CEDH · CASELAW;REPORTS;ENG — 15 décembre 1988

.sDD6737AE { font-size:11pt } .s211D6B00 { margin-top:0pt; margin-bottom:0pt; line-height:normal; widows:0; orphans:0; font-size:8.5pt } .sBB9EE52A { font-family:Arial }      EUROPEAN COMMISSION OF HUMAN RIGHTS     Application No. 11540/85     Haim KARNI     against   SWEDEN                   REPORT OF THE COMMISSION     (adopted on 15 December 1988)       TABLE OF CONTENTS                                                                      page   I.       INTRODUCTION (paras. 1-14) ............................     1           A.   The application (paras. 2-4) ......................     1           B.   The proceedings (paras. 5-10) .....................     1           C.   The present Report (paras. 11-14) .................     2     II.      ESTABLISHMENT OF THE FACTS (paras. 15-45) .............     3           A.   The particular circumstances of the case             (paras. 15-28) ....................................     3           B.   Relevant domestic law (paras. 29-45) ..............     5     III.     SUBMISSIONS OF THE PARTIES (paras. 46-79) .............     11           A.   The applicant (paras. 46-64) ......................     11           B.   The Government (paras. 65-79) .....................     13     IV.      OPINION OF THE COMMISSION (paras. 80-97) ..............     17           A.   Point at issue (para. 80) .........................     17           B.   Article 6 of the Convention (paras. 81-97) ........     17           APPENDIX I       :   HISTORY OF THE PROCEEDINGS .................     20   APPENDIX II      :   DECISION ON THE ADMISSIBILITY ..............     21   I.       INTRODUCTION   1.       The following is an outline of the case as submitted to the European Commission of Human Rights, and of the procedure before the Commission.           A.   The application   2.       The applicant is a Swedish citizen, born in 1917 and resident at Trelleborg.   He is a doctor of medicine.   Before the Commission, he is represented by Mr.   Kenneth Borin, a lawyer practising at Trelleborg.   3.       The application is directed against Sweden.   The respondent Government are represented by their Agent, Mr.   Hans Corell, Ambassador, Under-Secretary at the Ministry for Foreign Affairs, Stockholm.   4.       The case relates to the procedures engaged by the applicant, a doctor, to ensure his affiliation to the social security system, and the question whether he had any possibility of having the dispute concerning the refusal to affiliate him examined by a tribunal satisfying the conditions of Article 6 para. 1 of the Convention.           B.   The proceedings   5.       The application was introduced on 20 February 1985 and registered on 15 May 1985.   On 1 December 1986 the Commission decided, in accordance with Rule 42 para. 2 (b) of its Rules of Procedure, to give notice of the application to the respondent Government and to invite them to present before 6 March 1987 their observations in writing on the admissibility and merits of the application with regard to Article 1 of Protocol No. 1 to the Convention and Article 6 para. 1 of the Convention.           The Government's observations were dated 5 March 1987 and the applicant's observations in reply, after an extension of the time- limit to 30 May 1987, were dated 19 May 1987.   The applicant submitted a further letter dated 15 September 1987.   6.       Legal aid under the Addendum to the Commission's Rules of Procedure was granted by the President on 7 April 1987.   7.       On 8 March 1988 the Commission decided to declare inadmissible the applicant's complaint of a violation of Article 1 of Protocol No. 1 of the Convention.   The remainder of the application (Article 6 para. 1 of the Convention) was declared admissible.   8.       The parties were then invited to submit any additional observations on the merits of the application which they wished to make.           The applicant submitted further observations by letter of 8 June 1988 and the Government submitted further observations on 30 June 1988, arguing inter alia that the application should be rejected as inadmissible.   The observations of each party were communicated to the other party for information.   Additional observations from the applicant were dated 11 August 1988.   9.       On 9 July 1988 the Commission considered the state of proceedings of the case.           On 6 and 15 December 1988 the Commission considered the parties' submissions.   It found no basis for the application of Article 29 of the Convention.   The Commission then deliberated on the merits and took the final votes in the case.   10.      After declaring the case admissible the Commission, acting in accordance with Article 28 (b) of the Convention, placed itself at the disposal of the parties with a view to securing a friendly settlement of the case.   In the light of the parties' reactions the Commission now finds that there is no basis on which a friendly settlement can be effected.           C.   The present Report   11.      The present Report has been drawn up by the Commission in pursuance of Article 31 of the Convention and after deliberations and votes in plenary session, the following members being present:                   MM.   