VATcodexEU VAT case law · Court of Justice and General Court

Hospital and medical care EU VAT case law

13 cases of the Court of Justice and the General Court of the European Union on this point of VAT law, from 1988 to 2022.

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Under each case, what the Court decided, from its summary. The summaries are AI-generated and are not official documents: open the case for the Court’s own text.

C-228/20 I (VAT exemption for hospital services)

Judgment · 7 April 2022 · Germany

Exemption for private hospitals and recognition under national health insurance rules

Member States may require private hospitals to be duly recognised, that requirement applying to all establishments named in Article 132(1)(b), but discretion is bounded by fiscal neutrality. Legislation tying recognition to needs-based hospital planning or contract discretion is precluded where it treats comparable private hospitals supplying similar services under comparable social conditions differently. Comparability may be assessed by reference to regulatory conditions and performance and cost-efficiency indicators applicable to public hospitals, the calculation of fixed-rate daily fees, and coverage leaving patients bearing similar costs. Private hospitals and clinics in Member States where exemption depends on admission to a capacity-based public planning system or on discretionary contracts with sickness funds can challenge refusals grounded solely in the absence of demonstrated need.

C-513/20 Termas Sulfurosas de Alcafache

Judgment · 13 January 2022 · Portugal

Exemption of activities closely related to medical care, thermal registration fees

The fee can be exempt, but only where the file records the user's state of health, the planned and prescribed care and how it is to be administered, and must be consulted in order to deliver the care and achieve its therapeutic objectives. If the payment merely buys the right to purchase prescribed care, or the file's content is not essential to the care, there is no close link, even though the treatments cannot be had without paying. The establishment must also meet the Article 132(1)(b) status and social conditions test. Relevant to spa and thermal establishments, private clinics and other non-public providers charging administrative, registration or file-opening fees alongside exempt treatment.

C-211/18 Idealmed III

Judgment · 5 March 2020 · Portugal

Private hospitals and comparable social conditions

Those contractual and funding features are relevant factors in assessing comparable social conditions, alongside the public interest nature of the services. Price fixing is not a precondition, its absence does not defeat exemption. The proportion of contracted services within the provider's total activity is irrelevant. The test attaches to the services, not the provider. Once supplies fall within Article 132(1)(b) exemption is mandatory, and the national option to tax, including any unexpired minimum period, cannot keep them taxed. Relevant to private hospitals, clinics and diagnostic centres, particularly in Portugal, that hold an option to tax while progressively contracting with public health bodies or social security schemes.

C-700/17 Peters

Judgment · 18 September 2019 · Germany

Medical care exemption without a doctor and patient relationship

Care of this kind can fall within Article 132(1)(c) where it does not satisfy all the conditions of Article 132(1)(b): the latter does not limit the scope of the former, which covers services supplied outside a hospital environment. Article 132(1)(c) imposes only two conditions, provision of medical care and exercise of a medical or paramedical profession as defined by the Member State. No confidential relationship with the patient is required. Earlier references to such a relationship merely illustrated the place of supply distinction. Laboratory physicians, clinical chemists and other diagnostic specialists working under contract for laboratories or hospital operators can rely on Article 132(1)(c) even though they never meet the patient. Relevant to laboratory groups, outsourced diagnostics and German assessments on this basis.

C-334/14 De Fruytier

Judgment · 2 July 2015 · Belgium

Medical exemption for self-employed transport of organs and samples

Neither of the two provisions covers that transport. The transport is not itself medical care, and Article 13(A)(1)(c) contains no closely related activities limb. Even if the transport were an indispensable stage in the supply of hospital or medical care, a matter for the national court, the exemption fails on the status condition: a self-employed transporter is not a body governed by public law, hospital, centre for treatment or diagnosis, or an establishment of a similar nature. Fiscal neutrality cannot widen the exemption. Confirms that the medical exemption has a two limb test and that outsourced logistics providers fail the status limb regardless of how closely their services support therapeutic outcomes.

C-91/12 PFC Clinic

Judgment · 21 March 2013 · Sweden

Exemption for plastic surgery and cosmetic treatments

Such services are exempt only where intended to diagnose, treat or cure diseases or health disorders, including psychological ones, or to protect, maintain or restore health. Purely cosmetic interventions are not. The recipient's subjective view is not in itself decisive. The assessment must rest on medical findings by a qualified person, and the involvement of licensed medical professionals may influence that assessment. All other conditions of Article 132(1)(b) or (c), and Articles 131, 133 and 134, must also be satisfied. Clinics providing mixed cosmetic and reconstructive treatment cannot treat their output as uniformly exempt or uniformly taxable. Relevant to plastic surgery clinics, aesthetic medicine and dermatology providers, and their advisers, particularly where refund claims turn on the exempt or taxable split.

