07. Department of State letter regarding U.S. practices relating to medical care for private American citizens living abroad (March 31, 2004)




December 26, 2006



Mr. Makoto Higashiyama

Second Secretary and Consul

Embassy of Japan

2520 Massachusetts Avenue, NW

Washington, DC 20008



Dear Mr. Higashiyama:


I am writing in response to your letter of March 13, 2003. The following is intended to address your request for information regarding United States practices relating to medical health care for private American citizens living abroad.


In response to your question about the “limit or capacity and the type of medical services that the doctors can provide to U.S. citizens living abroad,” the United States government does not provide overseas medical services for private American citizens, i.e. American citizens, who are not employees of the U.S. Government. Therefore, it is the responsibility of private American citizens to pay for all medical expenses incurred overseas.


The United States government does not assume any responsibility for medical expenses incurred by private U.S. citizens. In addition, U. S. embassy medical staff (Regional Medical Officer, nurse practitioners, etc) generally cannot provide medical services to non-official American citizens, although there are rare circumstances in which they may do so if no other care provider is available. Only under certain limited circumstances is a consular post authorized to approve payment of certain emergency medical expenditures, which would require the Department of State’s approval and would be subject to repayment by the person treated.


In addition, you mentioned several services that are provided for Japanese nationals living abroad. The U.S. government does not have any similar programs; rather, the United States government policy is directed toward the role of U.S. consular officers and the responsibilities of private American citizens in relation to medical and mental health care abroad.


The following is a brief synopsis of the United State Government’s policy in relation to medical and mental health care overseas.


Medical Care:

1. Prior to travel abroad, the U.S. Government suggests travelers contact the Center for Disease Control to determine if any preventive health requirements exist in the country of destination.

2. In providing travel information to the general public, the Bureau of Consular Affairs emphasizes that all American should check their health insurance policies to ensure that foreign medical emergencies, including medical evacuations, are covered. See our homepage at travel.state.gov.

3. Every U.S. embassy and consulate is required to maintain an up-to-date list of doctors, dentists, and hospital facilities from which an inquirer can seek medical assistance. The list also notes the areas of specialization and the level of English language ability. We are not permitted to recommend a specific doctor or hospital since post may then be held responsible by the patient if any problems arise.


Mental Health Care:

4. A consular officer cannot repatriate the mentally ill unless they wish to return to the United States. They also cannot force an America citizen to enter a hospital, submit to medical or psychiatric care or return to the United States for treatment. A consular officer cannot serve as the legal guardian of an American declared mentally incompetent in the host country.

5. When a formal declaration of incompetence or statement from an attending physician exists, American Citizens Services may arrange specific care and assistance for the citizen, including the arrangement of a special reception for the repatriated person in the United States. Responsibility vests with the host government to compel the individual to board a flight. The U.S. embassy or consulate will assist the family in identifying appropriate escorts.

6. In cases where there is no formal declaration of incompetence or statement from attending physician, responsibility for the individual rests with the host government until the U.S. citizen requests or accepts United States government help.



7. When U.S. citizens request any type of emergency loan, their ability to repay the loan, however, is not evaluated. When a citizen receives a loan, the U.S. passport is limited for return to the U.S. and the name is entered in the name check system. Before a loan is issued, contact is made with family, friends, employers, etc. for formal assistance.

8. EMDA II (Emergency Medical/Dietary Assistance): Subsistence for Non-Incarcerated Individuals. EMDA II Medical Emergency Assistance loans are appropriate when there are medical indications that such assistance is necessary to prevent, or attempt to prevent, the loss of life or limb, or when failure to provide service may cause permanent disability.

9. EMDA II loan assistance may cover psychiatric as well as physical conditions, but generally is authorized for the short-term treatment necessary to stabilize a patient sufficiently to permit the patient to return to the United States, with escort if necessary for long-term treatment.

10. The repatriation loan program includes costs of the escort and certain fees.



11. Consular officers are responsible for making sure that prisoners receive appropriate medical care Protection of prisoners from mistreatment is a top priority. An examination by an independent physician may also provide confirmation of the mistreatment by a third party.

12. In instances when a U.S. citizen prisoner suffers from a medical ailment while incarcerated, a U.S. consular officer will insist that the prisoner receive appropriate medical attention or if needed, be treated by a competent medical practitioner from outside the prison.

13. U.S. citizen prisoners are eligible for EMDA loans and provided with vitamin supplements where permissible.


Disposition of Remains:

14. There are no U.S. Government funds to cover preparation or disposition of remains of deceased American citizens. The next of kin is responsible for any costs associated with disposition of the remains.




Please find attached more detailed information related to my above comments. I hope that this information is help to you and appreciate your concerns.


If you have additional questions regarding this matter please contact our office at (202) 312-9750.









Edward Betancourt


Office of Policy Review and Interagency Liaison

Bureau of Consular Affairs




Attachment: as stated