The Holy See's Healthcare System: Organisation, Health Assistance Fund and Care in Rome

The law on the government of the Vatican City State of 25 November 2018 entrusts to the Governorate’s Directorate of Health and Hygiene people’s health, the protection of public health and hygiene, and health and safety at work. The Vatican pharmacy, attached to it with technical and administrative autonomy, supplies and distributes pharmaceutical and para-pharmaceutical products, and makes and sells its own remedies and magistral preparations. The Governorate publishes a general number, +39 06 6982, with no extension specific to this directorate.

The FAS (Fondo Assistenza Sanitaria), based at the Palazzo del Belvedere, via della Posta 1, provides direct and indirect assistance. Its website presents a service charter, a single desk, an online desk, pages on its collaborations and opening hours, as well as its statutes and regulations. Direct assistance falls under the arrangement where the fund pays the provider; indirect assistance, under reimbursement to the beneficiary, according to the terms of its regulations.

The Governorate and France Diplomatie pages read publish neither the list of care facilities located on the territory, nor the opening hours of an emergency service, nor the conditions of access for a person not attached to the institution, nor fees. The State has nearly 900 residents, of whom about 460 citizens living within the walls: the population is small and largely attached to the institution. For care not covered on site, the territory being enclaved in Rome, the facilities of the city and the Italian health service are part of the usual pathway, though the sources read describe no particular agreement.

This is why the first step for a French national approached for a position is to ask the employer for the FAS service charter, the list of contracted providers, the hospitalisation and evacuation arrangements, and how care is covered in Rome. See the Holy See page.

The CLEISS (the French centre for international social security liaison) lists no social security agreement between France and the Holy See, and does not mention the Holy See in its Italy page, which indicates only that Italy applies the European coordination regulations. As the Holy See is not a member state of the European Union, these regulations do not apply to its system: neither the European card nor S1 forms give access to the FAS. The principle recalled by the European Commission for member states, under which cover depends on economic situation and place of residence and not on nationality, concerns life in Rome.

A French national attached to a Vatican employer therefore depends first on that employer’s rules, in particular the FAS, then on Italian rules for care received in Rome depending on their residence. The arrangements by status are detailed in healthcare reimbursement at the Holy See, and those of the Italian system in Italy’s healthcare system.

The pages read publish no emergency numbers specific to Vatican City nor a designated general practitioner: the Governorate answers on +39 06 6982 and the FAS provides opening hours and contacts on its website. For a stay in Italy, France Diplomatie indicates that the numbers of the night, weekend and public holiday medical on-call service appear every day in the local press and can be provided by the police. The French embassy in Italy (Piazza Farnese 67, Rome, +39 06 68 60 11) and the French consulate general in Rome (Via Giulia 252) inform nationals. The Italian Civil Protection runs a contact centre on 800 840 840.

• Save before arrival the insurer’s assistance number and that of the employer’s social service.
• Carry the insurance certificate, the list of treatments with their international nonproprietary names and the FAS card, if one is issued.
• Ask the employer for the contact details of the doctor or service that provides the first consultation.

France Diplomatie recommends, for Italy, checking that the vaccinations of the French schedule are up to date, notably diphtheria, tetanus, poliomyelitis, whooping cough and measles, and taking only medicines in their original packaging with a prescription stating international nonproprietary names; it advises against buying medicines in the street. The Vatican pharmacy supplies the territory with pharmaceutical products; its sales conditions should be confirmed with the Governorate.

• Mosquitoes: West Nile fever is possible locally, notably in northern Italy; protection against bites is advised.
• Ticks: check your skin after a walk in a rural area.
• Water: tap water and public fountains are generally drinkable, except in some isolated areas.
• Heat: summer precautions, in particular for older people and young children.

For care that the territory does not provide, the city of Rome provides the usual pathway: general practitioner, specialists, laboratories and hospitals of the Italian health service. A French national who lives in Rome registers with the competent Italian body depending on their situation (employee, self-employed, retiree with the S1 form), then receives cover under local rules, with financial contributions called tickets; the page Italy’s healthcare system details how it works. While awaiting registration, the European Health Insurance Card covers care that becomes necessary during a temporary stay, to be requested from your fund at least fifteen days before departure, with a provisional certificate valid three months if departure is closer (Assurance Maladie, the French national health insurance).

An employee of a Vatican entity who is also a beneficiary of the FAS asks their employer how the two schemes fit together: which providers accept direct assistance, which costs are reimbursed by the indirect route, which deadlines apply and which documents to provide. Keep all invoices, because indirect assistance rests on a reimbursement request, and keep a copy of the fund’s regulations.

For a pregnancy, maternity or paediatric care, the first question concerns the applicable scheme: FAS regulations for its beneficiaries, or the Italian scheme for a Rome resident. International insurance contracts generally apply a waiting period to maternity, and the CFE (Caisse des Français de l’étranger, the French social security fund for nationals abroad) requires conception after joining. For children, the French vaccination schedule must be up to date, notably diphtheria, tetanus, poliomyelitis, whooping cough and measles (France Diplomatie). People with a chronic illness carry their prescriptions in international nonproprietary names and a medical file, and check how their treatment is dispensed and reimbursed before settling in.

France Diplomatie advises travellers to request the European Health Insurance Card from their fund at least fifteen days before departure and to have an assistance contract covering all medical costs, surgery, hospitalisation and repatriation, failing which care may be refused, even in an emergency; the embassy covers these costs in no case. For a resident attached to the Holy See, the most common combination pairs the employer’s cover, supplementary cover for care in Rome, an evacuation contract and, if needed, the CFE to keep a foothold in the French scheme.

See CFE or private insurance, expat health insurance and repatriation and assistance. Expavy helps you compare these options via the online assessment. See also living at the Holy See.