C.A. NØRGAARD, President                      J.A. FROWEIN                      E. BUSUTTIL                      G. JÖRUNDSSON                      A.S. GÖZÜBÜYÜK                      A. WEITZEL                      J.C. SOYER                      H.G. SCHERMERS                      H. DANELIUS                      H. VANDENBERGHE                 Mrs.   G.H. THUNE                 Sir   Basil HALL                 MM.   F. MARTINEZ                      C.L. ROZAKIS                 Mrs.   J. LIDDY           The text of the Report was adopted by the Commission on 15 December 1988 and is now transmitted to the Committee of Ministers in accordance with Article 31 para. 2 of the Convention.   12.      The purpose of the Report, pursuant to Article 31 para. 1 of the Convention, is:           (1)   to establish the facts, and           (2)   to state an opinion as to whether the facts found              disclose a breach by the State of its obligations              under the Convention.   13.      A schedule setting out the history of the proceedings before the Commission is attached hereto as Appendix I and the Commission's decision on the admissibility of the application forms Appendix II.   14.      The full text of the parties' submissions, together with the documents lodged as exhibits, are held in the archives of the Commission. II.      ESTABLISHMENT OF THE FACTS           A.   The particular circumstances of the case   15.      The applicant moved from Switzerland to Sweden in 1982.   After having retired in January 1983 the applicant decided to open a private medical practice at Trelleborg since his income from his pension was insufficient.   16.      On 21 August 1984 the applicant applied for affiliation to the social security system.   According to the application the applicant intended to carry on medical practice at Trelleborg.   He did not intend to work full time but 30 hours a week.           By letter of 17 September 1984, the Social Insurance Office of Malmöhus (Malmöhus allmänna försäkringskassa) informed the applicant that, as from 28 August to 31 December 1984, he had been entered on the list of private medical practitioners within the Office's area, who were affiliated to the social security system.   The applicant was also informed of the fees he was entitled to charge his patients.   17.      Following his affiliation to the social security system the applicant maintains that he set up his medical practice at Trelleborg. He signed a contract for the premises for his practice and furnished it with an electrocardiograph and other special instruments.   In all, he invested some 90.000 SEK.   18.      By a letter dated 15 October 1984, the applicant received from the Social Insurance Office a preliminary notice as regards his affiliation to the social security system as from 1 January 1985. It read as follows:   "In view of the fact that new rules concerning affiliation to the social security system will enter into force as from January 1985, the Social Insurance Office informs you as follows.   The Social Insurance Office has found, after investigation, that you do not fulfil the conditions for continued affiliation to the rules on remuneration for medical care under the social security system.   The Office therefore intends to strike you off its list at the end of 1984.   In the annexed notice concerning the new rules an account is given inter alia of the conditions for being entered on the Insurance Office's list as from the coming year and of the possible exemptions.   If, in view of the above, you intend to submit a request for exemption or otherwise have any objection against the Insurance Office's assessment you should make this known immediately and at the latest within 14 days.   The communication should be sent to the Social Insurance Office together with the documents you wish to invoke. You will be informed later of the decision on the question of affiliation."   19.      On 26 October 1984 the applicant telephoned the Social Insurance Office stating that he had made investments during the autumn and would submit documents to show these investments.   20.      In an application of 27 November 1984 to the Insurance Office, the applicant requested to be allowed to continue as a doctor affiliated to the social insurance system also after 1 January 1985. He referred to conversations and correspondence with the County Council of the County of Malmöhus (Malmöhus läns landsting).   The application also contained a copy of a letter from the applicant to the County Council, dated 27 November 1984.   21.      In the letter to the County Council, the applicant requested to be allowed to continue as affiliated to the insurance system after 1 January 1985.   Besides referring to a conversation during a visit to the County Council on 22 October 1984, the applicant also stated that he had been abroad and had only learned at the end of October 1984 of the new regulations for affiliation after 1 January 1985 and also that he had been granted affiliation without having been advised of the impending changes.   