Certainly health care is one of the key points that make Andorra an extraordinary country. This competent and efficient system has earned Andorra to be considered the best health in the world or the best in the world in different and varied rankings.
For example, the Lancet medicine magazine published in 2017 a report prepared by the Institute of Evaluation and Metrics at the University of Washington (USA). This report collected data from 195 countries between 1990 and 2015, conducting an evaluation every five years. . The health system of the Principality led the world ranking in all these evaluations, from the 85 points obtained in 1990 to the 95 of 2015, in which Iceland obtained 94 points, Switzerland (92 points), Spain obtained 90 points and France, which is fifteenth, with 88 points. But how does it work?
Health and social security in Andorra are based on a simplified and centralized system very efficient. In this case, a single agency regulates all social devices and medical coverage of the country: the CASS, the Andorran Social Security Fund (China Andorran de Seguretat Social).
As the former Health Minister Charles Álvarez-Marfany (current Ambassador of Andorra to the Vatican) summed up very well, the effectiveness of health in Andorra is based on three fundamental principles:
- Co-responsibility, because citizens directly pay a part of the treatments.
- Solidarity, because people who cannot cope with the co-payment are not excluded from the system.
- The free choice of doctor. Patients can choose which doctor will treat them.
A quite remarkable advantage is that it has a greater subsidy for dental treatments than neighboring countries.
They also contribute to the very good functioning of the system a high income per capital, the low mass of the country, and the large participation of workers who contribute to social security. That is, the good shape of the Andorran economy.
On the other hand, due to the small number of inhabitants of Andorra there are health specialties to which there is no access in the country itself. For this reason, CASS has established agreements with social security services in Spain and France for which specialties not available in Andorra can be made there (later in detail).
How many does health care cost in Andorra?
Starting with the principle of co-responsibility, in Andorra, health works by co-payment. Health coverage covers a part of the total cost, not all costs. The medical expenses covered by CASS are basically divided into three according to the medical service and the amount subsidized.
- Those patients who go to outpatients or health centers, to inquiries or visits of specialists, CASS covers at least the 75% of the cost.
- I case of hospitalization health coverage covers the 90% of expenses, also allowing payment of only the percentage not covered by CASS.
- Expenses caused by occupational accidents or occupational diseases and births are 100% covered.
- Finally, if your health expenses in Andorra are made before services not affiliated with Andorran social security, reimbursements can be up to 33% of the total.
However, cASS finances 100% of the treatment to those people who demonstrate that they cannot cope with the debt, such as people without resources or in a situation of social exclusion, thus linking health with the principle of solidarity mentioned above, since no one is off the hook because of their bad economic situation.
It should be noted that first of all the user or patient is responsible for all costs. When he is treated by a doctor, he receives a sealed form and CASS receipts. The recovery of the percentage of the corresponding expenses is carried out through a local CASS office with all the documentation. Although currently there is also a computer system that does this process automatically and reimburse the amount by bank transfer if everything is correct after a few days.
A solution for those who do not want to carry with the punctual payments that the co payment supposes is hire a complementary insurance of expenses, which covers precisely the percentage of costs that CASS does not subsidize.
A competitive system
The third fundamental principle of health in Andorra is freedom. Freedom so much to treat (freedom for CHOOSING to doctor, of demand) as to exercise (freedom for BEING a doctor, of offer).
And it is that this health system can adhere as agreed all professionals that offer services subsidized by CASS by a simple process and with certain conditions, resulting in health in a a kind of check system with a co-payment in which the State is obliged to finance health services, but it is the user who chooses who, where and how to obtain them.
Thus, a patient can go to the Nora Senora de Meritxell Hospital and will be treated with all the guarantees and conditions of Andorran health. But you can also do it in one of the many private clinics agreed by the CASS for the service you demand and the CASS applies the same standards.
In fact, private doctors are legally authorized to perform surgical and diagnostic operations in a hospital if the client demands it and also with the novelty of the Referential Physician Andorra seeks to avoid saturation of the system and public hospitals by coordinating and organizing patients efficiently in private clinics, something unthinkable in neighboring systems.
How is health coverage obtained in Andorra?
To obtain health coverage in Andorra as a resident you can join the Andorran Social Security Fund. More than 90% of the countries inhabitants are covered by this social security, according to statistical data. However, there are non-covered passive residents who have their own private insurance.
Joining the Social Security Fund (CASS) is mandatory for all salaried people they exercise a professional activity and for the vast majority of residents.
