Andorra Physiotherapist CASS Contracts Drop 16% Amid Rising Demand

The number of physiotherapists contracted with Andorra's public health service, the CASS, has fallen by 16.4% over the past six years, even as the total number of registered professionals has risen.

In 2020, the Col·legi de Fisioterapeutes listed 188 members, with 164—over 87%—holding CASS contracts. By January 2026, membership had grown to 224, a 19% increase, but only 137 remained contracted, dropping the share to 60%. This shift has led to wait times of up to two months for public appointments.

Theo Rogue, president of the Col·legi de Fisioterapeutes, said the decline stems from two main factors. New arrivals from abroad cannot join the CASS network immediately, as regulations since 2019 require Andorran nationality or seven years of residency and work in the country. Meanwhile, some established physiotherapists have left the public system.

"Some colleagues say that with their expenses, the cost of living in Andorra, and the current CASS rates, they end up lowering the quality of care to see more patients per hour," Rogue explained. Others opt for private practice to maintain high standards and achieve better financial returns, where sessions often exceed €60 compared to under €17 in the public system.

CASS contract numbers peaked at 173 in 2022 before declining: 148 in 2023 (after removing 25 inactive professionals), 140 in 2024, 138 in 2025, and 137 now. The trend burdens remaining providers with longer waiting lists, creating a sense of overload, Rogue noted. The college defends both its members and public access to physiotherapy for those unable to afford private care.

For over a year, the college has collaborated with the health ministry on solutions, including targeted rate increases to make public work viable again without simply inflating prices. Efforts involve refining coding and tariffs to better value skilled manual therapy, alongside input from the Col·legi de Metges, whose prescriptions drive referrals.

Rogue called for a fresh approach to physiotherapy delivery. Changing accreditation rules to allow faster CASS entry for newcomers would need careful review to avoid unfairness to long-term residents, though special authorizations remain available in urgent cases.