AS TO THE ADMISSIBILITY OF

                         Application No. 11540/85
                         by Haim KARNI
                         against Sweden


        The European Commission of Human Rights sitting in private
on 8 March 1988, the following members being present:

              MM. C.A. NØRGAARD, President
                  J.A. FROWEIN
                  S. TRECHSEL
                  G. SPERDUTI
                  E. BUSUTTIL
                  G. JÖRUNDSSON
                  A.S. GÖZÜBÜYÜK
                  A. WEITZEL
                  J.-C. SOYER
                  H.G. SCHERMERS
                  H. DANELIUS
                  G. BATLINER
                  J. CAMPINOS
                  H. VANDENBERGHE
             Mrs.  G.H. THUNE
             Sir  Basil HALL
             MM.  F. MARTINEZ
                  C.L. ROZAKIS
             Mrs.  J. LIDDY

             Mr.  H.C. KRÜGER Secretary to the Commission

        Having regard to Article 25 of the Convention for the
Protection of Human Rights and Fundamental Freedoms;

        Having regard to the application introduced on 20 February
1985 by Haim Karni against Sweden and registered on 15 May 1985 under
file N° 11540/85;

        Having regard to:

  -     the first report provided for in Rule 40 of the Rules of
        Procedure of the Commission;

  -     the Commission's decision of 1 December 1986 to invite the
        Government to present written observations on the
        admissibility and merits of the application;

  -     the Government's observations dated 5 March 1987 and the
        applicant's reply dated 19 May 1987;

  -     the second report provided for in Rule 40 of the Rules of
        Procedure;

        Having deliberated;

        Decides as follows:

THE FACTS

        The facts of the case, as they appear from the parties'
submissions, may be summarised as follows.

        The applicant is a Swedish citizen, born in 1917 and resident
at Trelleborg.  He is a doctor of medicine.

        Particular facts of the case

        The applicant moved from Switzerland to Sweden in 1982.  After
having retired in January 1983, and as his income from his pension was
not sufficient, the applicant decided to open a private medical
practice at Trelleborg.

        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.  The owner of the
intended practice was Läkargruppen ABC-kliniken.  The applicant 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.

        Following the 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.  He furnished
it with an electrocardiograph and other special instruments.  In all,
he invested some 90.000 SEK.

        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
inter alia given of the conditions for being entered on the
Insurance Office's list after the new 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 do so immediately
and at the latest within 14 days.  It 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."

        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.

        In an application of 27 November 1984 to the Insurance
Office, the applicant requested to be allowed to continue as a doctor
affiliated with 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.

        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 of the new regulations for
affiliation after 1 January 1985 at the end of October 1984, 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.

        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 decison has followed 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.

        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.

        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."

        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.

        By letter of 14 February 1985 the applicant was informed that
on 13 February 1985 the Health and Social Delegation of the County
Council had rejected his application for an agreement on a medical
practice implying his affiliation to the social security system.

        The applicant closed down his practice immediately.

        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.

        Legislation relevant to the application

        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.

        Benefits for medical care are provided by the social insurance
system which also covers, for example, pensions and child allowances.
The system enables people with small economic resources and extensive
medical care needs to take advantage of health care services on the
same basis as others.  The legal basis for the system is the 1962
Social Insurance Act (lagen om allmän försäkring).

        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.

        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.

        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.

        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.

        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.

        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).

        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.

        The reform was proposed in a Government Bill to the Parliament
in April 1984 (Bill No. 1983/84:190).  A main reason for 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 also the activities of private
practitioners affiliated to the social insurance system were
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.

        The Bill was approved by the Parliament on 5 June 1984.
The proposed reform at that time had caused general debate in the
newspapers and other massmedia.  By approving the Bill the Parliament
authorised the Government to regulate the basis for remuneration for
medical treatment and also to issue directives as to what extent
private practitioners shall 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.

        The basis for remuneration to medical care principals laid
down by the Government appear in the 1984 Ordinance on Certain
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, as
amended (läkarvårdstaxan), below referred to as "the tariff".  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.

        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.

        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:

        "This legislation shall come into force on 1 January 1985.

        1.  A doctor who was included in the list kept by the social
        insurance offfice 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."

        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 as follows.

        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 notified later.

        The question of affiliation was 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 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 apply only 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.

