France has the best healthcare system in the world according to the only ranking of national health systems the World Health Organization has ever published, in its World Health Report 2000, which placed France first, Italy second and San Marino third out of 191 member states. That ranking is now more than 25 years old and the WHO has never repeated it, so the answer depends on the yardstick: the Commonwealth Fund’s comparisons of rich countries put Norway, the Netherlands and Australia on top in 2021, and a 2017 Lancet study of healthcare access and quality placed Iceland second in the world. This guide explains what each measure counts before giving the ranking itself.
What the WHO’s World Health Report 2000 actually scored
The WHO’s exercise was the organisation’s first attempt to compare the health systems of all its member states, and it did not simply reward the healthiest populations. It built an index from five parts, each with a fixed weight:
- Level of health (25%), measured as disability-adjusted life expectancy, or DALE: the years a person can expect to live in full health.
- Distribution of health (25%): how evenly that health is shared across the population.
- Responsiveness (12.5%): speed of service, protection of privacy and the quality of amenities.
- Distribution of responsiveness (12.5%): whether poorer or rural groups get the same treatment as everyone else.
- Fairness of financial contribution (25%): whether households pay for care in proportion to their means rather than being ruined by illness.
Adding those up gave a country’s overall “goal attainment”. The headline ranking went one step further. It measured how much each system achieved compared with what it could be expected to achieve for the money and education available, so the final list is a ranking of efficiency. That is why a country could rank first on performance while sitting far down on raw health. Oman is the clearest example: it placed 72nd for level of health but first for performance on level of health, because the gains it had made for its spending were so large, and it finished eighth overall.
The method drew criticism almost at once. Health bodies and commentators in many countries questioned the choice of the five factors, the data behind them and the weighting. The controversy was serious enough that the WHO declined to rank countries in any World Health Report after 2000. The table below is therefore a snapshot of how systems looked in the late 1990s, not a verdict on how they perform now.
Commonwealth Fund and Lancet HAQ: the rival rankings
Two newer measures are cited most often in place of the WHO list, and each counts something different.
The Commonwealth Fund, a private US foundation, has published a series of reports under the title “Mirror, Mirror” since 2004. It compares a small group of high-income countries, usually eleven: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. The data come from patient and doctor surveys plus OECD and WHO statistics, grouped under five themes: access to care, the care process, administrative efficiency, equity and healthcare outcomes. The United Kingdom was ranked best overall in 2007, 2010, 2014 and 2017; in 2021 Norway, the Netherlands and Australia were the top performers. Because it covers only rich democracies, the Commonwealth Fund cannot say anything about Singapore, Japan or Italy.
The Healthcare Access and Quality (HAQ) Index comes from the Global Burden of Disease study. Instead of surveying patients, it looks at death rates from causes that should rarely be fatal when timely, effective medical care is available, and turns them into a single score. On the 2017 Lancet publication, Iceland had the second-highest HAQ score in the world. Iceland’s system is state-centred and paid for mostly through taxes, about 84% of the cost, with service fees covering the rest; there is almost no private insurance and there are no private hospitals. Primary care has been universal since the 1973 Health Care Act, which requires every patient to register with a health centre and a general practitioner of their choice. Because Iceland has no specialist training system of its own, its doctors typically spend eight to ten years working abroad before coming home, and many keep links with the hospitals where they trained.
A fourth yardstick, spending, is easy to measure and often confused with quality. In 2019 the United States spent 16.8% of its GDP on healthcare, and Switzerland, the next highest in the Commonwealth Fund’s group, 11.3%, yet the Commonwealth Fund has placed the United States last among its eleven countries in every report. Spending buys inputs; none of the rankings above rewards spending for its own sake.
