The US spends far more on healthcare than any other country in the world, yet when it comes to quality and accessibility of care it lags behind on the global rankings. To evaluate the effectiveness of healthcare systems we’ve compared the healthcare rankings from the Legatum Prosperity Index 2019, which uses life expectancy, infant mortality and other measures of physical and mental health to determine an overall health score per country, with the World Bank's data on how much citizens have to pay for their medical care. We've crunched the numbers to determine which country's citizens receive the best healthcare for the best price, so click or scroll through to find out who they are.

Despite the fact the government spends a hefty 14.3% of its GDP on healthcare according to OECD figures, the US doesn’t score particularly highly for either the quality or value of care. It ranked in 59th place on the Legatum Prosperity Index for health, while access to care is unequal. According to a recent study one-third of US adults went without the recommended care due to the cost, which, combined with the fact that to receive care you typically need to be part of a medical insurance scheme, is reflected by the low direct out-of-pocket spending by citizens of just under 11% in 2017. In 2019 research found that 66.5% of bankruptcies in America were caused by healthcare, either through high costs or time out of work.

Coming in at 30th place, Cyprus ranked 29th on the Legatum Prosperity Index for health, although the percentage of its healthcare spending that is out-of-pocket is high at 44.6%. In fact, according to the latest OECD data, voluntary spending by citizens is higher than what the government contributes to Cyprus' healthcare system. Like many other countries, Cyprus is in lockdown currently although it has not been badly hit by coronavirus, with just 817 confirmed cases according to recent reports (1 May).

Out of total healthcare expenditure, 27.5% of Portugal’s healthcare spending comes out-of-pocket from its citizens, while it ranked 30^th on the Legatum Prosperity Index for health, putting it in 29^th place for value overall. The country’s healthcare system is made up of its national health service, Serviço Nacional de Saúde (SNS), as well as other social health insurance and private medical insurance schemes. Portugal went into lockdown far sooner than many other European countries, and as a result, it has recorded a comparatively low death toll of 1,063, with 25,524 confirmed cases (3 May).

Finland’s healthcare system is largely publicly funded and just over a fifth of overall expenses are paid out-of-pocket, though patient fees at the point of care are reportedly not high. The country has some of the lowest maternal mortality rates in the world and its life expectancy is high at 82 years, according to the World Bank. However, the country’s decentralised model, whereby each local municipality manages its health care system, can create inequalities in care and is expensive to maintain. 

In 26th place in our rankings, 34.8% of Malta’s healthcare expenses comes from its citizens. While the country's standard of care provided is high, and Malta ranked 14th on the Legatum Prosperity Index for health. Despite this more and more citizens are paying for private healthcare insurance, which has seen an increase in private clinics and hospitals. The island nation, which has a population of just under half a million, has managed to avoid the worst of the coronavirus outbreak, with just 480 confirmed cases and four deaths at last count (5 May).

A fairly low 17.6% of Belgian citizens’ total medical costs are paid out-of-pocket, while the country ranked 24^th on the Legatum Prosperity Index, putting it in 25^th place overall. However, the hub of the European Union recently recorded the highest coronavirus death toll in the world in relation to the size of its population, at 66.5 people per 100,000, according to figures released on 1 May. But the high death toll could partly be down to calculation method as Belgium is counting suspected, not just confirmed COVID-19 cases in its death tolls, while many other countries are not.

Italy’s healthcare system is widely considered one of the best in the Western world, yet it was put under immense strain by coronavirus, which has killed 29,079 of its citizens to date (5 May), the third highest death toll in the world. People pay 23.5% of medical expenses out-of-pocket, with the country's Servizio Sanitario Nazionale (SSN) providing universal, largely free, healthcare for all. Italy's medical care ranked 17th on the Legatum Prosperity Index for health, putting it in 24th place for value. 

