The Andorran health and social security system is very similar to the French system. The General Council (the parliament), the Ministry of Health and Welfare (Ministeri de Salut i Benestar), the Social Security Office (CASS or Caixa Andorrana de Seguretat Social) and the National Health Service (SAAS or Servei Andorrà d’Atenció Sanitària) govern healthcare in Andorra.
Central government and parliament are in charge of policy-making, but the main player in Andorran healthcare is CASS. It is responsible for collecting the funds to pay for health care services, agreeing the fee level of participating doctors, making pensions payments and compensation for employees who cannot attend work due to illness and medical treatment.
Contributions for the state health system come from the employed and are collected at source along with pension contributions. Employees on less than the minimum wage also pay social security contributions, but they are voluntary for people who are unemployed or self-employed. The level of contribution depends on how much a person earns and not on their medical health. Dependant family members are covered by the contributions from the employed member of the family. Approximately 8 percent of the population do not participate in the state system.
Citizens can only join CASS if they are employed by an Andorran company or individual. Employers are in charge of enrolling their staff into the system and cover starts 45 days after enrolment.
The employee pays between 6 – 9 percent of their salary in health contributions and this is matched by employers paying 13 percent of each employee’s salary, with some employers paying the full sum as an employment perk. Employees with dependant family members pay a higher rate of contribution to cover them. People who are not employed have to pay between 200 to 400 Euros per month if they want to opt into the state insurance system.
CASS will reimburse 75 percent of all outpatient medical expenses and up to 90 percent of hospital expenses. The treatments covered by CASS are listed in a directory called the Nomenclature of Medical Activities. When you receive treatment from a doctor or specialist, you will be given a stamped voucher, which you should return, along with receipts for prescription charges to the local CASS office. CASS reimburses you by bank transfer once they have processed your claim.
There are 10 state funded health centres in Andorra. They aim to complement care provided by GPs. They are staffed by nurses and are responsible for first aid, antenatal and childcare, nursing services, home and rehabilitative care, immunisation and health education. The health centres are open from Monday to Friday during working hours. Some are also open during the weekends and holidays. Patients requiring no-urgent treatment can attend the health centre by making an appointment to attend the surgery or for a home visits.
Citizens can register with the doctor of their choice and this may include CASS registered practitioners in Spain or France. CASS agrees doctors fees on an annual basis and those wishing to increase their fees have to declare themselves as private practitioners. People seeking state medical care must make sure that their doctor is contracted into the CASS scheme. Usually CASS doctors display a sign saying conventione or agree. Doctors and hospitals can refer patients for treatment in neighbouring France and Spain. CASS already has agreements with some practitioners in these countries and patients need to check that the doctor or hospital they are visiting is approved by the Andorran system.
Andorra is a very small country and consequently there is only one hospital, which is in the capital. CASS agrees the hospitals fees annually as it does with hospitals based in France and Spain, who have agreed to its fees. Andorra relies on hospitals outside of the country for complex or rare surgical procedures. Home care is the preferred option of care in Andorra. Hospital admission is set aside for serious illness, injury, and surgery.
Emergency care is available free for everyone including those without state health insurance. Often admissions to the Emergency Department are ski related accidents. The emergency phone number is 116 and it operates 24 hours a day. It is connected to the emergency ambulance service and is run by a permanent staff of hospital employees.
There are many private practices in Andorra provided by independent office-based doctors and specialists. The premises, equipment and personnel are funded by the physicians themselves. Private doctors are allowed to conduct surgical, diagnostic and other treatment services in the state hospital and in return for this provision; they have to commit to a number of hours each week where they will be on emergency call. Approximately 25 percent of Andorrans have private health insurance to boost up their state health care.
A voluntary association called the Volunteers of the Hospital Nostra Senyora de Meritxell offers nursing care services to a wide range of patients. Most nursing homes also have volunteer carers.
Some dental treatment is available through the state healthcare system, but it only covers routine visits and check-ups. Citizens must pay themselves for more detailed dental treatment like crowns and bridges.
Andorra has many chemists and in fact has one of the highest ratios in Europe. Pharmacists are licensed by the government. Pharmacies in Andorra can sell approved foreign medicaments from pharmaceutical companies who have agreements with the Ministry of Health and Welfare.