C-262/08 CopyGene

Judgment · 10 June 2010 · Denmark

Private cord blood stem cell banking and the hospital care exemption

The services are not closely related to hospital or medical care where the hospital treatment to which they are only potentially linked has not been performed, commenced or even envisaged. There is no temporal condition as such, but a merely hypothetical future treatment is insufficient. Article 13A(1)(b) neither prevents nor requires national authorities to treat such a bank as duly recognised. Authorisation under Directive 2004/23 is not automatic recognition, and the discretion must respect fiscal neutrality. Autologous or allogeneic use is irrelevant. A private biobank or cord blood service in the EU is standard rated unless linked to identified treatment.

C-86/09 Future Health Technologies

Judgment · 10 June 2010 · United Kingdom

VAT treatment of umbilical cord blood collection and stem cell banking

Where the activities are intended only to ensure that a resource is available for medical treatment in the uncertain event that treatment becomes necessary, and not to diagnose, treat or cure disease, they fall outside both Article 132(1)(b) and Article 132(1)(c), whether taken together or separately. Cryopreservation of living body parts is not itself preventive care. The exception is that cord blood analysis genuinely intended to enable a medical diagnosis, rather than merely testing cell viability, can qualify. Following CopyGene, the activities are not "closely related" to hospital care that has not been performed, commenced or envisaged. Private cord blood and stem cell banks, and tissue biobanks generally, must treat collection, processing and storage packages sold for speculative future use as taxable, notwithstanding accreditation as a health establishment or supervision by registered health professionals.

C-79/09 Commission v Netherlands

Judgment · 25 March 2010 · Netherlands

Structural staff secondment as a closely related supply, and the burden of proof in infringement actions

The action was dismissed in full. Whether a supply of staff is temporary or structural is not in itself decisive. What matters is whether it is an end in itself or a means of better enjoying the principal exempt service. The Commission had produced no evidence on that point, nor on the Horizon College conditions, nor that the public bodies acted under the same legal conditions as private traders, nor that any distortion of competition was real rather than hypothetical. Confirmation that duration is not the test for a closely related supply. Relevant to exempt sector employers using shared or joint employment arrangements, and to public bodies seconding officials to cross-border cooperation structures.

C-394/04 Ygeia

Judgment · 1 December 2005 · Greece

Scope of activities closely related to hospital and medical care

Such supplies are, as a general rule, taxable. They improve patient comfort and well-being but are not exempt unless they are essential to achieving the therapeutic objectives of the hospital and medical care supplied, and their basic purpose is not to obtain additional income from transactions in direct competition with commercial traders (telephone and television providers, hotels, restaurants). Only services forming an indispensable stage in delivering care qualify. The national court must assess this on the facts, including any medical prescriptions. Hospitals, clinics and similar recognised establishments cannot shelter hotel-style and amenity income under the care exemption merely by pointing to patient welfare.

C-45/01 Dornier

Judgment · 6 November 2003 · Germany

Exemption for psychotherapeutic treatment given by non-doctors in a private foundation's out-patient facility

Such treatment is closely related to hospital or medical care only where it is genuinely ancillary to principal hospital or medical care. However, medical care in point (b) covers all care within point (c), including paramedical services by non-doctors. Recognition needs no formal procedure and need not derive from tax law. A medical supervision condition exceeds Member States' discretion. Exemption under point (c) is independent of legal form. Both provisions may be relied on directly. Relevant to clinics, foundations and other non-public providers of paramedical care, including psychologists, physiotherapists and similar professions, operating through corporate or foundation structures.

C-76/99 Commission v France

Judgment · 11 January 2001 · France

VAT treatment of the transmission of medical samples between laboratories

France infringed Article 13(A)(1)(b) by taxing fixed transmission allowances. The concept of closely related activities does not call for an especially narrow reading. Where a health-care worker orders an analysis for diagnostic and therapeutic purposes, transmission of the sample sits between sample-taking and analysis and is closely related to it. Neither the classification of the transmission as a distinct act in national law nor separate invoicing can alter that. The patient is indifferent as to which laboratory analyses the sample. Confirms that the medical exemption follows the therapeutic purpose of the underlying analysis, not the contractual or invoicing structure chosen between providers. Relevant to laboratories, diagnostic networks and subcontracting arrangements in healthcare generally.

C-353/85 Commission v United Kingdom

Judgment · 23 February 1988 · United Kingdom

Scope of the medical care exemption for goods supplied by health professionals

The Court declared the United Kingdom in breach. Article 13A(1)(c) covers only the provision of medical care outside hospitals, within the confidential practitioner and patient relationship, and excludes supplies of goods within the meaning of Article 5. The single qualification is that minor provisions of goods strictly necessary at the time the care is given, and indissociable from the service, remain exempt. Medicines and prescribed corrective spectacles are physically and economically dissociable and are taxable. Article 13A(1)(b) affords no analogy. The dividing line drawn here still governs primary care and community health supplies.

Related topics

Exemptions · Provision of medical care in exercise of medical and paramedical professions · Exemptions for certain activities in the public interest · Closely related activities · National derogations · Welfare and social security work · Bodies governed by public law · Education and vocational training · Treatment as a non-taxable person · Proof