# World Health Organization ranking of health systems in 2000

The World Health Organization (WHO) ranked the health systems of its 191 member states in its World Health Report 2000. It provided a framework and measurement approach to examine and compare aspects of health systems around the world. It developed a series of performance indicators to assess the overall level and distribution of health in the populations, and the responsiveness and financing of health care services. It was the organization's first ever analysis of the world's health systems.

## Ranking

| Country | Attainment of goals / Health / Level (DALE) | Attainment of goals / Health / Distribution | Attainment of goals / Health / Overall goal attainment | Health expenditure per capita in international dollars | Performance / On level of health | Performance / Overall health system performance |
| Afghanistan | 164 | 0 | 183 | 184 | 150 | 173 |
| Albania | 102 | 128 | 86 | 149 | 64 | 55 |
| Algeria | 44 | 63 | 56 | 24 | 45 | 81 |
| Andorra | 10 | 25 | 17 | 23 | 7 | 4 |
| Angola | 165 | 178 | 181 | 164 | 165 | 181 |
| Antigua and Barbuda | 48 | 58 | 71 | 56 | 123 | 86 |
| Argentina | 39 | 60 | 49 | 34 | 71 | 75 |
| Armenia | 41 | 63 | 81 | 102 | 56 | 104 |
| Australia | 2 | 17 | 12 | 17 | 39 | 32 |
| Austria | 17 | 8 | 10 | 6 | 15 | 9 |
| Azerbaijan | 65 | 99 | 103 | 162 | 60 | 109 |
| Bahamas | 109 | 67 | 64 | 22 | 137 | 98 |
| Bahrain | 61 | 72 | 58 | 48 | 30 | 42 |
| Bangladesh | 140 | 125 | 131 | 144 | 103 | 88 |
| Barbados | 53 | 36 | 38 | 36 | 87 | 46 |
| Belarus | 83 | 46 | 53 | 74 | 116 | 72 |
| Belgium | 16 | 26 | 13 | 15 | 28 | 21 |
| Belize | 94 | 95 | 104 | 88 | 34 | 69 |
| Benin | 157 | 132 | 143 | 171 | 136 | 97 |
| Bhutan | 138 | 158 | 144 | 135 | 73 | 124 |
| Bolivia | 133 | 118 | 117 | 101 | 142 | 126 |
| Bosnia-Herzegovina | 56 | 79 | 79 | 105 | 70 | 90 |
| Botswana | 187 | 146 | 168 | 85 | 188 | 169 |
| Brazil | 111 | 108 | 125 | 54 | 78 | 125 |
| Brunei | 59 | 42 | 37 | 32 | 76 | 40 |
| Bulgaria | 60 | 53 | 74 | 96 | 92 | 102 |
| Burkina Faso | 178 | 137 | 159 | 173 | 162 | 132 |
| Burundi | 179 | 154 | 161 | 186 | 171 | 143 |
| Cambodia | 148 | 150 | 166 | 140 | 157 | 174 |
| Cameroon | 156 | 160 | 163 | 131 | 172 | 164 |
| Canada | 12 | 18 | 7 | 10 | 35 | 30 |
| Cape Verde | 118 | 123 | 126 | 150 | 55 | 113 |
| Central African Republic | 175 | 189 | 190 | 178 | 164 | 189 |
| Chad | 161 | 175 | 177 | 175 | 161 | 178 |
| Chile | 32 | 1 | 33 | 44 | 23 | 33 |
| People's Republic of China | 81 | 101 | 132 | 139 | 61 | 144 |
| Colombia | 74 | 44 | 41 | 49 | 51 | 22 |
| Comoros | 146 | 143 | 137 | 165 | 141 | 118 |
| Congo | 150 | 142 | 155 | 122 | 167 | 166 |
| Cook Islands | 67 | 92 | 88 | 61 | 95 | 107 |
| Costa Rica | 40 | 45 | 45 | 50 | 25 | 36 |
| Croatia | 38 | 33 | 36 | 56 | 57 | 43 |
| Cuba | 33 | 41 | 40 | 118 | 36 | 39 |
| Cyprus | 25 | 31 | 28 | 39 | 22 | 24 |
