The U.S. health-care system remains among the least-efficient inthe world.

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America was 50th out of 55 countries in 2014, according to aBloomberg index that assesses life expectancy, health-care spendingper capita and relative spending as a share of gross domesticproduct. Expenditures averaged $9,403 per person, about 17.1percent of GDP, that year — the most recent for which data areavailable — and life expectancy was 78.9. Only Jordan, Colombia,Azerbaijan, Brazil and Russia ranked lower.

The U.S. has lagged near the bottom of the Bloomberg Health-Care EfficiencyIndex since it was created in 2012. Hong Kong andSingapore — consistently at the top — are smaller countries withless diverse populations. Their governments also play a strongerrole in regulating and providing care, with spending per capitaaveraging $2,386 and longevity averaging about 83 years.

The U.S. system “tends to be more fragmented, less organized andcoordinated, and that’s likely to lead to inefficiency,” said PaulGinsburg, a professor at the University of Southern California anddirector of the Center for Health Policy at the BrookingsInstitution in Washington.

Expanded access

The index reflects the first full year of Obamacare. While theU.S. Affordable Care Act expanded access to health insurance andprovided payment subsidies starting on Jan. 1, 2014, its impact onlife expectancy will take a while to gauge. That’s partly becausehealth care isn’t the only influence on longevity.

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“It has to do with how we eat, how we live, poverty andinequality, social support,” said Jon Oberlander, a professor ofhealth policy at the University of North Carolina at Chapel HillSchool of Medicine.

Life-expectancy still is a way of measuring how well, overall, acountry’s medical system is working, which is why it is used in theindex.

Obamacare’s impact on cost per capita also is difficult toassess for 2014. Health-care expenditures started moderating in2010 because of the economic recovery and insurance-policy changesin the private sector, Oberlander said.

Over time, expanding coverage through Obamacare could boostspending “because we know that insured people use more servicesthan uninsured people,” Ginsburg said.

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Cuba and the Czech Republic — with life expectancy closest tothe U.S. at 79.4 and 78.3 years — paid much less on health care:$817 and $1,379 per capita. Switzerland and Norway, the onlycountries with higher spending than the U.S. — $9,674 and $9,522 —had longer life expectancy, averaging 82.3 years.

Chile, the first Latin American economy to join theOrganization for Economic Cooperation and Development, is the onlycountry from the continent to have ranked among the top 10, and itslife expectancy, at 81.5 years, was the highest.

Rankings for several nations have changed substantially overtime because of increased spending relative to the slow pace ofimprovement in life expectancy. Sweden fell to 27 in the latestindex from 14th in 2009 as per-capita spending rose by more than 50percent. Saudi Arabia dropped 20 spots to 38th as its spendingincreased by almost 80 percent. Bloomberg calculated an inferredranking back to 2009 for comparison purposes.

Greece moved up nine spots to 13th, as life expectancy rose byone year and per-capital spending fell almost 40 percent to $1,743from $2,879. The country is in the midst of aneconomic crisis that has wiped away about a quarterof its GDP.

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