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Decree 132/2022, articles 1, 9 and 10; CASS preferred-route guidance.", "country_ids": [ "AND" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "governance", "government_responsibilities", "referral_design" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": null, "institution": null, "locator": { "description": "HSiA pages 7 to 8; Decree 132/2022 physical pages 2 and 5; CASS sections La via preferent and Reemborsament" }, "material_id": "material:d0c1e534a22017847c71c9b3", "notes": [ "Do not infer unlisted staffing, borrowing, procurement or capital decision rights from general institutional autonomy." ], "origin": "candidate-analytical-mappings", "period": "basket rules from 2022 and current institutional guidance retrieved 2026-08-14", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "78d28ce6e86091766e72f96951b6e5a0145e3961358aab3d8e5b764a837b9255", "page_count": 24, "response_sha256": "78d28ce6e86091766e72f96951b6e5a0145e3961358aab3d8e5b764a837b9255" }, "statement": "The Ministry controls national policy and regulation, the General Council approves health-related legislation, Government rules define the basket, CASS controls contracting and reimbursement, and SAAS manages the core public delivery network.", "tags": [], "territory": "national decision architecture", "title": "Who controls policy, benefits, contracts and public operations", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.cass.ad/laviapreferent" }, { "kind": "source_reference", "source": "Health Systems in Action Insights: Andorra, 2025 Edition", "url": "https://eurohealthobservatory.who.int/docs/librariesprovider3/publicationsnew/20260224-andorra-hsia-insight-%D0%B5n.pdf?sfvrsn=7245c647_1" }, { "kind": "source_reference", "source": "Decree 132/2022 approving the Regulation establishing the Health Services and Products Basket", "url": "https://www.cass.ad/sites/default/files/documents/Decret%20132-2022%2C%20del%2030-3-2022%2C%20pel%20qual%20s%E2%80%99aprova%20el%20Reglament%20que%20estableix%20la%20Cartera%20de%20serveis%20i%20productes%20de%20salut..pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Dubois HFW, Martínez F, Cetani T, Rico A, editors. Health Care Systems in Transition: Andorra. Copenhagen: European Observatory on Health Systems and Policies; 2004;6(3). https://iris.who.int/server/api/core/bitstreams/d3bd5438-18ba-4f87-930a-045794fc31d1/content", "country_ids": [ "AND" ], "coverage_domains": [ "actors", "authoritative_review", "autonomy", "decision_rights", "facility_data", "governance", "government_responsibilities", "hospital_organization", "market_structure", "networks", "ownership", "patient_flows", "primary_care", "referral_design", "reform_history", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "lack of coordination between public and private providers", "institution": "European Observatory on Health Systems and Policies", "locator": { "locator_type": "pdf_page_set_anchor", "source_word_anchor": "lack of coordination between public and private providers", "source_word_count": 8 }, "material_id": "material:f8988b04c66128151d6935aa", "notes": [ "Use this review only for historical trajectory and never as the source of current facility counts or authority." ], "origin": "country-evidence-improvement-sources", "period": "historical baseline published 2004; no statement is treated as a current arrangement without contemporary corroboration", "publication_date": null, "publication_year": 2004, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "review_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "ce7324ffaec3f96ecb5bc9227e14584ba558838ef7e57948bef75695eac0504c", "page_count": 79, "response_sha256": "ce7324ffaec3f96ecb5bc9227e14584ba558838ef7e57948bef75695eac0504c" }, "statement": "The 2004 review documents the earlier mixed ambulatory model, one public SAAS hospital and unresolved public-private and cross-level coordination, providing a dated baseline for later referral and integration reforms.", "tags": [], "territory": "national historical system and cross-border provision up to 2004", "title": "Andorra: Health Care Systems in Transition", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://iris.who.int/server/api/core/bitstreams/d3bd5438-18ba-4f87-930a-045794fc31d1/content" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Government of Andorra. Sol·licitud de professió titulada de la salut. https://www.govern.ad/ca/tematiques/salut/empreses-i-professionals/sollicitud-de-professio-titulada-de-la-salut", "country_ids": [ "AND" ], "coverage_domains": [ "actors", "decision_rights", "governance", "market_structure" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "Sol·licitud d’acreditació per signar conveni amb la CASS", "institution": "Government of Andorra, Ministry of Health", "locator": { "locator_type": "html_section_anchor", "source_word_anchor": "Sol·licitud d’acreditació per signar conveni amb la CASS", "source_word_count": 8 }, "material_id": "material:3ec9a39ecfe95f58f943cb29", "notes": [ "Treat accreditation and CASS adhesion as a formal procedure; do not infer its completion rate or the number of contracted professionals." ], "origin": "country-evidence-improvement-sources", "period": "undated current procedure retrieved 2026-08-22; the listed applicable legislation includes a 2024 amendment", "publication_date": null, "publication_year": 2024, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "text/html", "response_sha256": "2ff79fb452b20cc1398bf020885f84c825a8dfbf477408bed92c90b780d65ba8" }, "statement": "The official procedure states that a professional seeking CASS-contracted