从财政角度分析安道尔的医疗保健系统

The Analysis of theHealthcare System in Nick Carroll, Aidyn Bibolov SIP/2026/040 IMF Selected Issues Papers are prepared by IMF staff asbackground documentation for periodic consultations withmember countries.It is based on the information available at 2026MAY IMF Selected Issues Paper European Department The Analysis of the Healthcare System in Andorra from a Fiscal Perspective, Principality of AndorraPrepared by Nick Carroll, Aidyn Bibolov Authorized for distribution by Jeff Danforth IMF Selected Issues Papersare prepared by IMF staff as background documentation for periodicconsultations with member countries.It is based on the information available at the time it was ABSTRACT:Andorra has a solid health system, delivering strong outcomes with lower public spending thanthe average in EU countries. However, health spending increased significantly between 2014 and 2025 and willremain a key source of pressure over the medium and long-term as the population continues to age. This paperreviews recent trends in government health spending in Andorra and identifies reforms that strengthen health RECOMMENDED CITATION:Carroll, N., and A. Bibolov (2026), "The Analysis of the Healthcare System inAndorra from a Fiscal Perspective," Washington DC: International Monetary Fund, Selected Issues Paper, SELECTED ISSUES PAPERS The Analysis of the HealthcareSystem in Andorra from a Fiscal Principality of Andorra Prepared by Nick Carroll, Aidyn Bibolov Acronyms CASSCaixa Andorrana de Seguretat SocialCOFOGThe Classification of the Functions of Government (COFOG) from the GovernmentFinance StatisticsECGExcess Cost GrowthGFSGovernment Finance StatisticsGHEDGlobal Health Expenditure DatabaseLTCLong-Term Care THE ANALYSIS OF THE HEALTHCARE SYSTEM IN Andorra has a solid health system, delivering strong outcomes with lower public spending thanaverage EU countries. However, health spending increased significantly between 2014 and 2025and will remain a key source of pressure over the medium and long-term as the populationcontinues to age. Reforms that strengthen health financing and more tightly manage high-cost A.Introduction 1.Andorra has a healthcare system that delivers strong outcomes.The health systemdelivers strong health outcomes with lower public spending than the average in EU countries. Lifeexpectancy is among the highest globally, and the system responded effectively to the pandemic,enabling a rapid reopening and recovery. However, public healthcare expenditure has risen 2.Government health spending has been growing strongly in Andorra in recent years. Government health spending increased from 3.5 percent of GDP in 2003 to 6.0 percent in 2025.Without reform, spending is projected to continue to increase as a share of GDP over the medium- 3.Balancing the accommodation of health spending growth with tighter management ofhigh-cost areas should be a central policy priority.Additional financing for health spending overand above population growth and inflation is likely to be needed over the long term, as thepopulation ages. To limit increases in social contributions and household financing and preserve B.Overview of the Andorran Health System 4.The Andorran public healthcare system provides broad coverage.The system delivershigh-quality care to the population with extensive access, low household out-of-pocket spending,and low maternal and infant mortality.3Andorra has several health institutions that finance, manageand deliver healthcare - the National Health service (Servei Andorrà d'Atenció Sanitària or SAAS 5.Total current health spending is 8.3 percent of GDP financed from taxation, socialcontributions and private financing.One quarter of health financing is from the centralgovernment budget, 18 percent from employee and self-employed contributions, 29 percent from 6.There are four main health spending components in the central government budget (Figure 1).The main components of health spending in the central government budget are the: (1)transfer to the SAAS, particularly for the national hospital, (2) transfers to the CASS, includingtransfers to cover the health fund deficit, (3) transfers to the University of Andorra, (4) health 7.CASS finances a range of health-related services and payments.The General Fund of theCASS covers a wide scope of health services and goods. These include: (1) direct transfers to thenational hospital for services, (2) payments to domestic providers for services, (3) payments toforeign providers, (4) health related benefits and pensions, (5) reimbursements for health-related 8.The largest pool of health financing is managed by the CASS.It has two parts: thePension Fund and the General Fund, (the latter includes health spending), which operate financiallyindependently. Health spending from the CASS General Fund is financed by a 3 percent payrollcontribution from employees and a 7 percent payroll contribution by employers (as well as self- Sources and notes: Drawn fro