Which countries have the best healthcare?

Credit: George Hodan/public domain
Neither Canada nor Japan cracked the top 10, and the United States finished a dismal 35th, according to a much anticipated ranking of healthcare quality in 195 countries, released Friday.

Among nations with more than a million souls, top honours for 2015 went to Switzerland, followed by Sweden and Norway, though the gold standard remains tiny Andorra, a postage stamp of a country nestled between Spain (No. 8) and France (No. 15).

Iceland (No. 2), Australia (No. 6), Finland (No. 7), the Netherlands (No. 9) and financial and banking centre Luxembourg rounded out the first 10 finishers, according to a comprehensive study published in the medical journal The Lancet.

Of the 20 countries heading up the list, all but Australia and Japan (No. 11) are in western Europe, where virtually every nation boasts some form of .

The United States—where a Republican Congress wants to peel back reforms that gave millions of people access to health insurance for the first time—ranked below Britain, which placed 30th.

The Healthcare Access and Quality Index, based on for 32 diseases that can be avoided or effectively treated with proper medical care, also tracked progress in each nation compared to the benchmark year of 1990.

Virtually all countries improved over that period, but many—especially in Africa and Oceania—fell further behind others in providing basic care for their citizens.

With the exceptions of Afghanistan, Haiti and Yemen, the 30 countries at the bottom of the ranking were all in sub-Saharan Africa, with the Central African Republic suffering the worst standards of all.

"Despite improvements in healthcare quality and access over 25 years, inequality between the best and worst performing countries has grown," said Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, and leader of a consortium of hundreds of contributing experts.

A warning sign

Furthermore, he added in a statement, the standard of primary care was lower in many nations than expected given levels of wealth and development.

The biggest underachievers in Asia included Indonesia, the Philippines, India and tiny Brunei, while in Africa it was Botswana, South Africa and Lesotho that had the most room for improvement. Regions with healthcare systems underperforming relative to wealth included Oceania, the Caribbean and Central Asia.

Among rich nations, the worst offender in this category was the United States, which tops the world in per capita healthcare expenditure by some measures.

Within Europe, Britain ranked well below expected levels.

"The UK does well in some areas, including cerebrovascular disease," noted co-author Marin McKee, a professor at the London School of Hygiene and Tropical Medicine. "But it lags behind in outcomes of some cancers."

The gap between actual and expected rating widened over the last quarter century in 62 of the 195 nations examined.

"Overall, our results are a warning sign that heightened healthcare access and quality is not an inevitable product of increased development," Murray said.

Between 1990 and 2015, countries that made the biggest improvements in delivering healthcare included South Korea, Turkey, Peru, China and the Maldives.

The 32 diseases for which death rates were tracked included tuberculosis and other respiratory infections; illnesses that can be prevented with vaccines (diphtheria, whooping cough, tetanus and measles); several forms of treatable cancer and heart disease; and maternal or neonatal disorders.

Explore further

First-ever global study finds massive health care inequity

More information: Ryan M Barber et al. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015, The Lancet (2017). DOI: 10.1016/S0140-6736(17)30818-8
Journal information: The Lancet

© 2017 AFP

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User comments

May 19, 2017
where a Republican Congress wants to peel back reforms that gave millions of people access to health insurance for the first time

The reforms you speak of are collapsing under their own weight. Republicans are trying to create a system that covers everyone but is sustainable. The author of this article is obviously biased.

May 19, 2017
Trump got it absolutely right when he said, in public, to Malcolm Turnbull, Prime Minister of Australia:

"We have a failing health care - I shouldn't say this to our great gentleman, my friend from Australia," he said, turning to Mr Turnbull.

"You have better health care than we do."

"But we're going to have great health care very soon."

Australia has universal free basic health care with a competitive private health sector (people have choice) and no employer involvement in employee's health care at all !!

As for JamesG's comment: has he seen what older people earning a modest retirement income are supposed to pay under Trump's plan? 1/3 to half their income...and the tea party Republicans want a complete repeal with no replacement.

It pays to get your facts right, but the Trump Republicans prefer to make up their own 'alternative facts'...

BTW US pays twice what Oz pay for their free health care...

