Information Note on the Court’s case-law 262

May 2022

De Kok v. the Netherlands (dec.) - 1443/19

Decision 26.4.2022

Article 8

Article 8-1

Respect for private life

Fine for refusal to take out basic health insurance and involuntary affiliation imposed on applicant unwilling to support conventional medical care: inadmissible

Article 9

Article 9-1

Manifest religion or belief

Fine for refusal to take out basic health insurance and involuntary affiliation imposed on applicant unwilling to support conventional medical care: inadmissible

Article 1 of Protocol No. 1

Article 1 para. 1 of Protocol No. 1

Peaceful enjoyment of possessions

Fine for refusal to take out basic health insurance and involuntary affiliation imposed on applicant unwilling to support conventional medical care: inadmissible

Facts – In the Netherlands the health insurance system consists of a compulsory basic health insurance that covers, inter alia , medical care by general practitioners, medical specialists, hospitalisation, conventional medication, and medical aids, and the possibility of taking out supplemental health insurance on a voluntary basis. Individuals with a conscientious objection to all forms of insurance may pay additional tax in lieu of premium. The applicant, who preferred to shoulder only the responsibility for his own health and to pay for the costs of homeopathic treatment himself, did not take out basic health insurance as required by the Healthcare Insurance Act. Consequently, an administrative fine was imposed on him by the National Healthcare Institute (“ZIN”). His objection and appeals thereto were dismissed. In the meantime, following the imposition of a second administrative fine, the ZIN took out, in accordance with the above Act, basic health insurance on behalf of the applicant, with a legally defined premium. No appeal lay against that decision.

Law – Article 8: The Court proceeded on the assumption that this provision was applicable and, thus, that both the obligation for the applicant to take out basic health insurance and the taking out of such insurance on his behalf had constituted an interference with his right to private life. That interference had been “in accordance with the law” and had pursued the legitimate aims of the protection of health and the protection of the rights of others, the objectives of the relevant legislation being to provide and maintain a well-functioning healthcare system in which everyone concerned was encouraged to make appropriate use of medical facilities, and to prevent people from being uninsured. As to whether the interference had been “necessary in a democratic society”, the compulsory basic health insurance scheme represented the answer of the domestic authorities to the pressing social need to ensure affordable and accessible healthcare for the population. In order to achieve this, it was deemed a requirement that everyone take out a basic health insurance so that the overall cost of healthcare would be shared by all, including those who did not want or need to make use of (certain forms of) the treatments covered. As was shown by the decisions of the domestic authorities and the legislative history of the Healthcare Insurance Act, the scheme both expressed and served social or collective solidarity. Further, no specific medical treatment had been refused to or imposed on the applicant and he had had the possibility of opting for supplementary health insurance that covered the homeopathic treatment preferred by him, albeit at an additional cost. It was not in itself contrary to the requirements of Article 8 for the State to regulate important aspects of the applicant’s private life without making provision for the weighing of competing interests in the circumstances of his individual case.

Accordingly, in the light of the wide margin of appreciation a State had as regards the rules it laid down with a view to achieving a balance between competing public and private interests, the obligation to take out basic health insurance and the ZIN’s taking out of insurance on the applicant’s behalf did not fall foul of Article 8.

Conclusion : inadmissible (manifestly ill-founded).

Article 9: The applicant’s distrust in the efficacy of conventional medical treatment covered by the basic insurance and his unwillingness to contribute to that system through insurance premiums, did not constitute a conviction or belief of sufficient cogency, seriousness, cohesion and importance to fall within the scope of this provision. Moreover, the applicant did not regard himself as a conscientious objector to health insurance.

Conclusion : inadmissible (incompatible ratione materiae )

Article 1 of Protocol No. 1: The obligation to pay health insurance premiums pursuant to the Healthcare Insurance Act had amounted to an interference with the applicant’s right to the peaceful enjoyment of his possessions which had been lawful and pursued a legitimate aim “in accordance with the general interest” for the purposes of this provision. Bearing in mind the wide margin of appreciation enjoyed by States in the implementation of social and economic policies and in view of the underlying principle of solidarity, the cost of the health insurance premium in question, the possibility to take out supplementary health insurance to cover homeopathic medicine and the possibility for individuals with a modest income to apply for a means-tested contribution towards the costs of compulsory health insurance, the interference had been proportionate to the legitimate aim pursued.

Conclusion : inadmissible (manifestly ill-founded).

(See also Geotech Kancev GmbH v. Germany , 23646/09, 2 June 2016, Legal Summary ; Vavřička and Others v. the Czech Republic [GC], 47621/13 and 5 others, 8 April 2021, Legal Summary )

© Council of Europe/European Court of Human Rights This summary by the Registry does not bind the Court.

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