On July 12, 2001, the Court of Justice of the European Communities (ECJ) announced its long-awaited decision in Vanbraekel v. Alliance Nationale des Mutualites Chretiennes,' offering its interpretation of Council Regulation 1408/71 article 22, and E.C. Treaty article 49, on the freedom to provide services. The dispute in Vanbraekel arose when a Belgian health insurance fund, Alliance Nationale des Mutualites Chretiennes (ANMC), refused to cover the cost of Jeanne Descamps' orthopedic surgery in France. Descamps sued for payment on the ground of a violation of E.C. law. The Court concluded that Descamps was entitled to a reimbursement calculated according to Belgian law, which was closer to the actual cost of her treatment. This ruling is significant because it further integrates the two parallel regimes applicable to cross-border medical care: the social security provisions of Regulation 1408/71 and the provisions on the freedom to provide services in E.C. Treaty article 49. Given the key role that services have in today's economy, European Community jurisprudence in this area has moved forward significantly in the last decade, and has begun to affect the current structure of Member State social security systems. Because Member States used Regulation 1408/71's restrictive language to keep limits on cross-border medical care, the ECJ has recently started to use article 49 of the E.C. Treaty to expand the benefits established in the Regulation. This case reflects a steady trend in the case law of the ECJ in favor of further enhancing the ability of Europeans to move freely and benefit from deeper health integration within the European Union. This trend is another example of the ECJ's central role in the European integration process: the ECJ limits Member State competence in favor of the European Community in a policy realm in which the founding treaties have conferred almost no powers to Community institutions.
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