status must obtain Government accreditation and then complete CASS adhesion steps.", "tags": [], "territory": "national procedure for regulated health professionals seeking to practise or contract in Andorra", "title": "Application to practise a regulated health profession", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.govern.ad/ca/tematiques/salut/empreses-i-professionals/sollicitud-de-professio-titulada-de-la-salut" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Caixa Andorrana de Seguretat Social. Memòria 2024. Andorra la Vella: CASS; 2025. https://www.cass.ad/sites/default/files/tramits/CASS%20MEMORIA%202024_Web_0.pdf", "country_ids": [ "AND" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "facility_data", "governance", "hospital_organization", "market_structure", "networks", "patient_flows", "reform_history", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "increment de l’activitat assistencial, tant al país com a fora", "institution": "Caixa Andorrana de Seguretat Social", "locator": { "locator_type": "pdf_page_set_anchor", "section": "Prestacions sanitàries, control d’incapacitats i pensions per invalidesa", "source_word_anchor": "increment de l’activitat assistencial, tant al país com a fora", "source_word_count": 9 }, "material_id": "material:fc784f422e7ee6f93f6b4b85", "notes": [ "Keep the reported percentage attached to high-complexity surgery activity and do not convert it into total hospital growth." ], "origin": "country-evidence-improvement-sources", "period": "calendar year 2024 administrative and financial reporting", "publication_date": null, "publication_year": 2025, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "102ff287848d4f5d1e81c695682ffc385eea5db10220c747db541a7212b8d2f1", "page_count": 299, "response_sha256": "102ff287848d4f5d1e81c695682ffc385eea5db10220c747db541a7212b8d2f1" }, "statement": "CASS reported increased activity inside and outside Andorra, a 25.2 percent rise in high-complexity surgery at the national hospital, and its first agreement with a private health centre other than SAAS for ambulatory surgery.", "tags": [], "territory": "CASS-financed activity inside and outside Andorra during 2024", "title": "CASS Annual Report 2024", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.cass.ad/sites/default/files/tramits/CASS%20MEMORIA%202024_Web_0.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Gómez-Jiménez J, Becerra O, Boneu F, Burgués L, Pàmies S. Análisis de la casuística de los pacientes derivables desde urgencias a Atención Primaria. Gac Sanit. 2006;20(1):40-46. doi:10.1157/13084126. https://www.gacetasanitaria.org/es-download-pdf-S0213911106714509", "country_ids": [ "AND" ], "coverage_domains": [ "facility_data", "hospital_organization", "networks", "observed_referral", "patient_flows", "primary_care", "referral_design", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "75,22% podrían ser derivados al modelo B", "institution": "Gaceta Sanitaria", "locator": { "locator_type": "pdf_page_set_anchor", "source_word_anchor": "75,22% podrían ser derivados al modelo B", "source_word_count": 7 }, "material_id": "material:cc44ec28e21929fc40b1a75f", "notes": [ "This is modeled redirectability in one 2003 emergency department, not an actual transfer rate or current system result." ], "origin": "country-evidence-improvement-sources", "period": "2003 emergency-department records analyzed in an article published 2006", "publication_date": null, "publication_year": 2006, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "46282a016921b6a2cf821db7091ea36cfe73d389bbd54c90584eaa1560f390e4", "page_count": 7, "response_sha256": "46282a016921b6a2cf821db7091ea36cfe73d389bbd54c90584eaa1560f390e4" }, "statement": "Among 25,319 low-acuity and low-complexity emergency patients in 2003, the authors estimated that 75.22 percent could potentially be redirected under a primary-care model with continuous emergency and diagnostic capacity.", "tags": [], "territory": "one Andorran hospital emergency department", "title": "Case-mix analysis of patients potentially referable from emergency triage to primary care", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.gacetasanitaria.org/es-download-pdf-S0213911106714509" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Government of Andorra. Decree 132/2022 of 30 March 2022 approving the Regulation establishing the Health Services and Products Basket. BOPA No. 43, 6 April 2022. https://www.cass.ad/sites/default/files/documents/Decret%20132-2022%2C%20del%2030-3-2022%2C%20pel%20qual%20s%E2%80%99aprova%20el%20Reglament%20que%20estableix%20la%20Cartera%20de%20serveis%20i%20productes%20de%20salut..pdf", "country_ids": [ "AND" ], "coverage_domains": [ "actors", "decision_rights", "governance", "government_responsibilities", "hospital_organization", "market_structure", "networks", "ownership", "primary_care", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "prestacions sanitàries que financen públicament la CASS i el Govern", "institution": "Government of Andorra", "locator": { "locator_type": "legal_articles", "source_word_anchor": "prestacions sanitàries que financen públicament la CASS i el Govern", "source_word_count": 9 }, "material_id": "material:c59dae91fec668915e9ed248", "notes": [ "Do not infer provider ownership or actual use from legal eligibility to deliver a publicly financed service." ], "origin": "country-evidence-improvement-sources", "period": "Decree dated 30 March 2022 and published 6 April 2022; subsequent amendments must be considered separately", "publication_date": null, "publication_year": 