        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 apply also to decisions not to
include doctors in the list for doctors affiliated to the system.


COMPLAINTS

        The applicant complains that his exclusion from the social
security system was inconsiderate and inhuman.  By refusing him
remuneration the authorities became responsible for the applicant's
financial troubles and misery.  The applicant submits that the measures
of the authorities preventing him from exercising his profession
involved a punishment without a legal process.

        The applicant invokes Article 1 of Protocol No. 1 and Article
6 para. 1 of the Convention.


PROCEEDINGS BEFORE THE COMMISSION

        The application was introduced on 20 February 1985 and
registered on 15 May 1985.

        On 1 December 1986 the Commission decided to communicate the
application to the Government and to invite them to submit written
observations on the admissibility and merits of the application.

        The Government's observations were received by letter dated
5 March 1987 and the applicant's observations were dated 19 May 1987.

        On 7 April 1987 the applicant was granted legal aid.


SUBMISSIONS OF THE PARTIES

A.      The Government

1.      The facts

        During autumn 1984 the Social Insurance Office at Lund had
notifications sent out to the doctors affiliated during the period
July 1983 to March 1984 (the period under point 2 of the transitional
provisions), but who had received preliminary notice that they did not
fulfil the minimum activity required.  The doctors who had been
carrying on their practice during the period, although not to a
sufficient extent under the transitional provisions of point 2, were
allowed to remain affiliated to the insurance system until 30 June
1985, in accordance with point 3 of the transitional provisions due to
a recommendation from the County Council.  Those who had been
affiliated to the system during this period, but who had not been
active received notification that they would be deleted from the list
of affiliated doctors as from 1 January 1985.

        The applicant did not belong to any of these categories, since
he was not at all affiliated during the period in question.  The
applicant was affiliated only for a limited period of time during a
later period.  Consequently, he did not receive any corresponding
notification or decision.

        The Government point out that the temporary permission from
the County Council granted in the letter of 20 December 1984 did not
entail an affiliation of the applicant to the insurance system.  The
County Council may only recommend or disapprove of an application for
affiliation to the system.  The decision only meant that the applicant
was remunerated over a certain period in accordance with corresponding
principles.  It was not based on the transitional provisions.  The
remuneration received by the applicant for 1985 amounted to 3,587 SEK
for 14 personal or telephone consultations.  The administration of the
remuneration from the County Council was effected by the Insurance
Office.

        It could be argued that the Insurance Office ought to have let
its preliminary notice of 15 October 1984 be followed by some kind of
message to the applicant about the final position taken by the Social
Insurance Office.  The applicant could also have been informed of the
position taken by the Insurance Office in relation to his
application to the Office of 27 November 1984 after the County Council
had decided not to recommend his affiliation.  However, any such
notification would have meant that he could not be affiliated to the
system after 31 December 1984.  If the applicant had been informed, he
could have made use of the right to appeal to the Regional Social
Insurance Court, a right to which he was entitled.  However, it should
be noted that such an appeal would have meant no alteration of the
Insurance Office's decision, since the applicant did not fulfil any of
the requirements prescribed in the transitional provisions for being
affiliated to the national insurance system after the expiry of 1984.
His application was depending on recommendations from the County
Council, and he had not received any such recommendation.

        To sum up, the first application for affiliation submitted to
the Insurance Office was granted with a certain time limit which
expired at the end of 1984.  The applicant was given no assurances or
information indicating that the time limit was to be extended.  This
decision was in conformity with the new transitional provisions of the
tariff.  By that decision the question was finally decided upon, and
it was not really necessary to notify the applicant by the preliminary
notice of 15 October 1984 as was done.  No appeal has been brought
against that decision.

        The second application of 27 November 1984 has not been
examined and decided upon by the Social Insurance Office.  However,
since the County Council had not recommended an affiliation, there was
no legal possibility to grant such an application.

        Even if the transitional provisions would apply, the applicant
did not fulfil the requirements prescribed therein.

        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.

2.      The admissibility

        Appeals can be made against decisions of the social insurance
offices to a court.  The applicant has filed no appeal against the
first decision in September 1984 which limited his affiliation to the
expiry of 1984.  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.

        In these circumstances the Government leave it to the
Commission to decide whether the domestic remedies have been exhausted
in this case.