He claimed that his arrangements for establishing the practice were substantially complete by the end of October and that he had invested considerable sums, including signing a year's contract for premises and the purchase of expensive apparatus and furniture.   He claimed that his medical practice was a vital necessity for him.   He had no alternative, since he was not entitled to any form of pension.   22.      The Social Insurance Office made no decision concerning the applicant's affiliation after the decision notified in the preliminary notice of 15 October 1984, and no decision was given on his application of 27 November 1984.   There is no explanation as to the reason for this silence.   Nor has the Office taken any other measures concerning the applicant's affiliation.   The National Social Insurance Board (riksförsäkringsverket) has not received any petition concerning the applicant's affiliation, neither from the applicant himself nor from the Insurance Office.   23.      According to records kept at the Insurance Office, the applicant received insurance remuneration for 24 consultations during the book-keeping period of November 1984 and for 11 consultations during the book-keeping period of December 1984.   The total remuneration amounted to just under 9,000 SEK.   24.      By letter of 20 December 1984 the applicant received inter alia the following information from the County Council:   "Your application will be dealt with together with the other applications for new establishments and applications for continued private and leisure practice from the private and leisure practitioners who do not fulfil the basic conditions for continued affiliation to the Social Insurance Office. Thus, the intention is to make an overall assessment of the need of private medical care, the present medical resources under private and public regime and the financial consequences for the County Council.   Since the time-limit for applications for continued private and leisure practice expires on 31 December 1984, the examination of your application can only be made in the beginning of 1985.   According to the guidelines of the administrative committee, all applications shall have been examined by 31 March 1985.   Awaiting the outcome of your application you have the possibility to continue your practice from 1 January 1985 on the following conditions.   Remuneration will be paid according to unchanged principles for a maximum of 200 consultations per month.   The remuneration will be paid by the County Council and should therefore be accounted for on a special form which will be sent to you shortly.   The above permission does not imply any stand as to continued practice after 31 March 1985.   If the application is rejected, no further prolongation will be granted."   25.      By letter of 25 January 1985 the applicant informed the County Council that his affiliation to the social security system had been granted without mentioning the subsequent reorganisation of the rules. He also informed the Council of his investments in his practice.   26.      By letter of 14 February 1985 the applicant was informed that on 13 February 1985 the Health and Social Delegation (hälso- och sjukvårdsdelegationen) of the County Council had rejected his application for an agreement on a medical practice implying his affiliation to the social security system.   27.      The applicant closed down his practice immediately.   28.      On 17 February 1985 the applicant applied to the County Council for a contribution towards the costs for the closing down of his medical practice.   This request was rejected by the County Council on 5 March 1985.             B.   Relevant domestic law   29.      Medical attendance in Sweden is mainly a matter for the public sector.   Of 21,000 doctors in 1985, 18,500 were employed at hospitals and other medical institutions within the public sector.   Another 1,000 were employed within the occupational health service.   Of the remaining group some 1,000 are estimated to work as private practitioners.   30.      Benefits for medical care are provided by the social insurance system which also covers, for example, pensions and child allowances. The legal basis for the system is the 1962 Social Insurance Act (lagen om allmän försäkring). 31.      This Act applies to Swedish citizens and those who, although not Swedish citizens, are resident in Sweden.   The administration of the system is carried out by Social Insurance Offices and the National Social Insurance Board.   Allowances for medical expenses are paid by local Social Insurance Offices pursuant to Chapter 2 of the Act, and include remuneration for out-patient medical care (läkarvård i öppen vård).   Remuneration is paid if such care is provided by the State, a county council or a municipal authority not part of a county council (public medical care) or by a doctor affiliated to the social insurance system (alternative medical care).   Most private practitioners are affiliated to the system.   According to the Act remuneration is paid on grounds stipulated by the Government.   32.      New rules came into force on 1 January 1985 regarding health insurance benefits for out-patient care and regarding the affiliation of private practitioners to the health insurance system.   