The UK’s National Health Service (NHS) was formed in 1948, based on the principle that good healthcare should be available to all. More than 70 years on, it is still considered among the best public medical systems in the world. That said, the British government has been criticised for its handling of the coronavirus crisis, with a lack of Personal Protective Equipment (PPE) for medical staff proving a huge issue, and many people have been raising money for the NHS such as the now world-famous Colonel Tom Moore (formerly Captain). The county’s healthcare is still largely free, however, with just 16% of expenses paid out-of-pocket by citizens.

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Spain has a universal healthcare system, which is largely free, except for some small payments for certain services, with 23.6% of its medical expenses covered by citizens directly out-of-pocket. Yet the medical system has struggled to cope with the number of coronavirus cases and the country has recorded 25,613 deaths (5 May). To give thanks to medical workers, many Spanish people stand outside their homes at 8pm every night and clap – a gesture which has spread to many other countries across the world. 

Hong Kong is considered to have high quality healthcare, which is divided into a public and private system, with 36% of its medical expenses paid by its citizens. During the coronavirus outbreak the country was swift with its testing and tracing actions, which has helped to keep its overall number of cases low at 1,041, with just four deaths. 

Out of Israel’s total medical expenses, 22.3% is paid by its citizens, while the country’s healthcare system ranks highly coming in 11th place on the Legatum rankings. Its coronavirus death toll is fairly low at 237 while there are more than 16,000 confirmed cases (5 May). The country’s universal healthcare system was introduced 20 years ago, with coverage for its citizens provided by four different healthcare plans. 

Despite the fact that just over one-third of South Korea’s medical expenses are paid out-of-pocket by its citizens, the system is considered among the best in the world. The country has a high life expectancy of 82.7 years according to the OECD, while it has the second highest amount of hospital beds at 12.7 per 1,000 people. The country successfully flattened the curve of COVID-19 infections during the coronavirus outbreak with use of extensive testing, contact tracing and tracking apps, and as a result of this it will begin relaxing lockdown measures from 6 May.

The Czech Republic has a decentralised healthcare system based on a compulsory insurance model, where most people obtain insurance plans from their employer in order to access free healthcare. Just 14.8% of the Czech Republic’s total medical costs are paid out-of-pocket by its citizens. With 7,810 confirmed COVID-19 cases and 252 deaths, the country has avoided the high death tolls of many other European countries and is beginning to ease lockdown measures. 

Residents of Cuba pay just 10.5% of their total medical costs out-of-pocket, the second lowest of any country in our list. They’re getting good value for money, too, with the country ranking in 27^th place on the Legatum Prosperity Index for health, which puts Cuba in 15^th place overall for value for money. The country has been praised by the World Health Organisation (WHO) for its healthcare progress over the last 30 years, marked by factors including lower infant mortality rate and increased life expectancy, which are now on a par with developed countries.

Austria’s healthcare works via a two-tier system which means that almost all of its population receive free medical care, but some choose to buy supplementary private insurance. In total, 19.2% of the country’s medical expenses are paid out-of-pocket. The country’s healthcare system has not been overburdened with coronavirus cases thanks to initiating lockdown measures early, which has resulted in a low death toll of 600 (5 May). 

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In Sweden, whose laidback approach to coronavirus policy has caused controversy, there have been 2,769 deaths and 22,721 confirmed COVID-19 cases (5 May). Its healthcare system is publicly funded and decentralised, with the bulk of responsibility for healthcare held by regional and municipal governments, while just 15% of overall medical care costs are paid out-of-pocket by Swedish citizens. The country is considered to have one of the best healthcare systems in the world and it boasts an average life expectancy of 83 years according to the World Bank.

Switzerland has an unusual healthcare model, where individuals take out private medical insurance yet private insurers are required to offer coverage to everyone. In total, 28.9% of medical expenses are paid out-of-pocket while the standard of care is considered high, putting it in third place in the Legatum Prosperity Index for health and in 12th place in our rankings for value for money. According to OECD data, Switzerland spends the second highest amount (government and citizens combined) on its healthcare system, second only to the US.