May 19, 2017
Saying that Obamacare is collapsing - and that the Republicans are trying to create a system that covers everyone - is just counter factucal - http://www.market...17-03-22
Please tell us what exactly the Republican plan is going to do - that will reduce costs, and/or make coverage more available.
The root problem in the U.S. health care system is actually pretty straight forward. Health care is a massive industry - with no competition. They can charge us what ever they please. A ct scan in England - under the private pay option - cost my mum around $500. I just paid about $500 co-pay - but the total cost was around $7,000 for a ct scan. Nothing else needs to be said.

May 19, 2017
Nothing else needs to be said.

You forget the part where health care providers need massive liability insurances themselves, because the justice system is a total screwup and you may need to pay millions if someone pours hot coffee on themselves while in your hospital.

May 19, 2017
And how does this correlate with the percentage of fat, sedentary smokers in the population?

May 19, 2017
Eikka - I understand that malpractice insurance is a problem in America - and another aspect of a royally f*cked up system. I don't believe that it is that big a factor in the overall cost of our system. I know several doctors and have had conversations with them about this issue. Mal practice for a Dr. will run you in the region of $4,000 - $40,000 per year depending on specialty, and region - https://www.trust...ractice/ A friend who has just finished her residency - is now being offered staff positions - looking in the $250,000 per year range. $20,000 per year - tax deductible - will not add that much cost per patient.

May 19, 2017
Silly study that tells us nothing substantive about health care systems and quality. Access to healthcare is heavily weighted to socialized healthcare but it doesn't show quality of healthcare outcomes. In other words, if you need treatment and you get treatment, how good are the results? That should be the baseline standard of healthcare quality, but this study doesn't show that.

Everyone in the U.S. has access to the healthcare system in one way or another but many don't avail themselves of it. You can't force people to take advantage of the healthcare system.

The World Health Organization report 2000 also ranked the U.S. very low overall for similar reasons to this study. But in the one area that really matters--responsiveness (how fast and how well the system works)--the U.S. ranked number 1. That's what non-socialized-healthcare gets you, the most responsive healthcare in the world. Which is what you want.


May 19, 2017
Those liability costs are a drop in the bucket of the excessive costs of insurance, and the excessive costs of the health services they pay for, atop the excessive profits for the insurer banks that aren't earned since the outcomes are much worse than the socialist countries we compete with.

You forget

May 19, 2017
No, that study evaluated mortality rates that would be lower with better healthcare, in a scientifically rigorous study of global data, which is why it was published in the peer-reviewed _Lancet_ science journal, which has earned one of the best reputations for scientific integrity.

Meanwhile your post is nothing but stupid lies easily debunked by even just looking at the abstract, or getting real facts from anywhere but say Breitbart / Fakes News / Tass.

We get it: You Conservatives hate healthcare, couldn't care less about your fellow citizens, can't understand how to compete with our socialist foreign competitors, can't understand compassion, will believe any lie peddled to you by your exploiters. But the only ones falling for your tired lies are each other. Don't waste our time on a science site with that propaganda.

Silly study

May 19, 2017
Oh, and true to form you're lying about even the WHO 2000 report you cherrypicked. The US does rank #1 in "responsiveness", but that is defined by the report as responding to Americans' *non-medical* goals. Which is of course important, but it is not the *only* important measure: non-medical goals of course cannot exclude medical goals when measuring the quality of a *medical* system. In the " disabilityadjusted life expectancy (DALE)" metric that the study designated the most important metric, the US ranked 24th on health itself, and only 32nd on the distribution of that equitably through the population. Which is not too far from the 2017 study this article is about. But the US did rank #1 in per-capita health expenditures for those pitiful health outcomes you're lying about.

The World Health Organization report 2000

May 19, 2017
Everyone in the U.S. has access to the healthcare system in one way or another
That is exactly what Rick Perry said in 2010 - http://www.politi...lth-car/ Of course - Perry could not support the claim with any data. Clearly the principle here is tell a lie enough times - and people will think it is the truth.
The reality is very different. All people in the U.S.A. do not have access to health care - https://www.nytim...tml?_r=0

