{"id":22573,"date":"2025-11-21T08:45:28","date_gmt":"2025-11-21T07:45:28","guid":{"rendered":"https:\/\/creandgroup.com\/opinion-article\/el-sistema-sanitari-i-els-seus-reptes\/"},"modified":"2025-11-21T08:53:49","modified_gmt":"2025-11-21T07:53:49","slug":"the-healthcare-system-and-the-challenges-it-faces","status":"publish","type":"opinion-article","link":"https:\/\/creandgroup.com\/en\/opinion-article\/the-healthcare-system-and-the-challenges-it-faces\/","title":{"rendered":"The healthcare system and the challenges it faces"},"content":{"rendered":"\n

Andorra\u2019s healthcare system as a whole is made up of both public and private actors: the CASS, the SAAS, private healthcare professionals and medical centres with agreements in place with the CASS, as well as private insurers offering co-payment products with varying levels of cover. This model is likely more efficient than those of other countries where the public and private spheres operate in isolation, creating inefficiencies and driving up costs for policyholders. Even so, the system faces challenges similar to those of neighbouring countries, with the steady rise in healthcare expenditure being one of the most significant. This trend has accelerated markedly in recent years. Healthcare expenditure under the general branch increased by around 12% in 2024 compared with the previous year and, unfortunately, data from the first quarter of 2025 show a similar rise. Contributions paid into the CASS by the population are not sufficient to cover this level of expenditure, and the Government must inject additional funds each year. These injections continue to grow, reaching close to EUR 58.9 million for the 2026 financial year, which is EUR 12.4 million more than in 2025 (an increase of more than 25%). Private insurance is facing comparable pressures. Insurers are having to adjust the premiums of their health products in order to meet the constant rise in medical costs.<\/p>\n\n\n\n

What are the main causes behind this increase in expenditure? As is often the case, there is no single reason since many factors are in play. However, certain factors stand out, including the rising cost of healthcare, population ageing and increasing levels of obesity.<\/p>\n\n\n\n

Healthcare costs have grown faster than the Consumer Price Index (CPI) in most developed countries for several years. Pharmaceutical spending is one of the main drivers of this trend. The growing number of chronic patients (as we will see later), together with the emergence of new, high-cost innovative therapies, continue to push pharmaceutical bills higher. New high-impact medicines (such as immunotherapies, gene therapies and personalised treatments for oncology or rare diseases) come with very substantial costs. According to data from the OECD and the European Medicines Agency (EMA), these new treatments can cost between EUR 50,000 and EUR 500,000 per patient per year, far above the cost of conventional therapies. For example, our organisation recorded a 17% increase in pharmacy expenditure during 2024 and a rise of more than 14% in the first nine months of 2025.<\/p>\n\n\n\n

The emergence of new surgical techniques, such as robotic surgery (including the possibility of remote procedures), along with the use of artificial intelligence and augmented reality, 3D printing for customised medical solutions, biomaterials and new diagnostic and analytical techniques, is inevitably driving healthcare costs higher.<\/p>\n\n\n\n

It is clear, however, that these therapies and innovative medicines bring major benefits, including shorter recovery times, improved life expectancy for certain conditions and, more generally, a better quality of life.<\/p>\n\n\n\n

Population ageing is an issue that all stakeholders must focus on, because if it is not already the main driver of rising healthcare costs, it will be in the near future. All developed countries are experiencing a continued ageing of their populations, due both to lower birth rates and to increased life expectancy as a result of advances in medicine. We all need to prepare for this reality, which is already with us and will become ever more pronounced.<\/p>\n\n\n\n

What does an ageing population mean for healthcare? In general, an ageing population leads to a rise in the number of patients with chronic conditions, such as cardiovascular diseases (hypertension, arteriosclerosis, and so on), neurodegenerative diseases (Alzheimer\u2019s and other forms of dementia), cancer, diabetes, respiratory conditions such as COPD (chronic obstructive pulmonary disease), osteoporosis and osteoarthritis. According to the EFPIA (European Federation of Pharmaceutical Industries and Associations), a large proportion of these patients suffer from more than one of these conditions (polymorbidity). Around 37% of Europeans over the age of 65 live with multiple chronic conditions, which often results in polypharmacy. However, this issue begins much earlier in life: around a quarter of the working-age population already has at least one chronic illness. The number of adults diagnosed with diabetes in the EU has almost doubled over the past two decades, rising from around 17 million in 2000 to 33 million in 2019, and is expected to reach 38 million by 2030.<\/p>\n\n\n\n

