The healthcare system in Andorra is a major contributor to the high standard of living in the principality. While low taxes, higher than average salary, easy access to clean water, clean air, schooling and the environment are important, it all goes to the wall without adequate healthcare.

In this article we’ll look through a brief history of healthcare in Andorra, coverage and how it ranks on a global scale.

Andorra’s Healthcare System: 100 Years Old

According to the World Health Organization, the Andorran health care system was officially established on 24 September 1918 in response to the devastation of the influenza pandemic.

“Prior to 1918, communes were solely responsible for contracting physicians and for enacting the few existing laws related to health care issues. Approximately 12 years later, these parish health boards became permanent bodies under the Health Care Administration Ordinance of 9 May 1931.”

Almost all traditional healthcare services are available in Andorra, with 3.33 physicians per 1000 residents. There are specialists in many fields practising throughout the country, many of whom speak at least some level of English, and all can be found via this comprehensive list of all the healthcare professionals and health centres available in Andorra.

However, being a small country, not all healthcare services are available locally. In this situation, patients will often travel to Barcelona or Toulouse for treatment.

Caixa Andorrana de Seguretat Social

Today, the insurance portion of Andorra’s healthcare system is known as Caixa Andorrana de Seguretat Social, or CASS for short. CASS was created as a social health insurance system in April 1968.

It is estimated that 92% of residents are covered under CASS. Enrolment is mandatory for salaried workers. Those not covered are likely to be mainly passive residents who are required to have private insurance.

CASS reimburses a portion of fees for medical consultations, examinations and pharmaceutical expenses. Hospital visits are typically covered up to 90% and services such as dental, GP, physiotherapy and so on are covered up to 75%. Giving birth in Andorra is 100% covered, so too are work-related accidents.

CASS Coverage Within Europe

Coverage doesn’t only apply to Andorra, but also France, Portugal and Spain.

Before leaving for travel, Caixa Andorrana de Seguretat Social should be notified. In the event of an accident, medical bills will be sent to CASS for reimbursement.

Hospital Quiron, Barcelona, Spain
No need to be concerned about hospital insurance on weekend trips to Barcelona. Speak with CASS before leaving Andorra.

Servei Andorrà d’Atenció Sanitària

The Andorran National Health Service, Servei Andorrà d’Atenció Sanitària, is known as SAAS. SAAS was created in December 1986 and is responsible for the administration and management of all public health care resources.

As Andorra’s history mostly involved patients privately contracting the service of doctors, SAAS aims to bring the private, public and volunteer sectors together to create a more efficient health care service.

Hospital Nostra Senyora de Meritxell

There is only one hospital in Andorra, Hospital Nostra Senyora de Meritxell. Also known as Centre Hospitalari Andorrà (CHA), it is located in Escaldes-Engordany and was established in 1997.

Andorra’s hospital houses both public and private physicians. Patients are treated to a modest but private room, often with a futon for a guest to stay.

There are approximately 2.5 beds per 1000 residents.

All but the most major emergencies are handled in Andorra. For extreme cases, patients are flown to Barcelona by helicopter.

Andorra: The Best Healthcare System in the World

A 2017 publication from The Lancet ranked healthcare systems from 195 countries and territories between 1990-2015. The study reviewed the most 32 frequent causes death from the “Global Burden of Disease“, and how these related to access and quality of adequate health care.

The study produced a HAQ score, or “Healthcare Access and Quality Index”, a score out of a possible 100. Andorra found itself to be the best health care system in the world, with a score of 95/100.

The top 10 scores included:

  1. Andorra: 95
  2. Iceland: 94
  3. Switzerland: 92
  4. Sweden: 90
  5. Norway: 90
  6. Australia: 90
  7. Finland: 90
  8. Spain: 90
  9. Netherlands: 90
  10. Luxembourg: 89
Ranking of healthcare access and quality around the world. Andorra's healthcare system scored the highest with a score of 95.
Andorra’s healthcare system ranked best in the world. Source: Healthcare Access and Quality Index, CC BY 4.0

Interestingly, many major developed countries didn’t rank so well in this study. Japan came in at 11th place (89 points), Canada at 17th place (88 points), UK at 30th place (85 points) and USA at 35th (81 points). It’s no wonder that Andorra is considered one of the best countries to live in.

Andorra’s Life Expectancy

Though the top spot fluctuates year by year, Andorra often takes the trophy for highest life expectancy in the world.

The 2010 Global Burden of Disease study found Andorra to be 2nd in the world with an average life expectancy of 79.8 for males (2nd behind Iceland at 80.0 years) and 85.2 years for females (2nd to Japan at 85.9 years).

2012 life expectancy from the WHO is 83. 2017 statistics from the US CIA places Andorra in 8th spot at 82.9 years.

Those speculating on the reasoning of Andorra’s high life expectancy often speak of the locally grown and grazed food – lots of leafy green vegetables, cows and (yes) horses, which graze high in the mountains.

Hiking and skiing is a big part of the culture, along with a slower pace of life with much lower stress than in many other cultures.

For most residents, air is fresh and the land is mountainous. A short walk to meet a friend often involves some climbing, and almost all apartments and houses come with a set of stairs, so even the laziest Andorran will get some mild exercise each day.


Overall, Andorra’s healthcare provides everything one needs to support a long, healthy life in the mountains.

With a small but functional hospital to support the population and a generous social security system that covers up to 100% of medical expenses, the tiny Principality of Andorra manages to beat most major developed countries in access and treatment of healthcare and life expectancy.

This is why so many expats choose Andorra for residency. Outside of the obvious fiscal advantages, they know their health will be taken care of for decades to come.

Feature Image: Lmbuga, Hospital Nostra Senyora de Meritxell. Escaldes-Engordany, Andorra, CC BY-SA 3.0