May 20, 2017
I would ask the so called 'conservatives' what false economy is! My Aunt Erma was a hoarder and a saver. Saved EVERYthing, even dead light bulbs. That said, she also saved old oatmeal drums from 'Quaker Oats'. Stored warfarin rat poison in one and kept it under the sink. One green day she left it on the shelf after some forgotten errand, and wouldn't you know it ....GUESS where the warfarin 'oatmeal' ended up. Yup, on her breakfast plate. You see, warfarin as sold as rat poison at one time looked just like the rolled oats in oatmeal. She poisoned herself with her false economy. Just like we are going to do with out insurance driven, 4 trillion dollar annual annual rip-off of the American health care consumer. Sheila Copps, the ex-Canadian Health Care Minister said that and I often quote it to American fools. Especially fools who swallow Hitlerian big lies straight almost out of the mouth of Rudolff Goebbels the National Socialist Propaganda Minister under the paperhanger

May 20, 2017
This is all well and good, but it misses the key point: Take the money out of healthcare and what happens to (what is left of) the American middle class? Take the money out of healthcare and how are politicians to pay for their second and third homes? Take the money out of healthcare and who will advertise on TV? It's absurd to think that healthcare is about making people healthy. It is, and always has been, about making people money. Silly Europeans.

May 20, 2017
Nobody's taking the money out of healthcare. When the US joins its global competitors in sanity with "Medicare for All", healthcare will of course be paid for to its providers.

It's the private health insurance that will be removed. The unearned profits will be gone. So insurance banks won't have that cash to manipulate markets anymore. So those profits won't get spent overseas far more than the healthcare workers and taxpayers overall spend theirs. So those $BILLIONS a year will remain in taxpayers pockets, spent more in the US than they are now.

Plus healthcare won't be dependent on employers, so bad employers won't trap workers that way. Which will make a more efficient labor market: more productive and better paid.

Which will eliminate a lot of waste. The more efficient, more domestic economy will be healthier; with universal access to healthcare, its people healthier. Europe's competitive advantage will finally be taken down a big notch.

This is all

May 20, 2017
having lived in Japan for 5 years I can tell you from my experience and that of relatives and friends here that Japan's healthcare is the worst I've experienced so far. It's all business and zero skill. Zero consideration for the patients. Doctors think themselves gods and think the people are idiots with bank accounts. They look at you from avobe and constantly make some clumsy mistakes. Dentistry is also the poorest one, but don't believe me, just googleit yourself. It's a business sucking your blood directly or worst, sucking the blood of the state. Many of my Japanese friends travelled to China, or Cuba to get their teeth done.

The best I experienced myself so far are China's and my homecountry Argentina. No bullshit, no unnecessary prescriptions, no countless visits.

May 21, 2017
Iceland, which is high on the list, recently:

Prosecuted and jailed their bankers,

re-jiggered their politics and laws,

Re-set their currency,

Forgave all debts public and private,


And excellent medical system.

So the lesson is:

That you can and should crash the banks, jail the bankers and corporate psychopathic scum, reform the laws, remove the usury, re-set the currencies, and MOST IMPORTANTLY----destroy controlling oligarchy.

And the world CAN and WILL right itself.

Works perfectly well, just like it always has. Excepting that the entire western media system has been a solid unified block of ~zero reporting~ on what has gone on in Iceland. They don't want you to know that the world works much better without oligarchy and their controlling and murderous structures. That the world can be a much better place and it is very close, with little in the way of time, or pain... between you and reaching that world.

May 21, 2017
I'm inclined to agree with you. But Iceland is an island with 330K people, all closely interconnected with an extremely long history and an undeniable need to sacrifice short-term for collective long-term survival. With a lot of independence from the rest of the world, at least as a choosable option. While I think that's actually true of every human, seeing the world that way is a lot harder for almost everyone else. And the short term costs are a lot higher for most of us, especially the most influential like Americans.


May 22, 2017
The first clue of a clueless article about the "best" something, is that it does not critically define what "best" is upfront in the context being discussed The outcome of 32 diseases' moralities does not necessarily define the "best" health care system, but rather the treatment of those diseases, without the consideration of the conditions and context that leads to them. For example, diseases that are treatable via vaccines - only demonstrate how effective the respective vaccination programs are, but may have no bearing on the number of trained physicians or hospital beds in the country per unit population. It does not describe the quality of drinking water, a most basic element of preventative healthcare. Articles based on undefined superlatives - are just that - baseless.