We must also consider another decisive factor behind rising healthcare expenditure: obesity. People are often reluctant to think of obesity as an illness or medical condition. According to the WHO (World Health Organization), obesity is a complex chronic disease defined by an excessive accumulation of fat that presents a risk to health. Obesity can increase the risk of type 2 diabetes and heart disease, affect bone and reproductive health, and raise the likelihood of developing certain types of cancer. It also affects quality-of-life factors such as sleep and mobility. Obesity, and overweight in general, generates both direct and indirect costs. Direct costs include medical expenses (such as surgery, medical tests and medication) and non-medical costs, such as transport required to access healthcare. Indirect costs include health-related absenteeism and reduced productivity. According to the World Obesity Federation, the number of people living with obesity could reach 2 billion by 2035, with an estimated economic impact of EUR 4 trillion \u2014 almost 3% of global GDP in 2035. Public and private costs associated with obesity and overweight are therefore enormous, and the medical consequences for those affected are deeply concerning. All of this is driving a steady increase in healthcare needs across all areas, from primary care to medical and surgical hospitalisation, diagnostic testing and pharmaceutical spending. Both public and private stakeholders must work to find solutions to address this situation.<\/p>\n\n\n\n

It may seem difficult to contain healthcare costs while also improving services in order to enhance the population\u2019s quality of life. Yet there are initiatives out there that can help to address either one or both of these issues. For example, at the European level there are several projects aimed at jointly negotiating and sharing centralised prices. Another area many countries are seeking to improve is air quality, particularly in large cities, as this factor is known to have a direct impact on numerous respiratory and immune-related conditions.<\/p>\n\n\n\n

However, what appears most likely to help contain costs, and above all to improve health, are the scientific and technological advances already available and those that will emerge in the near future.  Telemedicine is a tool that is already within our reach and its use is gradually increasing. It is not a groundbreaking or disruptive technology, but rather the application of telematic tools we already have at our disposal. These can help reduce waiting times in primary care and, above all, improve care for chronic patients, with or without reduced mobility, by limiting the need for them to travel to a medical practice. New vaccine-development technologies have shortened both development and production timelines. However, among all the new technologies and advances that are emerging, one stands above the rest: artificial intelligence. There are already a great many projects making use of AI. Some of the most widespread applications include diagnostic systems and AI-assisted platforms for designing and developing new medicines. In 2024, the Nobel Prize in Chemistry was awarded to scientists who, using an AI model, succeeded in deciphering the structure of almost all known proteins. This represented a major breakthrough that will significantly reduce the time and cost involved in countless scientific developments related to medicine.<\/p>\n\n\n\n

We are witnessing medical advances unlike anything seen before. Yet there are other actions that can improve our quality of life just as much (or even more) and at much lower cost. Humans have evolved as a species over thousands of years, just like other mammals. This adaptation has occurred slowly, over generations, enabling us to survive and reproduce in the best possible conditions. This meant sustained physical activity, a varied but modest diet, and an alert system that reacted to immediate dangers by activating our bodies and preparing us to face the threat (acute stress).<\/p>\n\n\n\n

This long evolutionary adaptation is now confronted by a new reality that has arrived suddenly and for which we are not genetically prepared: sedentary lifestyles; an abundance of food, much of it high in calories and low in nutritional value; and, finally, the pace of life, marked by significant work, social and financial pressures that expose us to constant stress (chronic stress). It is in this shift that many of the causes of the previously mentioned diseases can be found. Prevention is key, and all stakeholders must make an effort to prioritise it. This is not only about preventive medicine, which helps detect conditions at an early stage and often resolves them through prescribed medication. I am talking about preventing illness even before any symptoms appear. There is ample research showing that regular physical activity, together with a moderate diet based mainly on whole, minimally processed foods, reduces the onset of most chronic conditions. An active social life, along with having the tools needed to manage the causes of stress, are other factors that have clearly been shown to help reduce these conditions. Encouraging these habits should be an institutional priority, both to reduce social and healthcare expenditure and to improve the population\u2019s quality of life.<\/p>\n\n\n\n

More important than living many years is living those years in good health.<\/p>\n\n\n\n

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Diari d’Andorra el 21 and 21 \/11 \/2025<\/p>\n","protected":false},"featured_media":22562,"template":"","categories":[],"tags":[],"class_list":["post-22573","opinion-article","type-opinion-article","status-publish","has-post-thumbnail","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/creandgroup.com\/en\/wp-json\/wp\/v2\/opinion-article\/22573","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/creandgroup.com\/en\/wp-json\/wp\/v2\/opinion-article"}],"about":[{"href":"https:\/\/creandgroup.com\/en\/wp-json\/wp\/v2\/types\/opinion-article"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/creandgroup.com\/en\/wp-json\/wp\/v2\/media\/22562"}],"wp:attachment":[{"href":"https:\/\/creandgroup.com\/en\/wp-json\/wp\/v2\/media?parent=22573"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/creandgroup.com\/en\/wp-json\/wp\/v2\/categories?post=22573"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/creandgroup.com\/en\/wp-json\/wp\/v2\/tags?post=22573"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}