There are two ways to be covered by social security, with effective employment either on their own account or on behalf of others (with a local or foreign company) or being unemployed. The unemployed can choose to join the CASS by paying a contribution of 200 to 400 euros per month.
Although Andorran social security is not an independent health insurance, with CASS coverage you have additionally covered your trips to neighboring countries such as France, Portugal and Spain. However, you must request a travel flier from CASS before the travel and then send medical bills to CASS for reimbursement.
Private insurance. Necessary?
Recommended but not necessary. Private health insurance allows expanding the already complete Andorran social insurance (clinics and unconventional services). In addition, there are insurances that cover the remaining percentage when applying the corresponding CASS subsidy, to avoid timely payments completely. It is estimated that about 25% of the population has private health insurance for its benefits.
Distribution of the health system in Andorra
The andorra health network it is large if the size of the country is taken into account. There is a main hospital in the capital with 200 beds (Nora Senora de Meritxell Hospital).
Throughout the Principality there are 10 health centers that provide very high levels of care. They are open during the week, but rarely during the weekend. The centers provide preventive care, immunizations, first aid, prenatal and child care, family planning and general counseling.
You can receive urgent care by visiting a health center or having a home visit without an appointment. Elderly patients can be treated in a private 50-bed geriatric center (Center Geriatric Sant Vice d’Unclear).
Andorra has one of the largest proportion in the world per capital of pharmacies for the population. In the Principality there are more than 50 pharmacies that provide prescription and non-prescription medications and health supplements.
Frequently asked questions for tourists and foreigners
As we have only explained the health for those discharged from the system, we will now answer some questions frequently asked by tourists not registered in the CASS.
Does the European health card work in Andorra?
Although Andorra has some agreements with the European Union and because of its proximity to Spain and France, it tends to be believed that the European health card can be used, however, it is not so. It is important to inform yourself well before traveling.
Being Andorra a country that is not part of the European Union the European Health Card is not valid in the Principality.
Most accidents are due to winter sports during the high season of Andorra. Falls and injuries on the mountain skiing or practicing another similar sport are the most numerous, especially in adverse weather conditions. Therefore, travelers are advised to keep up with local alerts of the weather and avalanches. Avalanches usually occur during the middle of winter, early summer. Landslides may also occur after long periods of heavy rains. Crime-related injuries are almost nil.
Agreement between Spain and Andorra
There is a sanitary agreement between Spain and Andorra. Several steps must be taken and to have in clear what the agreement covers and what does not. Before traveling to Andorra you have to apply for the Social Security flier to Andorra, also known as E/AND-11. During the trip you must take this form and submit it with your ID if you need to use the health system.
However, this form does not free you from paying if you have to go to the doctor. With an urgency, the affected person must pay between 10% and 25% of medical assistance. You have to take into account that initially you pay the entire cost and when you return to Spain you must request a refund of the percentage that you did not have to pay.
In case it is not an emergency, you will have to pay everything of the medical cost. If the necessary medical assistance is not enough, it will not be very expensive, but the health abroad can be very expensive the more serious we suffer.
Agreement between France and Andorra
On December 12, 2000, the French Republic and the Principality of Andorra prepared a social security agreement. It aims to cover the largest number of people in the health and social protection sector.
This agreement specifies that individuals are subject to the social security regime of the country in which they are exercising:
- Salaried or non-salaried workers, regardless of nationality, now or before carrying out a professional activity in one of the two countries,
- Insured persons without activity, whatever their nationality,
- Public employees in exercise or retired.
The branches submitted to the Franco-Andorran agreement on health and social protection are the following:
- Sickness and maternity,
- Accidents and occupational diseases,
- Disability and death,
- Old age,
- Various family benefits.
What are the main causes of mortality in Andorra?
For residents, tumors, cardiovascular and respiratory diseases cause the greatest number of deaths. Infant mortality is very low. Andorra death rate in 2018 was 4.4% with 335 deaths.
One of the novelties of Health in Andorra is that of the Referring Physician, to improve access, efficiency and coordination of medical care.
The user registered in the CASS currently must choose a doctor or pediatrician as referring physician. This offers more personalized but general health care, and monitors the users' health status over time. It is the first node, the first diagnosis, that asks for visits to specialists and guides the health system and coordinates with the different health professionals who treat the patient. In addition, it is not necessary to pay the total cost in consultations with the Referring Physician. Directly only the part that corresponds to the user is paid, that is, 25% of the established rate.