        The Government maintain with reference to what is said below
that the application should be declared inadmissible, as far as
Article 6 is concerned, for being manifestly ill-founded and, as far as
Article 1 of Protocol No. 1 is concerned, as being incompatible
ratione materiae with the Convention for falling outside the scope of
this provision or as being manifestly ill-founded.

3.      The merits

        3.1. Article 6 of the Convention

        The applicant complains that the measures taken by the
authorities, preventing him from exercising his profession, involved a
punishment without a legal process.

        The Government find no sort of punishment involved in not
affiliating the applicant to the social insurance system after the
expiry of 1984, and refer to the legislation.  A procedure satisfying
the conditions of Article 6 exists according to the Swedish
legislation.

        Thus, decisions concerning applications for affiliation to the
social insurance system can be brought before the Regional Social
Insurance Courts and further before the Supreme Social Insurance
Court.  These courts are independent and impartial tribunals,
established by law, and competent to alter or revoke decisions of the
Social Insurance Offices which they find not to be in accordance with
law or for some other reason incorrect.  In view of this the
Government do not find it necessary to take any position as to the
question whether the examination according to this procedure involves
a determination of civil rights.

        A remuneration claim for economic losses can always be examined
by the general courts.

        For these reasons the Government maintain that there has been
no violation of Article 6 and that the applicant's complaint in this
regard is manifestly ill-founded.

        3.2. Article 1 of Protocol No. 1 to the Convention

        The primary aim of the social insurance system is to secure
everyone a satisfactory medical care at a reasonable price or free of
charge.  Since most private practitioners are affiliated to the system
and thus depending on it to obtain a sufficient income, changes in the
system can affect their financial situation.  However, the right to
work as a physician is not regulated in the social insurance system.
Nothing prevents a physician from practising his occupation without
being affiliated to the system, and the reform is not aimed at
preventing any doctor from exercising his profession.  In the Bill
(p. 12) it is expressly stated that the reform does not entail any change
in the right of private practitioners to practise their profession.

        A physician not affiliated to the system must of course charge
a fee from his patients which covers all his costs and gives him an
income which is sufficient.  This means that it becomes more expensive
for the patient to visit a physician who is not affiliated to the
social insurance system.  However, there are some private practitioners
exercising their occupation without being affiliated to the system,
mainly specialists.

        In order to establish whether Article 1 of Protocol No. 1 is
applicable to the applicant's situation the meaning of the expression
possessions must be examined, and whether there has been some kind of
interference with the applicant's right in this regard.

        Until the new legislation entered into force the applicant's
income from the social insurance system amounted to a sum less than
9,000 SEK.  That income has not been affected by the new legislation.

        The new legislation affects only the income from fees which
the applicant expected to receive as being affiliated to the social
insurance system after the expiry of 1984.  In other cases (for
instance No. 8410/78, Dec. 13.12.79, D.R. 18 p. 216) the Commission
has stated that a claim for fees can only be considered a possession
within the meaning of Article 1 of Protocol No. 1 when such a claim
has come into existence in a particular matter on the ground of
services rendered on the basis of existing regulations on fees.  A
mere expectation that existing regulations on fees will not be changed
in the future cannot be considered as a property right.

        The case referred to concerned a notary's claim for fees
regulated in the legislation of the State concerned.  The Government
are of the opinion that the same argument would apply to the
applicant's case.  The new legislation had no effect on services
rendered by the applicant before 1 January 1985 when it entered into
force.  The fact that the applicant's expectation to be affiliated to
the social insurance system also after the expiry of 1984, was not
fulfilled does not imply an interference with the peaceful enjoyment
of his possessions.  This conclusion may be drawn since the provision
in question protects only existing property and not the right to acquire
property.

        In the case of van Marle and others (Eur.  Court H.R., van
Marle and others judgment of 26 June 1986, Series A no. 101) the Court
as well as the Commission found that Article 1 of Protocol No. 1 was
applicable in principle.  In that case (p. 13, para. 41) the Court
emphasised that "by dint of their own work, the applicants had built
up a clientèle" which according to the Court constituted an asset and
thus a possession within the meaning of Article 1.  The measures taken
by the State in that case had, the Court found, radically affected the
conditions of their professional activities and the scope of those
activities was reduced.  Their income fell as did the value of their
clientèle.

