Health in Andorra in 2024: how does it work?

Health in Andorra is public-private and works through a parapublic management health system (Andorran Health Care Service, SAAS) with regulated agreements and financing subsidized by social security through co-payment. The Andorran health system is such a competent and efficient system that it has earned it to be considered as the best healthcare in the world or one of the best in the world in different and varied rankings. So surely healing is one of the key points that make the Principality an extraordinary country.

For example, the medical journal The Lancet published a report in 2016 developed by the Institute for Evaluation and Metrics at the University of Washington (USA). This report collected data from 195 countries between 1990 and 2015, carrying out an evaluation every five years. The Andorran health system 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?

How healthcare works in Andorra

Health in Andorra is based on a highly efficient simplified and centralized system. In this case, a single body regulates all social devices and medical coverage in the country: the CASS, the Andorran Social Security Fund (China Andorran de Seguretat Social). On the other hand, the Andorran Health Care Service or SAAS It is the parapublic entity, with its own legal personality and financial autonomy that assumes the management and administration of all public resources - human, material and financial - dedicated to health care in the country.

This ensures that the health system is competent and effective. As the former Minister of Health Carles Álvarez-Marfany summarized very well (current ambassador of Andorra to the Vatican), the Andorran health system is based in three fundamental principles:

• The co-responsibility, because citizens pay directly for part of the treatments.
• The solidarity, because people who cannot afford the copayment are not excluded from the system.
• The free choice of doctor. Patients can choose which doctor will treat them.

A rather remarkable advantage is that it has higher subsidy for dental treatments than neighboring countries. High per capita income, the low overcrowding of the country, and the large participation of workers who contribute to social security also contribute to the very good functioning of the system. That is to say, the good shape of the Andorran economy.

On the contrary, due to the small number of inhabitants of Andorra, there are specialties in health to which there is no access in the country itself. For this reason, the CASS has established agreements with the social security services of Spain and France for which specialties not available in the Principality can be performed there (in detail later).

Andorran healthcare price

The price of Healthcare in Andorra depends on whether a person is Andorran resident or foreign. Residents, being covered by the CASS, enjoy agreed and reduced prices, while foreigners have tourist or non-resident prices, which are much higher. We are going to explain here the prices for residents and later we will mention the case of tourists and why it is important to have a travel insurance.

Starting with the principle of co-responsibility, healthcare for residents works by copayment. 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 subsidized amount. Assuming that healthcare is accessed by preferred route (see Referring Physician section for more information):

• Those patients who go to outpatients or health centers, to inquiries or visits of specialists, the CASS covers the 75% of the cost and the user is responsible for 25% of the price.
• I case of hospitalization health coverage covers the 90% of expenses, also allowing the payment of only the percentage not covered by the CASS, that is, paying only 10% of the total price.
• 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 to social security andorrana, refunds are up to 33% of the total. Thus, the price 66% or more is paid.

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.

Is healthcare in Andorra public or private?

Health in Andorra is public with a co-payment in terms of financing, but it is managed privately and parapublicly through agreements to which all health professionals can adhere. The third fundamental principle of healthcare in Andorra is freedom. Freedom both to be treated (freedom for CHOOSING to doctor, of demand) as to exercise (freedom for BEING a doctor, on offer). In fact, they can consult all the health professionals and convention centers with the CASS that practice in Andorra here.

And it is that to this health system can be included What 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 Hospital Nostra Senyora de Meritxell and they will be offered healthcare with all the guarantees and conditions of Andorran healthcare. But You can also do it in one of the many private clinics agreed by the CASS for the service requested and the CASS applies the same prices and standards. That is to say: health coverage is guaranteed by the CASS but it is the user who chooses how to exercise it.

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.

Therefore, so it is, Andorra has public health, but it is a system that seeks to be competent and efficient. On the one hand, in terms of public health, it is limited to setting conditions, requirements and agreements and, on the other, private health (clinics, professionals, centers, etc.) adhere to the agreements, accept their conditions and requirements and compete in public health. . On the other hand, the user only has to bear his part of the co-payment and only if he does not have complementary insurance.

Referring doctor and Preferential Route in Andorra

One of the latest developments in Health in Andorra is that of the Referring Physician, to improve access, efficiency and coordination of medical care. The user currently registered in the CASS you must choose a GP or pediatrician as a Referring Physician. This offers a more personalized but general health care, and monitors the user's health status over time. It is the first node, the first diagnosis, which requests visits to specialists and guides the health system and coordinates with the different health professionals who treat the patient.

In addition, in the consultations with the Referring Physician, it is not necessary to pay the full cost. Only the part that corresponds to the user is paid directly, that is, the 25% of the established rate. The call is established by the referring doctor Preferential access route to health. The operation of this route is simple: to access visits from specialist doctors you must be referred from the referring doctor, which must be paid a visit first. It is the referring doctor who should refer us to them.

Of course, there are exceptions to this. Specifically, in addition to the referring doctor, we are also referred through the preferred route from the emergency services of health centers or to access services after hospitalization. The referring doctors must be doctors with the specialty of General Medicine, but also, if you have a disease or condition that requires specialized periodic monitoring, you can have a referring specialist doctor to whom you consult directly once the initial referral has been made by the referring physician. In this case, it is the same specialist who has chosen who makes the assignment.