33.      Prior to 1 January 1985 remuneration was paid for each visit to the doctor.   This applied to both public care and alternative care.   The patient paid a stipulated maximum patient's fee, and the doctor affiliated to the social insurance system received a stipulated sum for each patient's visit, directly from the social insurance office.   If the doctor was employed within public medical care, for instance by a County Council, the County Council received the corresponding sum.   34.      The reform entailed the application of new rules for remuneration as from 1 January 1985.   In order to limit social insurance expenses, and to achieve better regional distribution of care throughout Sweden and taking into consideration that the medical care principal (sjukvårdshuvudmannen) had the responsibility for medical care planning within its area, the previous form of remuneration calculated on the number of patient's consultations was replaced by a form of a more roughly estimated remuneration.   35.      In the new system the sum is calculated on the basis of the number of inhabitants within the medical care area for which the medical care principal is responsible and covers medical care provided both by doctors employed by the medical care principals and by other doctors.   The remuneration is paid to the medical care principal after deduction of the sum paid per consultation to private practitioners affiliated to the social insurance system.   36.      To enable joint planning of medical care, and since a deduction is made on remuneration to the medical care principals for private medical care, the rules were at the same time changed for affiliation of private practitioners to the system.   Prior to 1 January 1985, any doctor could upon application be affiliated to the social insurance system.   The Insurance Office entered the doctor on a list kept by the Offices for this purpose.   Subsequent to 1 January 1985, private practitioners may in principle only be affiliated to the system at the recommendation of the medical care principal (not necessary in areas with very few doctors).   37.      However, any private practitioner already affiliated when the new regulations came into force on 1 January 1985 was permitted to remain within the system without recommendation from the medical care authorities, provided the doctor's practice had been of a certain magnitude.   38.      The reform was proposed in a Government Bill to the Parliament in April 1984 (Bill No. 1983/84:190).   A main purpose of the reform was to improve the possibilities for people living in those parts of Sweden which are sparsely populated - for example wide areas in the northern parts of Sweden - to get access to medical care.   The Government saw this as a fulfilment of the aims set up in the 1982 Health and Medical Services Act (hälso- och sjukvårdslagen), which stipulates that the aim for the health and medical care is good health and medical care supplied on the same conditions to the whole population.   In the sparsely populated areas there was a considerable lack of doctors in the public as well as in the private care.   In the city regions the case was the reverse.   In order to see to it that the population within the area for which the medical care principal is responsible gets access to good health and medical care, as prescribed in the Health and Medical Services Act, the medical care principals had to be made capable of estimating the range of the care supplied. It was therefore deemed necessary that the activities of private practitioners affiliated to the social insurance system were also co-ordinated with the activities of the medical care principals as far as planning was concerned.   The medical care principals therefore were given a determining influence when deciding whether private practitioners can be affiliated to the social insurance system.   39.      The Bill was approved by Parliament on 5 June 1984.   The proposed reform had caused general debate in the newspapers and other mass media.   By approving the Bill, Parliament authorised the Government to regulate the basis for remuneration for medical treatment and also to issue directives regarding the extent to which private practitioners should be included in the lists kept by the Social Insurance Offices and thus affiliated to the insurance system. The amendments came into force on 1 January 1985.   40.      The basis for remuneration to medical care principals laid down by the Government appear in the 1984 Ordinance on Remuneration to Medical Care Principals from the Social Insurance under the Social Insurance Act.   The basis for remuneration from the national social security system to private practitioners is stipulated by the Government in the 1974 Tariff of Medical Care Charges (läkarvårdstaxan; hereinafter referred to as "the tariff"), as amended.   The tariff states the conditions under which private practitioners may join the social security system by being entered on the Social Insurance Office list, thus being entitled to remuneration from the insurance.   The tariff also stipulates the maximum fee which a doctor may charge for a treatment or consultation.   