2022, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "65c696a8e6b76972585cbbbcb7492635ab4cab9bd8695501b0d265ada704e1b1", "page_count": 37, "response_sha256": "65c696a8e6b76972585cbbbcb7492635ab4cab9bd8695501b0d265ada704e1b1" }, "statement": "The regulation defines the publicly financed basket, distinguishes CASS financing from government-financed public health, permits authorized domestic providers, and provides a formal route for eligible foreign providers.", "tags": [], "territory": "national benefits-basket rules covering eligible domestic and foreign providers", "title": "Decree 132/2022 approving the Regulation establishing the Health Services and Products Basket", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.cass.ad/sites/default/files/documents/Decret%20132-2022%2C%20del%2030-3-2022%2C%20pel%20qual%20s%E2%80%99aprova%20el%20Reglament%20que%20estableix%20la%20Cartera%20de%20serveis%20i%20productes%20de%20salut..pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry of Health, Social Affairs and Employment, Andorra. Projecte Pla Nacional de Salut 2020. Working document. Andorra la Vella; 28 September 2015. https://extranet.who.int/countryplanningcycles/sites/default/files/planning_cycle_repository/andorra/pns_2020_projecte.pdf", "country_ids": [ "AND" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "governance", "government_responsibilities", "networks", "observed_referral", "patient_flows", "primary_care", "referral_design", "reform_history", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "L’atenció primària està fragmentada entre els capçaleres liberals", "institution": "Ministry of Health, Social Affairs and Employment, Andorra", "locator": { "locator_type": "pdf_page_set_anchor", "source_word_anchor": "L’atenció primària està fragmentada entre els capçaleres liberals", "source_word_count": 8 }, "material_id": "material:b6a61ccb49d1236728310d33", "notes": [ "Keep the 2011 survey and 2013 assessment as pre-reform evidence, not as a current preferred-route compliance measure." ], "origin": "country-evidence-improvement-sources", "period": "working plan dated 2015, reporting ENSA 2011 and WHO primary-care assessment findings from 2013", "publication_date": null, "publication_year": 2015, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "2009fc22f25aef6f2d1419d3cc8ea5279b86b97b6e179830431c5831e6b1411e", "page_count": 149, "response_sha256": "2009fc22f25aef6f2d1419d3cc8ea5279b86b97b6e179830431c5831e6b1411e" }, "statement": "The plan reported high self-reported use of a reference GP before the later preferred-route reform, but also documented fragmentation between independent GPs and SAAS nurses, limited cross-professional meetings and the absence of a shared information system.", "tags": [], "territory": "national survey evidence and a 2013 WHO assessment of 26 GPs, 41 CAP nurses and 390 patients", "title": "Draft National Health Plan 2020", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://extranet.who.int/countryplanningcycles/sites/default/files/planning_cycle_repository/andorra/pns_2020_projecte.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Litvinova Y, Rechel B. Health Systems in Action Insights: Andorra, 2025. Copenhagen: European Observatory on Health Systems and Policies, WHO Regional Office for Europe; 2026. ISBN 978-92-890-1467-0. https://eurohealthobservatory.who.int/docs/librariesprovider3/publicationsnew/20260224-andorra-hsia-insight-%D0%B5n.pdf?sfvrsn=7245c647_1", "country_ids": [ "AND" ], "coverage_domains": [ "actors", "authoritative_review", "autonomy", "decision_rights", "facility_data", "governance", "government_responsibilities", "hospital_organization", "market_structure", "networks", "ownership", "patient_flows", "primary_care", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "manages the only hospital in Andorra, 12 primary care centres", "institution": "European Observatory on Health Systems and Policies and WHO Regional Office for Europe", "locator": { "locator_type": "pdf_page_set_anchor", "source_word_anchor": "manages the only hospital in Andorra, 12 primary care centres", "source_word_count": 10 }, "material_id": "material:1becd05d5430a8244204fe09", "notes": [ "Keep the current system description separate from policy goals and from any unmeasured assumption about preferred-route adherence." ], "origin": "country-evidence-improvement-sources", "period": "2025 edition published in 2026; organizational description mainly uses 2023 data and identifies the preferred route introduced in 2020", "publication_date": null, "publication_year": 2026, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "review_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "78d28ce6e86091766e72f96951b6e5a0145e3961358aab3d8e5b764a837b9255", "page_count": 24, "response_sha256": "78d28ce6e86091766e72f96951b6e5a0145e3961358aab3d8e5b764a837b9255" }, "statement": "The current Observatory profile separates national stewardship by the Ministry, central purchasing by CASS, public facility operation by SAAS, contracted self-employed ambulatory provision, and planned cross-border specialist and tertiary care.", "tags": [], "territory": "national system with contracted cross-border care in France and Spain", "title": "Health Systems in Action Insights: Andorra, 2025 Edition", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://eurohealthobservatory.who.int/docs/librariesprovider3/publicationsnew/20260224-andorra-hsia-insight-%D0%B5n.pdf?sfvrsn=7245c647_1" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Carroll N, Bibolov A. The Analysis of the Healthcare System in Andorra from a Fiscal Perspective. IMF Selected Issues Paper No. 2026/040. 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