The objective of the referring doctor and the preferred route is, obviously, to avoid a collapse of the specialist doctors due to visits that are not necessary, since the referring doctor must offer an adequate justification and according to his professional criteria to refer the patient to a specialist . The percentages indicated above are applied only when accessed by the preferred route. When accessed by non-preferential route, the CASS only covers the 33% in visits, the 60% in acts, tests and prescribed products and the 60% in acts of re-education and functional rehabilitation (compared to the 75%, the 75% and the 65%, respectively) .

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 country's inhabitants are covered by this social security, according to statistical data. However, there are non-covered passive residents who have your own private insurance. This is due to the fact that passive residents, by not exercising economic activity in the country, are not obliged to contribute to social security.

Joining the Social Security Fund (CASS) is mandatory for all salaried people who exercise an economic or professional activity and therefore for the vast majority of residents. There are two ways to be covered by Andorran health through social security: with effective employment, either self-employed or as an employee (with a local or foreign company) or by being unemployed. The unemployed can choose to join the CASS by paying a contribution of 200 to 400 euros per month. Thus, entrepreneurs autonomous and workers for companies are covered by the CASS.

Although Andorran social security is not an independent health insurance, With CASS coverage, your trips to neighboring countries are additionally covered like France, Portugal and Spain. However, you must request a travel flyer from CASS before the travel and subsequently send the medical bills to the CASS for reimbursement. May read more information about coverage abroad and its procedures in this section of the CASS page.

Private insurance. Necessary?

Recommended but not necessary. Private health insurance makes it possible to expand the already complete Andorran social insurance (clinics and unconventional services). In addition, there are supplementary insurance that covers the remaining percentage when applying the corresponding subsidy from the CASS, to avoid punctual payments altogether. It is estimated that around 25% of the population has private health insurance for its benefits. May Read about complementary private insurance to avoid the CASS copay and about private insurance for passive residents here. Its price is around €40-50 per month.

Distribution of the Andorran healthcare system

The andorra health network It is large if you take into account the size of the country. There is a main hospital in the capital with 200 beds (Hospital Nostra Senyora de Meritxell).

Throughout the Principality there are 10 health centers that provide very high levels of care. They are open during the week, but rarely on the weekend. The centers provide preventive care, immunizations, first aid, prenatal and infant care, family planning, and general counseling.

You can get urgent care by visiting a health center or having a home visit without an appointment. Elderly patients can also be cared for in a 50 bed private geriatric center (Center Geriàtric Sant Vicenç d'Enclar).

Andorra has one of the rates pharmacies per inhabitant highest in the world. In the Principality there are more than 50 pharmacies that provide prescription and non-prescription drugs 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.

Is the European Health Insurance Card (TSE) valid in Andorra?

No it doesn't work. Although Andorra has some agreements with the European Union and due to its proximity to Spain and France, there is a tendency to believe that the European health card can be used, however, this is not the case. It is important to be well informed before traveling. As Andorra is a country that is not part of the European Union, the European Health Card is not valid in the Principality.

What are the main causes of mortality?

For Andorran residents, tumors, cardiovascular and respiratory diseases cause the greatest number of deaths. Infant mortality is very low. Andorra's mortality rate in 2018 was 4.4% with 335 deaths.

Health in Andorra for Spaniards and other foreigners: tourist price

For a non-resident person, for example a Spaniard, the visit to the emergency room can have a cost of €350 without any problem at the Meritxell hospital, so in case travel to the country It is advisable to take out insurance or at least have track insurance when skiing. Thus, in case of having a problem, you have health care in Andorra without having to pay an exorbitant price. This is because the prices for non-residents are higher because tourist rates are applied, in addition to the fact that the CASS does not cover them and they must pay the 100% of the price.

Beware of accidents in the mountains

Most accidents are for winter sports during the high season of Andorra. Falls and injuries in the mountains skiing or practicing another similar sport are the most numerous, especially in adverse weather conditions. For this reason, travelers are advised to keep up to date with local alerts of the meteorological and avalanche situation. Avalanches generally occur during the middle of winter, early summer. Landslides can also occur after long periods of heavy rain. Crime-related injuries are almost nil.

Agreement between Spain and Andorra

There is health agreement between Spain and Andorra. You have to take several steps and be clear about what the agreement covers and what it does not. Before traveling to Andorra you have to request the travel flyer to Andorra at Social Security, also know as E/AND-11. During the trip you must carry this form and present it along with your ID if you need to use the health system.

However, this form does not free you from paying in case you have to go to the doctor. With an urgency the affected person must pay between 10% and 25% of medical assistance. Bear in mind that you initially pay the entire cost and upon 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 the medical cost. If the necessary medical assistance is little, it will not be very expensive, but healthcare abroad can become very expensive the more serious what we suffer. You can get more information in any case by reading about the social security agreement between Spain and Andorra here, which although it is another type of agreement, shares some things.

Another option is to take out travel insurance, as we discussed in this article of tips for traveling to Andorra.

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 greatest number of people in the health and social protection sector. This convention specifies that individuals are subject to the social security scheme of the country in which they are carrying out an activity:

• 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.

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If you need more information, want to reside in Andorra or move your business, do not hesitate to contact us here. For more information about Andorra, on the other hand, visit our blog.