        Section 2 of the transitional provisions in the present case
aims precisely at protecting those private practitioners who had built
up a clientèle before the reform entered into force.  That category of
practitioners could remain affiliated to the system, provided their
occupation during a preceding period had a certain volume.

        In the Government's opinion the position taken by the Court in
the van Marle case can apply only if the clientèle built up has
reached a certain level and given the person concerned a certain level
of income on a fairly regular basis.  A clientèle consisting only of
a few persons or a clientèle from which only limited payments are
received must not necessarily constitute a possession within the
meaning of Article 1.  In the case of van Marle and others the
applicants had carried out their profession for several years during
which they had built up their clientèle giving them an income of which
they must have been dependent for their support when their
applications for registration as certified accountants were rejected.
The applicant in the case now before the Commission had carried out
his practice for about two months, during which he received less than
9,000 SEK from the Insurance Office.  That income was based on fees
for a total of 35 consultations.  It is unknown to the Government
whether these patients had visited him on a regular basis and intended
to do so in the future, or whether they had visited him only occasionally.
The facts submitted by the applicant are not sufficient to draw any
conclusions in this regard.

        With reference to the above the Government maintain that the
applicant's complaint falls outside the scope of Article 1 of Protocol
No. 1.

        If the Commission would be of the opinion that the refusal to
affiliate the applicant to the social insurance system, with the
consequence that his patients would have to pay him the whole fee
charged and that the number of patients would therefore decrease,
would imply a deprivation of the applicant's possessions, it must be
examined whether this deprivation has been made in the public interest
and subject to conditions provided for by law and by general
principles of international law.  The Government submit that this is
the case.

        The conditions for affiliation of private practitioners to
the social insurance system are provided by law.  The conditions for
private practitioners, affiliated to the system when the new legislation
entered into force, to remain affiliated have been regulated in detail
in the transitional provisions to the new legislation.

        The most important aims of the reform have been described.
From this it appears that the reform was made in the public interest.

        It remains to examine whether there is a fair balance between
the measures taken by the authorities and the rights of the
individual.

        The legislation provides that private practitioners affiliated
to the system prior to the reform, and who had built up a practice
which gave them an income of a certain level or made large investments
in a practice before a certain date, can remain affiliated to the
social insurance system.  Among those who were refused affiliation
after the reform were those who had started their practice shortly
before the legislation entered into force, like the applicant, or
those who applied for affiliation after that date and could not get a
recommendation from the medical care principal when such a
recommendation was required.  These practitioners had and still have
the possibility to be affiliated to the system, provided that they
open up practice in a district where a recommendation of the medical
care principal is not required.  This possibility is still open to the
applicant.  A refusal to affiliate a doctor only applies for those
counties in which the medical care principals are entitled to and
actually do refuse to give a recommendation for affiliation.

        Thus, the reform has only entailed a limitation of the right
of a private practitioner to be affiliated to the system.  He can no
longer be affiliated at any place where he wants to open his practice.
In view of the purpose of the reform such an interference in the
individual's rights must be regarded as justified.

        Regarding the applicant's case the Government emphasise the
following.  Already when he started his practice, the applicant had
been informed that he had been affiliated to the social insurance
system only until the end of 1984, all in accordance with the
applicable provisions of the tariff.  He was given no information
indicating that he could count on affiliation after that day; as
already mentioned this was not possible according to the new
legislation.  The applicant must have been fully aware of this time
limit and he had no reason to believe that he would have his
affiliation renewed.  It seems as if the applicant has started his
practice without having checked the conditions for being affiliated to
the system according to the new legislation.  Even if the applicant was
living abroad, the Government find it remarkable that the applicant in
the beginning of the autumn of 1984 had no idea of the reform.  The
decision had already been taken and had caused a lively debate in the
mass media and among Swedish doctors.  In view of this and the limited
income the applicant had received from his practice, the Government
maintain, should the Commission arrive at the conclusion that an
interference with possessions has taken place in the applicant's case,
that this interference was justified.

        For these reasons the Government contest the applicant's
allegation that there has been a violation of Article 1 of Protocol
No. 1.  The complaint is also in this regard manifestly ill-founded.

        4. Conclusions

        The Government conclude:

        - concerning the admissibility that the application should
be declared inadmissible, if not for failure to exhaust domestic
remedies, for being manifestly ill-founded, alternatively, as far as
Article 1 of Protocol No. 1 is concerned, for being incompatible
ratione materiae with the provisions of the Convention, and

        - concerning the merits that there has been no violation of
the Convention.