Of that fee the doctor receives a fixed sum directly from the patient (the patient's fee in 1985 was 55 SEK).   The remaining part of what has been charged is paid to the doctor from the Social Insurance Office.   Such remuneration is paid to the doctor for each patient's visit even subsequent to the reform.   41.      The new regulations in the tariff following the parliamentary decision of 5 June 1984 were issued on 16 October 1984 (Ordinance No. 1984:767).   As from 1 January 1985, a private practitioner thus may join the social insurance system only if recommended by the medical care principal.   However, this requirement does not apply to a person taking over a practice from a doctor who is already affiliated to the system.   Neither does it apply to the establishment of new practices in certain areas of Sweden in special need of doctors (Section 3 of the tariff).   The areas concerned are the sparsely populated wide areas situated mainly in the northern parts of Sweden.   42.      The Ordinance included certain transitional provisions relating to doctors affiliated to the national insurance system at the time when the new regulations came into force.   The transitional provisions correspond to what was recommended in the Bill (pp. 32-33) and approved by Parliament, and read as follows:     (Swedish)   "Denna förordning träder i kraft den 1 januari 1985.   1.   En läkare som vid utgången av år 1984 är uppförd på förteckning hos allmän försäkringskassa skall från och med den 1 januari 1985 av försäkringskassan föras av från förteckningen om han inte uppfyller kraven för att stå kvar på denna.   2.   En läkare som är uppförd på förteckningen vid utgången av år 1984 och som inte är heltidsanställd hos sjukvårdshuvudman skall även fortsättningsvis vara uppförd på förteckningen utan krav på tillstyrkan från sjukvårdshuvudmannen.   En förutsättning är att verksamheten bedrivs på samma ort och att läkaren under tiden juli 1983 - mars 1984 har bedrivit verksamheten i sådan omfattning att han fått ersättning från den allmänna försäkringen motsvarande minst två månaders heltidsverksamhet.   Har läkaren under denna tid på grund av sjukdom varit förhindrad att i tillräcklig omfattning bedriva verksamhet skall detta krav ändå anses uppfyllt.   Detsamma gäller om verksamheten hindrats av annat skäl som godtas av riksförsäkringsverket.   En läkare som börjat sin verksamhet så sent att han inte har kunnat bedriva den i tillräcklig omfattning under den i första stycket angivna tiden, men som före april 1984 gjort betydande investeringar eller vidtagit andra långtgående åtgärder i verksamheten, får efter särskild prövning av riksförsäkringsverket medges att även fortsättningsvis vara uppförd på förteckningen.   I de fall läkaren under år 1984 har övertagit en befintlig praktik från en läkare som är uppförd på förteckning hos försäkringskassan, får han åberopa den tidigare innehavarens verksamhet för att uppfylla förut angivna förutsättningar.   3.   Läkare som avses under punkt 2, som inte är heltidsanställd hos sjukvårdshuvudman och som inte uppfyller där angivna krav för att även fortsättningsvis vara uppförd på försäkringskassans förteckning, får vara kvar på denna tills vidare eller under viss tid efter utgången av år 1984 om sjukvårdshuvudmannen tillstyrker det."         (English translation)           "This Ordinance shall come into force on 1 January 1985.           1.   A doctor who was included in the list kept by the social         insurance office at the end of 1984 shall be deleted         therefrom as from 1 January 1985, if he does not fulfil         the requirements for remaining on the list.           2.   A doctor who was included in the list at the end of         1984, and who is not employed full-time by the medical         care principal, may continue to be included in the list         without having to be recommended by the medical care         principal, provided the practice is run at the same         place and that, over the period July 1983 to March 1984,         the doctor has carried out his practice to such an extent         that he has received remuneration from the social insurance         office corresponding to at least two months full-time         activity.   Should the doctor have been prevented by         illness during this time from carrying on his practice         to the extent required, this requirement shall in any         case be considered to have been fulfilled.   The same         applies in the event of the practice not having been         carried on for some other reason accepted by the National         Social Insurance Board.           A doctor who established his practice too late to have         been able to carry it on to a sufficient extent during         the period stated in the first paragraph but who, prior         to April 1984, has made considerable investments or taken         other long-term measures regarding the practice may,         upon special examination by the National Social Insurance         Board, be permitted to remain on the list.           In the event of a doctor having taken over an existing         practice in 1984 from a doctor who is already on the         Social Insurance Office list, he may refer to the         activities of the previous owner in order to fulfil         the stipulated requirements.           