May 22, 2017
In a country with as high an average income as we have in America every citizen should have the same level of health care as our elected representatives enjoy. What high income wage earners in AmurdiKKKa must fear most is a single payer health insurance system with the premiums based on income. Otherwise known as an income tax. Isn't that fair? A single payer system is the answer. The rest of the developed world already knows this. A single payer system eliminates the cost of paper work and administration and the profit incentive for insurance companies to not meet their obligation coverage.

May 22, 2017
The very first sentence of the paper linked from the third sentence of the article, that the article is about:
"National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality)."

Shut up troll.

The first clue of a clueless

May 22, 2017
From the article it seems pretty celar that if the US were to adopt a socialized health care system it could save itself a lot of money

E.g. if it adopted a system like, say, Belgium of Austria that would shoot it into the top 10 in no time and also would amount to a potential tax break on the order of 4000 dollars per person (man, woman and child) per year. With universal healthcare thrown in as a bonus. That's not to be sneezed at.

>>"What only the "crazy" conservatives seem to realize is that America is responsible for
>>most of the innovation that makes health care dramatically better than it once was"

Well, the investment comes mainly from international companies (just 2 of the top 8 pharam companies are from the US: Pfizer and Johnson&Johnson). Among the biggest medical device companies you have heavyweights like Siemens and Philips. So I think it's a bit of a stretch to say "most innovations happen in the US"

May 22, 2017
Interesting statistics except the author conveniently forgot to mention that several of these nations with the ''best'' healthcare also practice euthanasia and they abort ''defective'' babies, i.e. Down Syndrome babies. Government funded healthcare is another way for the politicians to control the lives of the citizenry. Whenever they inject themselves into a process, the costs naturally go up because an ever burgeoning, non-contributing bureaucracy develops that adds NOTHING to either the quality of or availability of healthcare. The best example of that is the Veterans Administration, which is free, while veterans die waiting for care. These whiny brats who want everything to be ''free'' are, unfortunately willing to give up their freedoms, spend someone else's money for what they are responsible for doing for themselves.

May 22, 2017
The US does make a huge investment in medical innovation, but it's mostly paid by American consumers/taxpayers not American medical investors. The Federal Department of Health and Human Services, the National Institutes of Health, $billions annually paid to academic research and government research labs: all taxpaid. Americans' globally highest healthcare costs are padded with expenses on risky experimental treatments many of which will be proven failures here before the winners are applied abroad. Insurers are notoriously averse to funding experimental (AKA "innovative") treatments, so public budgets, tax subsidized charitable orgs and private patients' pockets pay for them - though insurance premiums also contribute some.

The resulting commercial successes of course immediately steer their profits to only private investors. Healthcare is property, so in the USA its costs are socialized so its benefits are privatized .

Well, the investment

May 22, 2017
Interesting only to you theocratic fetus and zombie worshippers who force your corrupt, cowardly churches on your most vulnerable neighbors because you're obsessed with euthanasia and abortion. Controlling the lives of people even before the cradle and (you think) after the grave.

Like forcing women (mere childbearing animal vessels to you theocrats) to bear and care for children with defects so severe the child would live only a short time in nothing but misery - if it even gained consciousness. God's plan to love us to death so he can decide who to torture for eternity.

The beloved Medicare and VA systems (cheaper and better care for more people than any other payers) show that government health insurance properly designed and administered (ie. excluding Conservative monkeywrenchers and incompetents) is far better than private bankers controlling healthcare. Americans refuse to let Conservatives throw it away, envying "foreign socialists".


May 22, 2017
Please post it.

Guglielmo Tell:
A word

May 23, 2017
You crazy "Conservatives" (radicals) are destroying the USA's public investments in the innovation that leads the world, and makes America's medical industry profitable. Some damage from Trump's Conservative budget:
National Institutes of Health—$6 billion cut
Centers for Disease Control and Prevention—a 17 percent cut of $1.3 billion
Food and Drug Administration—a 31 percent cut, from $2.7 billion to $1.89 billion (supposedly offset by increased fees from drug and device makers)
Planned Parenthood—barred from Medicaid funding or any other Health and Human Services program
Children's Health Insurance Program (CHIP)—at least a 20 percent cut over the next two fiscal years, as a part of overall cuts in Medicaid funding

These cuts directly destroy Americans' healthcare, and their lives. Along the way it deletes funding for innovation.

What only the "crazy" conservatives

May 24, 2017
I look around America and everyone is stupid, fat, old or all three.

As for the medical field America has been getting along only by poaching doctors from poor countries.

