When travelling in foreign Countries in which one is not ensured at the national health service provider, it is necessary to know if and how to access local healthcare, in case of necessity. If the European Union has regulated this matter favouring access to healthcare in all its Member State, the situation in the rest of the world is much more fragmented. This is why certain Countries decided to stipulate bilateral treaties.
What bilateral treaties are
Differently from multilateral treaties, bilateral treaties are agreements stipulated exclusively between two state entities. These can be nations, but also international organizations. They can vary in terms of subject and complexity. Regardless the subject that they concern, bilateral treaties, as any other form of treaty, are usually binding in nature.
Bilateral treaties: healthcare
Healthcare falls within the different subject which bilateral treaties can concern. The aim of healthcare-related bilateral treaties is generally that of stimulating the movement of people across the two Countries/state entities, by granting, or more often facilitating, access to healthcare for citizens of the other contracting party.
Here is, for example, the introduction to the reciprocal agreement regarding healthcare between Australia and Italy, as ratified by the Law of June 7th, 1988, n. 266, promulgated by the Italian Presidency of the Republic:
“Aiming to facilitate the temporary stay of their respective citizens in the territory of the other Country, and in the desire to grant that such citizens are in the conditions to receive all healthcare foreseen by the national healthcare system of the host Country, the Italian Republic and Australia have agreed what follows:”
Bilateral healthcare treaties: Italy
Leaving aside broader aspects of social security, Italy has stipulated healthcare-related bilateral agreements with the following Countries:
- Cape Verde
- Vatican City and the Holy See
- Former Jugoslavia (Macedonia, Serbia, Montenegro, Bosnia-Herzegovina)
- Principality of Monaco
- San Marino
Bilateral healthcare treaties: structure
The healthcare-related bilateral treaties that Italy stipulated with those Countries usually fall within the wider scope of social security (pension calculation, contributions ecc.). In addition to that, they usually gather together more than one document. Besides the convention itself, in fact, there is always another text that defines the application of the convention, generally referred to as an administrative agreement. At times, there are even more documents, such as circulars, that further specifies the content of the convention.
Bilateral healthcare treaties: content
The treaties establish the conditions to be respected in order to have the right to access public healthcare, and to what extent. Specifically, they define which categories of people, types of temporary stays and sanitary risks they cover.
In this section, the treaty defines the characteristics that individuals shall possess in order to benefit from the treaty itself. The following example is taken from a document available on the Italian Ministry of Health website, which resumes the bilateral healthcare treaty signed with Australia:
“Covered categories: all Italian and Australian citizens that have the right to healthcare
Diplomatic missions personnel, and cohabiting member of their families”
Covered temporary stays
In this section, the treaty defines the characteristics that the temporary stay shall have, in order for the individual who carries it out to be covered by the treaty. The characteristics of the stay mainly vary according to its purpose and its duration. Here is an example taken from the same document as above:
“Covered situations: temporary stay for a period no longer than 6 months […]
Covered sanitary risks
The treaty here defines which medical situations falls within its scope. In other words, this is the range of medical treatments that the treaty grants access to, for the covered individuals.
Looking at the same treaty as above, here is our example:
“Covered risks: unforeseen diseases: necessary and urgent healthcare, provided in a direct form.”
In the more practical documentation that adds to the treaty, such as the administrave agreement or the circulars, it is possible to find also technical details, concerning forms to fill in and offices to visit, in order for those who match the criteria to actually benefit from the provisions of the treaty.
In case one does not meet the necessary criteria to be covered by the treaty, he/she could still benefit from an indirect assistance, as far as public healthcare is concerned. He/she must verify this according to the rules in place for Third Countries that have not signed any bilateral treaty with Italy.
Summing up, being aware of the existence of these treaties is very important in the organization of work travels abroad. When going to Countries outside the European Union, it is necessary to make a series of considerations. Firstly, one need to know if the Country where he/she is going has signed a bilateral healthcare treaty with Italy.
Secondly, if there is a bilateral agreement in force, he/she needs to comprehend if his/her situation matches the necessary criteria.
After having done that, it should be clear if and how it is possible to access public healthcare in the Country one is going, in case of necessity.
Finally, one last consideration to make, is the possibility to accompany this state-provided protection, with a private travel insurance. The two, in fact, are not alternatives, since the former grants access to public healthcare, while the latter allows access to the private one.