ECJ C-573/20 (Casa di Cura Città di Parma) – Questions – Deduction of input VAT by healthcare professionals

On 30/10/2020 the Commissione tributaria provinciale di Parma lodged VAT questions about the non-deductibility of VAT for subjects who operate in the health sector and carry out only exempt operations: it is clear that the health care worker who has not been able to deduct the VAT on purchases relating to his business ends up “downloading” this higher cost on the patient or in any case on those who benefit from these services, increasing the final cost of its performance.

Questions

[Is there] a conflict between national legislation and [EU] law and, in particular, between Article 19(5) and Article 19bis of Presidential Decree 633/72 (the Italian national legislation which governs the mechanism for calculating the non-deductible proportion of VAT), on the one hand, and Article 17(2)(a) of Directive [77/388/EC] of 17 May 1977, ¹ on the other?
[Is] the difference in treatment between Italian healthcare professionals, deemed to be ‘final consumers’ (liable to VAT) and healthcare professionals of other Member States of the European Union (such as Belgium, Bulgaria, Germany, Greece, France and Spain), deemed to be ‘intermediary operators’ (with the right to deduct VAT), [compatible with EU law]?
[Is there] unequal treatment as regards the rules on VAT between the various Member States of the European Union, given that unlike the situation in Italy where healthcare services are exempt from VAT, in other Member States of the European Union (Belgium, Bulgaria, Germany, Greece, France and Spain) the same healthcare services are subject to VAT, with the result that different rates of VAT and, therefore, a different right to deduct are applied to the same healthcare services?
[Is] the inequality between Italian healthcare professionals (including Casa di Cura Città di Parma) and the professionals of other Member States of the European Union (Belgium, Bulgaria, Germany, Greece, France and Spain) – in that the healthcare services provided by the latter are subject to value added tax and, as a result, unlike Italian healthcare professionals, they have the corresponding right to deduct and/or to reimbursement of VAT paid on purchases – [compatible with EU law]?’
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