        B. The applicant

        1. The facts

        The applicant had worked as a physician in Switzerland.  He
returned to Sweden and acquired a small house outside Trelleborg.  His
daughter stayed in Switzerland for her schooling.  The applicant
visited occasionally Switzerland in order to keep contact with his
daughter.

        The applicant has studied in Sweden and he is a Swedish doctor
of medicine.  He was also a senior lecturer in internal medicine at
the Karolinska Institute in Stockholm.  He is a specialist in internal
medicine.

        Because of his long stay abroad his pension was very small
since January 1983.  Being still vital he wished to continue his work
as a doctor.  In order to earn his living and to be able to support his
daughter he decided to start a small private practice of internal
medicine at Trelleborg.  His aim was to work about 75% of full time.

        Trelleborg is a small industrial town with a population of
about 25,000 inhabitants.  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
any.  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 make an announcement to the
Insurance Office and he was affiliated with no condition other than
the necessity to apply the obligatory tariff.

        During 1984, not having got any temporary post, the applicant
spent a part of the year with his daughter.  He announced 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.  During September - October 1984
he acquired apparatus and furniture for his planned 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.  The applicant became anxious.  As a
result of the rules of that time he considered the affiliation as a
pure formality.  In order to have his affiliation secured after the
new year 1985 he took contact with persons in the county
administration who had the competence to pass a resolution and wrote
petitions to the Regional 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.

        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.

     2. The new legislation

        Practically all medical care was and is still at the expense
of the public administration.  Swedish citizens consider this as
natural because of the high taxes.  They do not want to pay much for
the medical care irrespective of whether they consult a private doctor
or one engaged in the public health care.  It is also considered as a
natural right of the citizen to choose his doctor.

        During the early 1980's the volume of the private care
increased considerably.  The main aim of the 1985 reform was to limit the
activity of the private practitioners and to favour the public care.
The purpose was to socialise the medical care.  The reform was much
discussed in the media.  However, the applicant was not informed about
the Government Bill in connection with the start of his practice.  As
previously mentioned the applicant stayed part of the time in
Switzerland with his daughter.  With the reform the authorities aimed
at limiting the competition of the private doctors in two ways.
First, the rules regarding State subsidies to the County Council were
changed.  A lump sum had to cover all medical care, public as well as
private, instead of paying for the number of consultations.  Secondly,
the free regulations for the affiliation to the social insurance
system were restricted since a recommendation from the County Council
was required.

        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.  As
a result of the payment of a lump sum the financial situation of the
County Council has been impaired.  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.

        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 refused
recommendation cannot be appealed to a court for reconsideration.
There is no right to complain.  The applicant has sent applications to
the Regional Insurance Office and to the County Council.

           Another possibility was to request that the transitional
provisions would apply for a continued affiliation.  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 Regional 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 Regional 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.  This is very grave, because his case could not be examined.
Since no decision was given there was no decision to appeal against.
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.  He has also sent a petition to
the Minister of Social Affairs and to each leader of the political
parties.  Against this background it is completely exceptional that
his case was not even dealt with by the authorities.  The obstruction
the applicant was exposed to is so astounding that it can only be
explained by a conscious aversion against his person.

        From the above it can be concluded that the views of the
Government concerning the possibility to appeal and have examined the
case as well as to complain to a court are misleading and partly
wrong.

        The applicant had announced his aim to start a private
practice when he was affiliated.  At that time he was not informed of
the new regulations.  However, these were well known to the authorities
at the Insurance Office.  Nevertheless, they failed to inform the
applicant about the new rules.  It is obvious that if he had been
correctly informed he would not have made those investments and
efforts for the practice activity for only a couple of months in 1984.

        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 Regional 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 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.  Despite his efforts through letters
and personal contacts, he has not been informed of the content of the
transitional provisions.

        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 wrong.
Certain regulations allow a possibility for continuation of the
affiliation in the case of the applicant.  In any case it is not
possible to know the outcome if his applications had been dealt with
by the National Social Insurance Board or reconsidered by the Court.

