New health league tables put UK below Jamaica and Chile

The National Health Service, lauded by British governments as the best in the world, is ranked 24th in a new league table rating health efficiency in 191 countries.

The National Health Service, lauded by British governments as the best in the world, is ranked 24th in a new league table rating health efficiency in 191 countries.

The UK comes above Germany and Switzerland in the rankings, published yesterday by the World Health Organisation (WHO), but is below Italy, France, Jamaica, Morocco and Chile. The US comes even lower, at 72nd.

The most efficient service is Oman's – probably because of a drastic cut in child mortality over the past 40 years. The least efficient is Zimbabwe's.

Last year Britain came 18th in a table that used five measures to rank systems, putting France on top. The new research uses just one of the five measures, a country's ability to use resources efficiently.

Researchers took account of levels of education to create a level playing field for rich and poor countries before they measured relative "healthy life expectancy" – the number of years of healthy life people can expect to enjoy.

However, critics said the survey ignored important factors, including diet, in judging how health systems compare. Many of the top scorers are wealthy Mediterranean countries, where people eat plenty of fruit and vegetables.

All the low-scoring countries are poor African states burdened by HIV and Aids and civil war.

David Evans, a health policy researcher at the World Health Organisation, in Geneva, led the study. He said: "This is an attempt to explain why some countries seem to be very efficient and others do not. It is a first step in asking what can be improved and what can't."

The research, published in the British Medical Journal, tries to estimate how healthy the population of different countries would be if there were no modern health services and to estimate the difference each health system makes.

The researchers say the efficiency of a system is linked to how much a country spends on health per head. "There seems to be a minimum level of health expenditure below which the system simply cannot work well," they say, adding that performance increases dramatically as spending approaches £50 a year per head.

They estimate it would cost £3.7bn – about 0.3 per cent of annual global spending on health – to bring the poorest countries up to the £50 threshold.

However they admit there is little information available for the poorest countries. Although some countries could be close to achieving their health potential, there was no way of calculating how they could do so.

Even though the US spends more than any other country on health as a proportion of its gross domestic product, the country's low ranking reflects the fact that the general level of health in the US is "not very high", Dr Evans said. Previous studies have rated the US higher because it scored well for "responsiveness" – the time people have to wait and ease with which they obtain care.

The WHO study, the World Health Report 2000, showed that long waiting times and difficulty in obtaining care are the weakest features in Britain's health service.

The top 25 countries

1 Oman
2 Malta
3 Italy
4 France
5 San Marion
6 Spain
7 Andorra
8 Jamaica
9 Japan
10 Saudi Arabia
11 Greece
12 Monaco
13 Portugal
14 Singapore
15 Austria
16 UAE
17 Morocco
18 Norway
19 The Netherlands
20 Solomon Islands
21 Sweden
22 Cyprus
23 Chile
24 United Kingdom
25 Costa Rica

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