3.   Doctors referred to under point 2, who are not         employed full-time by a medical care principal and who         do not fulfil the requirements stipulated therein for         remaining on the Social Insurance Office list, may         remain until further notice, or for a certain period         after the end of 1984, if recommended by the medical         care principal."   43.      In accordance with what was recommended in the Bill (p. 33), doctors not fulfilling the requirements for automatically remaining in the insurance system should be notified thereof as soon as possible after 1 July 1984 and advised of the conditions for affiliation after 1 January 1985.   During autumn 1984 the National Social Insurance Board issued information to the local Social Insurance Offices, and the doctors affected were informed individually by these offices. According to the National Social Insurance Board, information should be issued from the local offices in the following manner:           A preliminary notice from the Insurance Office should be sent to the doctor stating that upon investigation it had been found that the doctor did not fulfil the requirements for continued affiliation to the insurance system and that the office therefore intended to delete the doctor from its list at the expiry of 1984.   Information as to the new regulations, including the transitional provisions, was to be included with the notice.           The notice stated that a petition for exemption or objections to the assessment of the Insurance Office should be submitted immediately or within 14 days and should be addressed to the local Social Insurance Office.   The preliminary notice should state that a decision concerning affiliation would be communicated later.           The question of affiliation was then to be examined by the Insurance Office.   Petitions for exemption from the requirements stipulated by the transitional provisions point 2, regarding practice having been carried on prior to 1 April 1984, were to be forwarded to the National Social Insurance Board for examination.           As to the question of affiliation of new private practitioners to the insurance system during the period up to 1 January 1985, when the Act came into force, the Bill stated that decisions to include such practitioners in the Insurance Office's list after 1 July 1984 should only apply until the end of 1984 (the Bill p. 33).   A provision to that effect was also included in an amendment to the transitional provisions to the tariff.   In that provision, which entered into force on 1 July 1984, it was stipulated that a decision to enter a private practitioner on the list after 30 June 1984 was to apply only until the end of 1984.   The establishment of new practices in areas in special need of doctors was exempted from the provision.   44.      Pursuant to Chapter 20 Section 11 of the 1962 Social Insurance Act appeals can be lodged with the Regional Social Insurance Court (försäkringsrätten) against a decision of the Social Insurance Offices and of the National Social Insurance Board.   Further appeals can be addressed to the Supreme Social Insurance Court (försäkringsöver- domstolen).   However, an appeal may not be filed against the decision of a Social Insurance Office by an individual until the Insurance Office has reconsidered its decision pursuant to Chapter 20 Section 10 of the Social Insurance Act.   An appeal lodged prior to the reconsideration of the decision shall be deemed to be a request for reconsideration.   These provisions also apply to decisions not to include doctors in the list for doctors affiliated to the system.   45.      Chapter 7 Section 1 of the Local Government Act (kommunallagen) provides that a decision by a Municipal Council or a County Council is subject to a municipal appeal (kommunalbesvär) to the Administrative Court of Appeal (kammarrätten) if the decision:           (1)   has not been taken in accordance with the law,           (2)   violates the law or any other statute,           (3)   has been taken outside the legal authority of the              Municipal Council or the County Council,           (4)   violates the private rights of the claimant, or           (5)   for some other reason must be considered unfair.           Further appeals can be made to the Supreme Administrative Court (regeringsrätten). III.     SUBMISSIONS OF THE PARTIES           A. The applicant   46.      In order to have patients it is necessary for the private practitioner to be affiliated to the social insurance system.   Doctors outside this system in Sweden of today are rare, if they exist at all. The applicant realised the necessity to be affiliated to the system.           Before 1985 a doctor could easily be affiliated to the social insurance system.   He only had to notify the Insurance Office and he was affiliated with no condition other than that he had to apply the obligatory tariff.   47.      During 1984, not having got any temporary post, the applicant spent part of the year with his daughter in Switzerland.   