://nl.wikipedia.org/wiki/Diagnosebehandelingcombinatie.

  130. 130.

    Nalevingsmeting Europees Aanbesteden 2006. Onderzoek naar naleving van Europese aanbestedingsregels in Nederland [Compliance Monitor European Tendering 2006. Research on compliance with EU public procurement rules]. By Significant B.V., November 2008. http://www.ez.nl/Actueel/Kamerbrieven/Kamerbrieven_2008/November_2008/Nalevingsonderzoek_aanbesteden.

  131. 131.

    For the difference between academic and general hospitals in the Netherlands: In Dutch: Essers et al. (2008).

  132. 132.

    Compared to 2002 and 2004 the compliance rate was lower, especially in the field of public services contracts. Nonetheless, figures show that the amount of public procurement procedures has increased, possibly due to the increased splitting of contracts into different parcels.

  133. 133.

    This has to do with the important role the Netherlands’ Board for Health care has performed in the accommodation of intramural health care. Until 2008 hospitals had to require both a license and a building permit from the Board for new construction projects and major renovations under the Health care Institutions Act. The Board considered applications for building permits by checking compliance with the procurement rules. Currently, government involvement in health care construction diminishes and hospitals and other health care institutions will have to handle their property investments by earning back those investments by means of their activities. See http://www.bouwcollege.nl.

  134. 134.

    Voorzieningenrechter Rechtbank Breda, KG ZA 04-486, LJN: AR7227.

  135. 135.

    Gerechtshof’s-Hertogenbosch, C0500057, LJN: AU4635.

  136. 136.

    The Court of Appeal found that it was not necessary to scrutinise possible fulfilment of this condition and the third condition ‘financed by the state’.

  137. 137.

    Hoge Raad, C06/022HR, LJN: AZ9872. As the highest court in fields of civil, criminal and tax law in the Netherlands, the Supreme Court examines only whether a lower court observed proper application of the law in reaching its decision. At this stage, the facts of the case as established by the lower court are no longer subject to discussion. After ruling, it will refer to a Court of Appeal, which will decide on the merits of the case.

  138. 138.

    Hebly (2008).

  139. 139.

    http://www.minvws.nl/kamerstukken/staf/2007/aanbestedingsplicht-ziekenhuizen.asp.

  140. 140.

    Commission v. France (social housing), supra n. 63, para 59.

  141. 141.

    http://www.minvws.nl/kamerstukken/staf/2007/aanbestedingsplicht-ziekenhuizen.asp. Letter of 26 January 2009.

  142. 142.

    http://www.minvws.nl/kamerstukken/staf/2007/aanbestedingsplicht-ziekenhuizen.asp. Letter of 23 April 2009.

  143. 143.

    Conclusie A-G Keus, C06/022HR, LJN AZ9872.

  144. 144.

    Currently, uncertainty evolves around the question whether the so-called ‘care offices’ (Zorgkantoren) are considered to be contracting authorities. Care offices are responsible for the implementation of the General Exceptional Medical Expenses Act (AWBZ). They have been set up by the jointly operating care insurers, but operate independently.

  145. 145.

    University of Cambridge, supra n. 2.

  146. 146.

    Agorà, supra n. 56, Adolf Truley supra n. 58 and Commission v. France (social housing), supra n. 63.

  147. 147.

    Bundesgerichtshof, Ruling from 29 June 2009, BvR 2959/07.

  148. 148.

    The Higher Regional Court in Düsseldorf had decided differently. According to this Court, the type of contract did not contain an obligation to provide a service but included a delegation of the exercise of official authority. Higher Regional Court Düsseldorf, Decision from 5 April 2006, VII-Verg 7/06.

  149. 149.

    See for example, Hervey and Trubek (2007), pp. 623–647.

  150. 150.

    COM (2008) 414.

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Hatzopoulos, V., Stergiou, H. (2011). Public Procurement Law and Health Care: From Theory to Practice. In: van de Gronden, J., Szyszczak, E., Neergaard, U., Krajewski, M. (eds) Health Care and EU Law. Legal Issues of Services of General Interest. T.M.C. Asser Press, The Hague. https://doi.org/10.1007/978-90-6704-728-9_17

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