[WASHINGTON] The US health-care system remains among the least-efficient in the world.
America was 50th out of 55 countries in 2014, according to a Bloomberg index that assesses life expectancy, health-care spending per capita and relative spending as a share of gross domestic product.
Expenditures averaged US$9,403 per person, about 17.1 per cent of GDP, that year - the most recent for which data are available - and life expectancy was 78.9. Only Jordan, Colombia, Azerbaijan, Brazil and Russia ranked lower.
The US has lagged near the bottom of the Bloomberg Health-Care Efficiency Index since it was created in 2012.
Hong Kong and Singapore - consistently at the top - are smaller countries with less diverse populations. Their governments also play a stronger role in regulating and providing care, with spending per capita averaging US$2,386 and longevity averaging about 83 years.
The US system "tends to be more fragmented, less organised and coordinated, and that's likely to lead to inefficiency," said Paul Ginsburg, a professor at the University of Southern California and director of the Center for Health Policy at the Brookings Institution in Washington.
The index reflects the first full year of Obamacare. While the US Affordable Care Act expanded access to health insurance and provided payment subsidies starting on Jan 1, 2014, its impact on life expectancy will take a while to gauge. That's partly because health care isn't the only influence on longevity.
"It has to do with how we eat, how we live, poverty and inequality, social support," said Jon Oberlander, a professor of health policy at the University of North Carolina at Chapel Hill School of Medicine.
Life-expectancy still is a way of measuring how well, overall, a country's medical system is working, which is why it is used in the index.
Obamacare's impact on cost per capita also is difficult to assess for 2014. Health-care expenditures started moderating in 2010 because of the economic recovery and insurance-policy changes in the private sector, Mr Oberlander said.
Over time, expanding coverage through Obamacare could boost spending "because we know that insured people use more services than uninsured people," Mr Ginsburg said.
Cuba and the Czech Republic - with life expectancy closest to the US at 79.4 and 78.3 years - paid much less on health care: US$817 and US$1,379 per capita. Switzerland and Norway, the only countries with higher spending than the US - US$9,674 and US$9,522 - had longer life expectancy, averaging 82.3 years.
Chile, the first Latin American economy to join the Organisation for Economic Cooperation and Development, is the only country from the continent to have ranked among the top 10, and its life expectancy, at 81.5 years, was the highest.
Rankings for several nations have changed substantially over time because of increased spending relative to the slow pace of improvement in life expectancy.
Sweden fell to 27 in the latest index from 14th in 2009 as per-capita spending rose by more than 50 per cent. Saudi Arabia dropped 20 spots to 38th as its spending increased by almost 80 per cent. Bloomberg calculated an inferred ranking back to 2009 for comparison purposes.
Greece moved up nine spots to 13th, as life expectancy rose by one year and per-capital spending fell almost 40 per cent to US$1,743 from US$2,879.
The country is in the midst of an economic crisis that has wiped away about a quarter of its GDP.