He notified his affiliation to the social insurance system, which was accepted in September 1984.   The applicant was not informed that the regulations for the affiliation were to be changed.   48.      During September - October 1984 the applicant acquired apparatus and furniture for his practice.   He also signed a contract for the consultation room.   He invested an amount of about 100,000 SEK.   His affiliation was valid to the end of 1984.   Being informed by some colleagues that such an affiliation was always given for the running year only he was convinced that the affiliation would automatically be prolonged.   He started his practice at the beginning of November 1984.   Shortly thereafter he was informed in writing by the Insurance Office that his affiliation would not be prolonged after the end of 1985.   As a result of the rules of that time the applicant considered the affiliation as a pure formality.   In order to secure his affiliation after the new year 1985 he contacted persons in the county administration who were competent to pass a resolution and wrote petitions to the Social Insurance Office and to the County Council.   All his measures resulted only in a limited prolongation of the affiliation until 31 March 1985.   The applicant terminated his practice in February 1985.   The activity, which had hardly begun, was in a phase of building up and not of any considerable proportions.   49.      It is important to give the background of the personal life situation of the applicant.   His dream was once more to get in contact with patients of his speciality, cardiology.   For this purpose he equipped his practice with expensive apparatus.   The applicant is today 71 years old.   One can easily imagine what kind of psychological consequences the smashing of this dream had.   If he had been 20-30 years younger he would not have taken any legal steps but would have tried once more.   However in his high age, and financially ruined, a new start was simply impossible.   He strongly felt that the last train had left him.   No single person is apparently responsible, but the faceless bureaucracy can be made responsible for this severe hit against a person of high character with a benevolent aim for his eyes.   50.      The applicant's petitions to the authorities were partly an appeal against not being affiliated, partly an application to be affiliated under the new rules valid from 1 January 1985.   51.      The applicant emphasises that the new rules had a very harmful impact on the working conditions of the private doctors.   Prior to the reform only an announcement was necessary for the affiliation.   Under the new rules a recommendation of the County Council is necessary.   The radical change of the rules for the affiliation to the insurance system called for extensive transitional provisions.   The Ordinance (the tariff) was issued on 16 October 1984.   According to the new regulations all doctors who were registered as affiliated to the social insurance system would be struck off the list if they did not comply with the new conditions.   52.      The applicant had principally two possibilities to retain his affiliation.   First, he could apply for a new affiliation according to the new rules.   For this purpose it was necessary to have a recommandation of the County Council.   Such a recommendation is a political decision.   The County Council is not a court.   A decision to refuse a recommendation cannot be appealed to a court for reconsideration.   There is no right to complain.   53.      Another possibility was to request that under the transitional provisions the applicant should continue to be affiliated.   Such issues were dealt with by the National Social Insurance Board.   A decision of this Board could be appealed to the Insurance Court.   According to the transitional provisions an examination by a court was possible.   The applicant has sent several applications to the County Council and to the Social Insurance Office in order to have his affiliation prolonged.   For some inexplicable reason these applications have never been forwarded to the National Social Insurance Board.   It was the duty and responsibility of the Council and of the Office to forward these applications to the National Social Insurance Board.   There are special regulations according to which the Social Insurance Office has to forward applications to the competent body.   Consequently in this case the authorities have without any reason failed to take a decision.   Since no decision was given there was no decision to appeal against.   54.      The way the authorities dealt with this case was strange, especially having regard to the fact that the applicant was extraordinarily active to maintain his rights.   He contacted personally the authorities to which he described his situation.   The obstruction the applicant was exposed to is so astounding that it can only be explained by a conscious aversion against his person.   55.      The applicant received the preliminary notice of not being affiliated after 1 January 1985 at the end of October 1984.   He protested personally on 22 October 1984 to chairman Holgersson at the County Council, who assured the applicant that he could count on a continuation of his affiliation.   