        The applicant has requested remuneration for the financial
loss the treatment has caused him.  It is correct that the ordinary
courts may examine a remuneration claim against the State.  In the
case of the applicant such a possibility does not exist, since there
is no decision as a basis for the remuneration claim.  The applicant
lacks the possibility to have his remuneration claim examined.

     3. The admissibility

        Regarding the question of exhaustion of domestic remedies it
is necessary to distinguish between the examination under the
transitional provisions and under the new legislation.  As to the
transitional provisions the applicant never received any final
decision and no notice of appeal which is obligatory.  In spite
of all efforts his case was never transferred to the National Social
Insurance Board.  By neglecting their responsibility the authorities
deprived the applicant of his right to have his case examined.
This is remarkable.

        Regarding the new legislation the decision of the County
Council cannot be appealed to a court.  Under the new rules such a
case cannot be examined by a court.  The County Council is not a court
but a political organ.

        Consequently, the application is well-founded.  Since the
affiliation was important for his practice and his possibility to earn
a living this is a question of his "civil rights".  Consequently the
applicant has been prevented from working in his profession.  He
maintains that Article 6 of the Convention and Article 1 of Protocol
No. 1 have been violated.

        The applicant invokes in support of his application the Benthem
case (Eur.  Court H.R., Benthem judgment of 23 October 1985, Series A
no. 97) and the van Marle case (quoted above).


THE LAW

1.      The applicant alleges a violation of Article 1 of Protocol
No. 1 (P1-1) to the Convention in that he was excluded from affiliation to
the social security system, and no remuneration was paid for his
having to close down his medical practice.  The Government submit that
the complaint is incompatible ratione materiae with the provisions of
the Convention, or manifestly ill-founded.

        Article 1 of Protocol No. 1 (P1-1) reads:

"Every natural or legal person is entitled to the peaceful
enjoyment of his possessions.  No one shall be deprived of his
possessions except in the public interest and subject to the
conditions provided for by law and by the general principles of
international law.

The preceding provisions shall not, however, in any way
impair the right of a State to enforce such laws as it deems
necessary to control the use of property in accordance with the
general interest or to secure the payment of taxes or other
contributions or penalities."

        The Commission considers that the vested interests in the
applicant's medical practice may be regarded as "possessions" within
the meaning of Article 1 of Protocol No. 1 (P1-1).  The question of
affiliation to the social insurance system was a decisive element for
the running of the practice.  However, the affiliation which had been
granted to the applicant was limited until the end of 1984.  The first
issue which arises is whether the fact that the applicant's
affiliation was not prolonged after 1984 can be regarded as an
interference with his rights under Article 1 of Protocol No. 1 (P1-1).

        However, the Commission considers that it can leave open this
question because, even if it is assumed that the facts of the case
constituted an interference with the applicant's rights under Article 1
of Protocol No. 1 (P1-1), any such interference would be justified under
that provision for the following reasons.

        The interference cannot be regarded as a "deprivation" of
property.  The provisions of the Health and Medical Services Act and
the Tariff lay down, inter alia, regulations as to the provision of
medical services in general and the affiliation of private
practitioners to the social security system.  The refusal of an
affiliation does not prevent the doctor from practising privately.  It
only means that the costs of the consultations given by the doctor
will not be covered by the social security system, the effect being
that the patients will have to pay the full fee for the consultations.
Although the question of affiliation to the social security system may
be decisive for the possibility of running a profitable practice, any
interference resulting from a refused affiliation must, in the
Commission's view, be characterised as a "control (of) the use of
property" and not as a "deprivation" of property.  Accordingly, it is
the second paragraph of Article 1 of Protocol No. 1 (P1-1) which is
material (cf. mutatis mutandis Comm.  Report, 10.11.87, Tre Traktörer
Aktiebolag v.  Sweden, paras. 111-114).

        Under the second paragraph of Article 1 (P1-1-2) the
Commission must examine whether the refusal to prolong the applicant's
affiliation to the social security system was "necessary to control
the use of property in accordance with the general interest".  The
task of the Commission in this context is to examine the lawfulness,
purpose and proportionality of the measures taken by the domestic
authorities (cf. e.g.  No. 10378/83, Dec. 7.12.83, D.R. 35 p. 235).
The question of proportionality requires a determination as to whether
there was a reasonable relationship between the means employed and the
aim sought to be realised or, in other words, whether a fair balance
has been struck between the demands of the general interest and the
interest of the individual.  In determining whether a fair balance
exists, the State enjoys a wide margin of appreciation with regard
both to choosing means of enforcement and to ascertaining whether the
consequences of enforcement are justified in the general interest for
the purpose of achieving the object of the measure in question (see
Eur.  Court H.R., Agosi judgment of 24 October 1986, Series A no. 108,
p. 18, para. 52).