The WHO 2000 top ten, from France to Japan
With those caveats, here is the WHO’s top ten, with each country’s rank for level of health (DALE) and for spending per person in 2000, and its life expectancy at birth in 2023 from the United Nations for comparison. The chart plots that last column.
| WHO 2000 rank | Country | Level of health (DALE) rank | Spending per head rank | Life expectancy 2023 (UN, years) |
|---|---|---|---|---|
| 1 | France | 3 | 4 | 83.33 |
| 2 | Italy | 6 | 11 | 83.72 |
| 3 | San Marino | 11 | 21 | 85.71 |
| 4 | Andorra | 10 | 23 | 84.04 |
| 5 | Malta | 21 | 37 | 83.30 |
| 6 | Singapore | 30 | 38 | 83.74 |
| 7 | Spain | 5 | 24 | 83.67 |
| 8 | Oman | 72 | 62 | 80.03 |
| 9 | Austria | 17 | 6 | 81.96 |
| 10 | Japan | 1 | 13 | 84.71 |
A quarter of a century later, all ten still have life expectancies above 80 years, and eight of them are above 83. Whatever its flaws, the list still reads as a roll call of well-run systems.
France and Italy
France came first because it scored near the top on almost every component: third for level of health, fourth for spending and fourth for performance on health. Its system dates from 1945 and covers every citizen and legal resident through mandatory insurance funds, which since reform all reimburse at the same rate. Patients choose a reference doctor, usually a general practitioner, who acts as a gatekeeper to specialists under the “parcours de soins coordonné”. The Pitié-Salpêtrière in Paris, shown at the top of this page, is a teaching hospital of Sorbonne University and part of the Paris public hospital group AP-HP.
Italy, second, had set up its universal Servizio Sanitario Nazionale only in 1978, replacing a patchwork of sickness funds that had left around 7% of the population uninsured, mostly in the south. It is run region by region, a devolved structure that followed the 2001 constitutional referendum.
San Marino, Andorra and Malta
Three small states took third, fourth and fifth places. San Marino runs a universal system complemented by private care. Andorra’s public system goes back to 24 September 1918, when it was created in response to the Spanish flu. Malta has a recorded hospital from 1372, and today its public service is free at the point of delivery, backed by a strong network of general practitioners. Small, compact populations may have been helped by the distribution measures, which together made up more than a third of the WHO index.
Singapore, Spain, Oman, Austria and Japan
Singapore ranked sixth while spending less per head than any other country in the top ten except Oman (it was 38th for spending), thanks to compulsory Medisave accounts that make households pay part of their own bills, backed by MediShield insurance and MediFund for those who cannot. Spain, seventh, runs a universal system and by 2016 led the world in organ transplants.
Oman’s eighth place reflects its efficiency score rather than its health level, as explained above. Austria, ninth, was a big spender, sixth per head, and ranked eighth for how evenly health was shared. Japan, tenth, had the highest level of health of any country and the highest overall goal attainment, but slipped to tenth once those results were set against the resources available; its universal health insurance dates from 1961.
Why the United States placed 37th despite spending the most
The WHO ranked the United States first in the world for spending per person and 37th overall. It placed 24th for level of health and 72nd for performance on level of health, the same efficiency measure on which Oman came first. The United Kingdom was 18th, Germany 25th, Canada 30th and Australia 32nd, so the UK and Australia, which have both led recent Commonwealth Fund reports, were outside the WHO top ten.
The American figures that drag the country down in newer comparisons are about coverage rather than technology. According to the Commonwealth Fund’s biennial survey, 43% of working-age adults were inadequately insured in 2022: 9% had no insurance at all, 11% had a gap in coverage during the year, and 23% were insured all year but with cover too thin to make care affordable.
That contrast is the best reason to treat any single answer with care. The WHO rewarded efficiency and fairness, the Commonwealth Fund rewards access and patient experience among rich countries, and the HAQ Index rewards avoiding preventable deaths. France leads the WHO’s global ranking, while newer comparisons favour Norway, the Netherlands, Australia and Iceland. For countries that make treatment free at the point of use, see our guide to countries with free healthcare; for the outcome most of these systems are ultimately judged on, see the ranking of countries with the highest life expectancy.