In November 1984 the applicant sent applications to the Social Insurance Office and to the County Council. None of these applications have been dealt with properly since they have not been forwarded to the National Social Insurance Board.   His letter of 25 January 1985 has not been treated properly either. The submission "this means in fact that his application for affiliation in a formal sense still remains unanswered by the office" is very near the truth, namely, that damage has been caused to the applicant during four years, because his request has not been correctly handled.   56.      The applicant has not appealed against the decision of September 1984 to affiliate him only to the end of 1984.   It was the common practice to sign a contract for the running year only.   The applicant supposed that the affiliation would be prolonged automatically for the next year. 57.      The Government assert that it is insignificant that the applicant did not have the final decision on his application for continuation of the affiliation because he nevertheless does not fulfil the conditions in the transitional provisions.   This is incorrect.   Certain regulations make it possible that the applicant continues to be affiliated.   In any case one does not know what would have been the outcome if his applications had been dealt with by the National Social Insurance Board or reconsidered by the Court.   58.      The applicant submits that, in his efforts to obtain affiliation to the social insurance system after the expiry of 1984, he was seeking a determination of his civil rights.   59.      The applicant has requested compensation for the financial loss the treatment has caused him.   It is correct that the ordinary courts may examine a compensation claim against the State.   In the case of the applicant such a possibility does not exist, since there is no administrative decision which could form the basis for such a claim.   The applicant lacks the possibility to have his claim examined.   60.      It is necessary to distinguish between the examination under the transitional provisions and under the new legislation.   Under the transitional provisions the applicant never received any final decision and no notice of appeal.   His case was never transferred to the National Social Insurance Board.   By failing to fulfil their duties the authorities deprived the applicant of his right to have his case examined.   61.      Under the new legislation the decision of the County Council cannot be appealed to a court.   The County Council is not a court but a political organ.   62.      Consequently, since the affiliation was important for his practice and his possibility to earn a living this is a question of his "civil rights".   The applicant has been prevented from working in his profession as a result of the refusal of affiliation.   He maintains that Article 6 of the Convention has been violated.   63.      In support of his application the applicant invokes the Benthem case (Eur.   Court H.R., Benthem judgment of 23 October 1985, Series A No. 97) and the van Marle case (Eur.   Court H.R., van Marle and others judgment of 26 June 1986, Series A No. 101).   64.      The Government's reference to the possibility of lodging a municipal appeal with the Administrative Court is in his view misleading.   This special kind of appeal does not result in a reconsideration of the case.   So in fact the decision of the County Council cannot be appealed to a court in the meaning of Article 6 of the Convention.           B.   The Government   65.      In the Government's opinion it seems that the applicant started his practice in the autumn of 1984 without having checked the conditions for affiliation to the social insurance system or which provisions were to be applied. 66.      Since the applicant never received any decision regarding his application of 27 November 1984 he was never given an opportunity to make use of his right to appeal.   It seems that the applicant was not aware of his right to make appeals.   However, it would be useless for the applicant to bring his case to the courts and to do this after such a long time.   The law is clear and the transitional provisions do not give the applicant any chance of having his application for affiliation to the social system granted in the way he wished.   The courts which have to apply the new legislation and the transitional provisions thereto cannot possibly arrive at any other conclusion.   67.      According to the letter of 17 September 1984, the applicant was affiliated to the national insurance system only for a limited period, i.e. from 28 August to 31 December 1984.   During this period it could be said that the applicant was given a right to be affiliated to the system.   This decision could have been appealed to the Social Insurance Court but this was never done.   With respect to this period there seems to be no need to examine whether this right could be regarded as a civil right within the meaning of the Convention.   68.      The question which then arises is whether after the expiry of 1984 it could be said that the sets of procee