Andorra

With a temperate climate that produces cold, snowy winters and warm, dry summers, Andorra draws tourists from around the world. Made up of only 468 square kilometers, this southwestern European nation has a population of 71,201. Tourists are also attracted to the low tax base, and residents from neighboring European countries regularly shop in its stores. Altogether, tourism accounts for more than 80 percent of the Gross Domestic Product (GDP) of Andorra. The absence of income taxes also attracts immigrants, both legal and illegal. The per capita income of $24,000 places Andorra 41st in world incomes. As a result, the standard of living and access to healthcare are high, and travelers to Andorra are usually impressed with the quality of available medical services. The government reports a zero unemployment rate, and there is no identifiable poverty in Andorra. In 2004, Andorra agreed to cooperate with the European Union on a number of economic, social, and cultural accords. Despite the high standard of living, data on many health indicators are unavailable for Andorra.

Healthcare is considered a fundamental right in Andorra, and Article 30 of the constitution guarantees citizens that the government will protect their health by providing social security, which is financed by cooperation between the public and private sectors. This guarantee was supplemented by the passage of the General Law on Health in March 1989. Spending on healthcare is consequently high in Andorra, although it has fluctuated some. Between 1998 and 2003, spending fell from 7.2 percent of the GDP to 4.9 percent. By 2006, the percentage had again risen and is currently 7.1 percent of total GDP. Andorra allots $2,453 (international dollars) per capita for healthcare services. The government covers 68.6 percent of total health expenditures, earmarking 89.2 percent for social security. The private sector furnishes 31.4 percent of total healthcare outlays, and 71.10 percent of that amount is derived from out-of-pocket expenses. There are 3.70 physicians, 3.11 nurses, 0.15 midwives, 0.68 dentists, and 1.03 pharmacists per 1,000 population in Andorra.

At 83.51 years, Andorra has the highest life expectancy in the world. Females can expect to outlive males by an average of six years. Literacy is universal. One hundred percent of children complete primary school, but enrollment at the secondary level is only 81.3 percent. One hundred percent of Andorrans have access to safe drinking water and improved sanitation. On average, women in Andorra give birth to 1.3 children each. This is the 16th lowest fertility rating among nations of the world.

The infant mortality rate of 4.04 deaths per 1,000 live births is the 10th lowest in the world. The under-5 [Page 133]mortality rate is also low at 7 per 1,000 live births. In general, immunization rates are predictably high. Ninety-nine percent of infants are immunized against diphtheria, pertussis, tetanus (DPT1 and DPT3), and tuberculosis, 98 percent against measles, and 95 percent against Haemophilus influenzae type B. However, only 54 percent of infants receive hepatitis B vaccinations.