No new medical schools have been built since, what the 1970s?

Just hammering the youth with stupidity in compulsory education, robbing the public purse, and endemic corruption from the bottom to the top.

May 24, 2017
I look around

Are you just looking around your TV at "America"? Because many new medical schools have been built since the 1970s, as even a 10 second Google search shows:

"New medical schools" aren't a measure of medical innovation in a country with hundreds of them, where thousands of candidates from most countries already apply to learn medicine.

The "poaching" claim is extraordinary, requiring extraordinary evidence. Please post it. I'm not going to take the perhaps >15 seconds to disprove that by Googling since your first assertion I addressed was an easily disproved lie.

Oh, and obviously not everyone in America is stupid, fat or old. There are plenty of young, smart Olympians for example. Among many others.

Your last attack on the USA wasn't even a complete sentence, though maybe an accurate series of images - about the USA or any of the dozens of other countries I've visited or lived in.

May 24, 2017
That might be true. Are there more Ethiopian doctors in Chicago than there are non-Ethiopian doctors in Chicago? All your stat indicates is: Chicago pays better and/or is safer than Ethiopia; the US accepts immigrants very well; and Ethiopia can't keep its doctors trapped there.

You can call that poaching, but even if it were, so what? Those doctors (or their fellow immigrant doctors) aren't the primary source (though they might contribute substantially) of US medical innovation, which is what we're talking about.

Guglielmo Tell:

May 25, 2017
Guglielmo Tell:
EmceeSquared: What the

So you're saying that Chicago wouldn't have enough doctors if the World Bank hadn't starved Ethiopia, which constitutes the US poaching foreign doctors.

The US graduates many thousands of native born doctors a year. Few foreign doctors, as a percentage either of all foreign doctors or of all people in the US creating innovation, are in the US creating innovation. A Sikhs inventing fiber optics is just the most irrelevant part of your post.

Meanwhile the US is and always has been a magnet for immigrants who are freer here to innovate or succeed by following the status quo. While the US is also the leading innovator nation as it has been for centuries.

Yours and the other assertions - without facts - that US innovation is somehow not to the credit of the US are not at all persuasive.

May 26, 2017
Guglielmo Tell:
You are

State the contradiction. Now.

Sikhs and Ethiopians are of course free to go. More importantly, free to stay. They stay. What the hell are you talking about?

The Soviet Union was a hellscape that kept its people prisoner, so the ones who could escape did so. To the US where they could be more free to make a living just live.

The US innovates in its own hospitals, as is completely well established. Including by you: You're simultaneously denying the US innovates in its own hospitals, while saying foreign doctors do. You're the one contradicting yourself. And, as typical for you cranks, projecting your major malfunction onto me.

Your conspiracy theories are devoid of facts, logic and evidence. You introduced them with a baseless insult to me. You've posted garbage I've easily shot down, while demonstrated no actual flaw in what I've posted at you.

Post *something* valid, or else just shut up already. Now.

May 27, 2017
Guglielmo Tell:

I told you to state the contradiction. You did not. Because I gave none.

Coltan? Congo? Everything else you're posting is more gibberish, like a stuck pig whining in its squealy language for justice from its mommy.

You apologize now. Or shut up. Better yet, both.

May 28, 2017
Guglielmo Tell:

Squeal some more like a pig stuck with the stench of your own swill. Go on, squeal with an apple in your mouth.

May 30, 2017
Guglielmo Tell:
Go on

OK, filthy liar, tell us more about how a dead pig is sexual to you. The truth is more interesting than your stupid lies.

Jun 11, 2017
Is it a coincidence that in countries where the government provides a free safety net those governments try to divert people away from fast food and unhealthy practices generally, to exercise and get fit. That's because the healthier the people are, the less they have to pay in health care.

But when the government does not provide this then they are more liable to turn a blind eye to these unhealthy practices because of the revenue they collect from fast food outlets.

An example is fast food outlets in Australia must show the number of calories each item on their menu contains, a government health initiative...

Jun 11, 2017
Is it a coincidence that in countries where the government provides a free safety net those governments try to divert people away from fast food and unhealthy practices generally, to exercise and get fit.

There is clearly a causality feedback loop between taxpayers funding healthcare and taxpayers funding programmes that reduce unhealthy behavior while increasing healthy behavior.

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