Singapore has a government-run, universal healthcare system, with 32.1% of all healthcare expenses paid out-of-pocket. There is also a large private medical sector. The country has managed to control the spread of coronavirus through contact tracing and testing, and despite the fact that cases have increased recently, it has still only recorded 18 deaths.

Joining Singapore in 10th place on our rankings is Canada, whose healthcare system, often called Medicare, works via different territorial and provincial insurance plans which give universal care to citizens. As a result, just 14.2% of all medical expenses are paid directly out-of-pocket by citizens. It has had around 30% fewer COVID-19 deaths per capita than the US, as of 4 May. Some of this can be explained by its better-funded public healthcare system, while increased testing has also played a big part. 

Everyone living in Ireland is entitled to public healthcare under the Health Service Executive, its national health service which was established in 2005. The system is funded through taxation and subsidised fees for certain services, and so while the country has one of the highest rates of total spending on healthcare per capita in the OECD, just 12.3% of that spending comes directly out of its citizens' pockets. Compared to the UK, Ireland’s death toll for coronavirus is fairly low at 1,319 and the country has been praised for its earlier and tougher introduction of social distancing measures. 

All of Luxembourg’s 600,000 citizens are entitled to free public healthcare, which is administered through its Ministry of Health. And so perhaps unsurprisingly, just 10.7% of total medical expenses are paid out-of-pocket. The country has recorded 96 COVID-19 deaths at the time of writing, and currently reports 3,828 confirmed cases.

Combining a low out-of-pocket expense (12.7%) and a high ranking on the Legatum Prosperity Index for health (12^th), our ranking places Germany as the sixth best country in the world for healthcare when it comes to value for money. While Germany has been hit hard by coronavirus, its death toll is significantly lower than Spain (25,613), Italy (29,079) and the UK (32,000), with the figure currently at 6,993 (all figures as at 5 May). This is due to a number of factors including increased testing and plentiful intensive care beds.

Denmark’s publicly funded healthcare system is largely managed by each of its five regional governments, although some specialised services are managed at a national level. Just 13.7% of its overall healthcare spending is out-of-pocket, while it ranks eighth on the Legatum Prosperity Index, putting it in joint fourth place overall for value. The country went into lockdown early during the coronavirus pandemic, and as a result its health service has not been overwhelmed and it has been able to loosen restrictions.

Out of all of the countries on our list, French citizens pay the least out-of-pocket for healthcare, at just 9.4% of total spending. The French government, however, spends 9.3% of its GDP on healthcare which is higher than many other OECD nations such as Canada (7.5%) and the UK (7.5%), although it remains significantly lower than the US government (14.3%). But France's response to coronavirus been criticised, with president Emmanuel Macron admitting in a recent television address to the nation: “Were we prepared for this crisis? On the face of it, not enough. But we coped.” The country’s COVID-19 death toll is high at 25,201 as of 5 May.

Norway has a decentralised healthcare system where responsibility for the provision of care is at the hands of municipal government. Healthcare is not actually free – residents pay for treatment, including GP consultations, up to the value of 2,000 Krone ($204/£163)-a-year, at which point they are eligible for an exemption card which gives them free treatment. Despite this, just 14.2% of overall healthcare expenditure is paid directly out-of-pocket by citizens.

Healthcare in the Netherlands is of a high quality and easily accessible. The system is managed by the government, but individuals are required to take out health insurance from private companies, and so just 11% of all healthcare costs are paid for out-of-pocket. The country’s death rate from coronavirus is 5,168, far lower than many European countries. 

Japan has one of the highest life expectancies in the world at 84 years, according to the World Bank, and the country is widely regarded as having one of the best healthcare systems in the world. Each Japanese citizen is required to take out health insurance but this is largely paid for by the government, with the remaining 10-30% paid for by the individual, depending on means. Insurance companies are banned from making a profit on medical insurance, resulting in a system that’s cheaper and more efficient for citizens. Overall, just 12.8% of medical expenses are paid out-of-pocket by citizens.

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