        The new legislation which is at issue was adopted by
Parliament on 5 June 1984 following a Government Bill presented in
April the same year.  The provisions concerning affiliation to the
social insurance system after 1984 were contained in the amended
medical care tariff which was issued on 16 October 1984.  The
provisions correspond to what was proposed in the above-mentioned Bill
(pp. 32-33).  Moreover, a transitional provision to the tariff, which
had entered into force on 1 July 1984, provided that a decision to
enter a private practitioner on the Social Insurance Office's list
after 30 June 1984 was to apply only to the end of 1984.

        Point 3 of the transitional provisions provided that a doctor,
in the applicant's situation, could be entered on the Social Insurance
Office's list after the end of 1984 only if he had been recommended by
the medical care prinicpal, i.e. the County Council.  The applicant
has not been so recommended.

        The Commission is satisfied that the non-affiliation of the
applicant was lawful under Swedish law and that it was in the "general
interest" as part of a more comprehensive reform of the health and
medical services.

        As regards the proportionality, the Commission recalls that
the original affiliation of the applicant was limited in time, and
under the applicable law there was no guarantee of a prolongation of
the affiliation after 1984.  Even if the applicant was not actually
informed of the situation, he could have been so if he had taken
appropriate advice before setting up his practice.  The Commission
considers that, in these circumstances, and having regard to the wide
margin of appreciation enjoyed by States in this regard, the
non-affiliation of the applicant under the new legislation was not
disproportionate to the aims pursued.

        Accordingly, any interference, by the non-affiliation, with
the applicant's right to the peaceful enjoyment of his possessions was
justified under the terms of the second paragraph of  1 of
Protocol No. 1 (P1-1).

        It follows that, in this respect, the application is manifestly
ill-founded within the meaning of Article 27 para. 2 (Art. 27-2) of the
Convention.

2.      The applicant alleges a violation of Article 6 para. 1 (Art.
6-1) of the Convention, in that he was refused continued affiliation
to the social security system without legal process.  The Government
submit that this complaint is manifestly ill-founded.

        Article 6 para. 1 (Art. 6-1) first sentence reads:

"In the determination of his civil rights and obligations or
of any criminal charge against him, everyone is entitled to
a fair and public hearing within a reasonable time by an
independent and impartial tribunal established by law."

        The Commission considers that there are three different sets
of proceedings which must be taken into account in the examination of
the above complaint under Article 6 (Art. 6) of the Convention:

    -   the Social Insurance Office's preliminary notice of 15 October
        1984 which was not, contrary to the text of the notice,
        followed by a final decision on the question of the
        applicant's affiliation to the social security system after
        1984;

    -   the applicant's request to the Social Insurance Office of
        27 November 1984 for affiliation to the social security system
        after 1984;

    -   the applicant's request to the County Council of 27 November
        1984 for affiliation to the social security system ater 1984.

        The first issue which arises is whether in one or more of
these proceedings the applicant was seeking a determination of his
"civil rights" within the meaning of Article 6 para. 1 (Art. 6-1) of
the Convention.  If this were so, it would then have to be decided
whether the applicant had the possibility of bringing any dispute
relating to his "civil rights" before a tribunal within the meaning of
Article 6 para. 1 (Art. 6-1).

        The Commission has made a preliminary examination of these
issues in the light of the parties' submissions.  It considers that
these issues raise questions of fact and law which are of such an
important and complex nature that their determination requires an
examination of the merits.  This complaint is therefore admissible,
no other ground for declaring it inadmissible having been established.

        For these reasons, the Commission


        DECLARES INADMISSIBLE the complaint of a violation of
        the right to property (Article 1 of Protocol No. 1 (P1-1) to
        the Convention);


        DECLARES ADMISSIBLE, without pre-judging the merits, the
        remainder of the application.


        Secretary to the Commission      President of the Commission





             (H. C. KRUGER)                  (C. A. NØRGAARD)