Andorra is a small independent principality situated between France and Spain in the Pyrenees mountain range. Its population has an average life expectancy of around 82.9 years – the average life expectancy for men is 80.7 years, while for women it is 85.3 years. Andorra has one of the top ten highest life expectancies of any country in the world. This can be attributed to fresh mountain air with very little pollution, a diet of locally grown produce, and an outdoors culture, which promotes walking, sports, and activities.The healthcare system in Andorra may also contribute to the above. Despite its small size, Andorra has a well-established healthcare system, which began in 1918. In 2017, Andorra was ranked by The Lancet publication on a “Healthcare Access and Quality Index” scale, and scored 95 out of a possible 100, beating Switzerland, Sweden, Australia and the Netherlands to first place.
In this article, we will take a brief look at the healthcare system in Andorra, and at how to register if you are an expatriate.
Healthcare overview
This section provides an overview of the healthcare system in Andorra, covering the healthcare system structure, the governing body of the healthcare system, and how state healthcare is funded. It also includes information about the medical facilities in Andorra.
Governing body & funding
The governing bodies of the healthcare system in Andorra include the General Council (of parliament), the Ministry of Health and Welfare, the Social Security Office (aka CASS) and the National Health Service (SAAS).
Public health services and facilities are funded through tax contributions or “social security”. The unemployed and self-employed can opt out of paying social security payments if they are unable to. The social security system typically covers between 75% and 90% of the cost of medical expenses for those who are eligible.
The social security/CASS system covers expatriates with active residency permits, as well as their families. However, expatriates with passive residency permits, along with tourists, are not covered by this healthcare system. If this applies to you, then you may need to purchase private medical insurance.
Medical facilities
There is only one main hospital in Andorra, the Nostra Senyora de Meritxell Hospital, in Escaldes-Engordany. The hospital houses both public and private physicians under one roof. In addition to the hospital, there are around 12 healthcare centres run by SAAS. When specialist care is required, it is most common to be referred to a medical facility in nearby Barcelona or Toulouse.
The healthcare centres mostly provide preventive care, such as vaccinations, basic first aid, prenatal/antenatal and childcare, family planning and general counselling. Essentially, health centres are there to provide all of your essential and routine healthcare and checkups. House visits with doctors or healthcare workers can be arranged by appointment. There is also a 50-bed private geriatric centre, the Centre Geriàtric Sant Vicenç d’Enclar, for the care of elderly patients.
Register for healthcare
This section describes how to register for healthcare in Andorra. It covers purchasing and using health insurance and private practice doctors, as well as receiving general and emergency healthcare.
Health insurance & private practice
An estimated 25% of residents in Andorra have supplementary private health insurance in addition to the cover they receive from the state. Some will also opt to see private doctors and specialists. That being said, general practitioners (GPs) and medical specialists generally attend to patients in both the public sector and the private sectors in Andorra, due to the limited number of facilities etc.
The main reason that many people in Andorra purchase additional healthcare is that secondary care is predominantly confined to the private healthcare sector. This means that if you do not have supplementary health insurance with appropriate cover, you could face paying higher costs out of pocket for secondary healthcare. This includes treatments such as rehabilitation and dialysis, as well orthopaedic and diagnostic services.
If you are not covered by the state social security and need to purchase a private health insurance plan, you may need to do some research on whether it covers evacuation. Due to the land-locked and mountainous location of Andorra, as well as its small size, in the event of an accident or a situation that necessitates specialist care, you may have to be evacuated (usually by helicopter) to Spain or France for treatment.
Visiting a doctor
You can register with a doctor at your local health centre, including CASS registered practitioners in either Spain or France. To be eligible for CASS (public healthcare), you will need to be employed by either a private company or an Andorran company, or be a legal resident. Those who do not fit the criteria will be required to have private health cover in place. Employees typically pay between 6% and 9% of their salary to CASS contributions, and employers pay 13% in contributions per employee. Unemployed and self-employed workers can opt in or out of social security contributions.
The system generally works by the patient paying the upfront costs first, and then CASS reimbursing them. CASS typically covers around 75% of outpatient medical costs, and up to 90% (with a few special circumstances seeing 100% cover, such as work related injuries and giving birth) of hospital expenses. After treatment, you should be given a receipt and stamped voucher from your treating doctor. You can take this to your local CASS office to request reimbursement via bank transfer.
Receiving healthcare
You must register for a doctor, but you will not need to specifically register elsewhere for things like emergency treatment at hospital. If you have private health insurance, make sure you know the policy provider and your policy number. If you are eligible to be covered (or partially covered) by the state, you need to keep receipts for reimbursement. You should be automatically enrolled on the CASS system when you commence your employment contract. If you are unsure whether you have been, then you should speak to either the HR or Finance department of the company that you are working for.