| Czech Republic | 35 | 19 | 30 | 40 | 81 | 48 |
| Democratic Republic of the Congo | 174 | 174 | 179 | 188 | 185 | 188 |
| Denmark | 28 | 21 | 20 | 8 | 65 | 34 |
| Djibouti | 166 | 169 | 170 | 163 | 163 | 157 |
| Dominica | 26 | 35 | 42 | 70 | 59 | 35 |
| Dominican Republic | 79 | 97 | 66 | 92 | 42 | 51 |
| Ecuador | 93 | 133 | 107 | 97 | 96 | 111 |
| Egypt | 115 | 141 | 110 | 115 | 43 | 63 |
| El Salvador | 87 | 115 | 122 | 83 | 37 | 115 |
| Equatorial Guinea | 152 | 151 | 152 | 129 | 174 | 171 |
| Eritrea | 169 | 167 | 176 | 187 | 148 | 158 |
| Estonia | 69 | 43 | 48 | 60 | 115 | 77 |
| Ethiopia | 182 | 176 | 186 | 189 | 169 | 180 |
| Federated States of Micronesia | 104 | 112 | 111 | 81 | 110 | 123 |
| Fiji | 106 | 71 | 78 | 87 | 124 | 96 |
| Finland | 20 | 27 | 22 | 18 | 44 | 31 |
| France | 3 | 12 | 6 | 4 | 4 | 1 |
| Gabon | 144 | 136 | 141 | 95 | 143 | 139 |
| Gambia | 143 | 155 | 153 | 158 | 109 | 146 |
| Georgia | 44 | 61 | 76 | 125 | 84 | 114 |
| Germany | 22 | 20 | 14 | 3 | 41 | 25 |
| Ghana | 149 | 149 | 139 | 166 | 158 | 135 |
| Greece | 7 | 6 | 23 | 30 | 11 | 14 |
| Grenada | 49 | 82 | 68 | 67 | 49 | 85 |
| Guatemala | 129 | 106 | 113 | 130 | 99 | 78 |
| Guinea | 167 | 166 | 172 | 159 | 160 | 161 |
| Guinea-Bissau | 170 | 177 | 180 | 156 | 156 | 176 |
| Guyana | 98 | 126 | 116 | 109 | 104 | 128 |
| Haiti | 153 | 152 | 145 | 155 | 139 | 138 |
| Honduras | 92 | 119 | 129 | 100 | 48 | 131 |
| Hungary | 62 | 40 | 43 | 59 | 105 | 66 |
| Iceland | 19 | 24 | 16 | 14 | 27 | 15 |
| India | 19 | 13 | 121 | 133 | 118 | 112 |
| Indonesia | 103 | 156 | 106 | 154 | 90 | 92 |
| Iran | 96 | 113 | 114 | 94 | 58 | 93 |
| Iraq | 126 | 130 | 124 | 117 | 75 | 103 |
| Ireland | 27 | 13 | 25 | 25 | 32 | 19 |
| Israel | 23 | 7 | 24 | 19 | 40 | 28 |
| Italy | 6 | 14 | 11 | 11 | 3 | 2 |
| Ivory Coast | 155 | 181 | 157 | 153 | 133 | 137 |
| Jamaica | 36 | 87 | 69 | 89 | 8 | 53 |
| Japan | 1 | 3 | 1 | 13 | 9 | 10 |
| Jordan | 101 | 83 | 84 | 98 | 100 | 83 |
| Kazakhstan | 122 | 52 | 62 | 112 | 135 | 64 |
| Kenya | 162 | 135 | 142 | 152 | 178 | 140 |
| Kiribati | 125 | 121 | 123 | 103 | 144 | 142 |
| Kuwait | 68 | 54 | 46 | 41 | 68 | 45 |
| Kyrgyzstan | 123 | 122 | 135 | 146 | 134 | 151 |
| Laos | 147 | 147 | 154 | 157 | 155 | 165 |
| Latvia | 82 | 56 | 67 | 77 | 121 | 105 |
| Lebanon | 95 | 88 | 93 | 46 | 97 | 91 |
| Lesotho | 171 | 164 | 173 | 123 | 186 | 183 |
| Liberia | 181 | 191 | 187 | 181 | 176 | 186 |
| Libya | 107 | 102 | 97 | 84 | 94 | 87 |
| Lithuania | 63 | 48 | 52 | 71 | 93 | 73 |
| Luxembourg | 18 | 22 | 5 | 5 | 31 | 16 |
| Macedonia | 64 | 85 | 89 | 106 | 69 | 89 |
| Madagascar | 172 | 168 | 167 | 190 | 173 | 159 |
| Malawi | 189 | 187 | 182 | 161 | 187 | 185 |
| Malaysia | 89 | 49 | 55 | 93 | 86 | 49 |
| Maldives | 130 | 134 | 128 | 76 | 147 | 147 |
| Mali | 183 | 180 | 178 | 179 | 170 | 163 |
| Malta | 21 | 38 | 31 | 37 | 2 | 5 |
| Marshall Islands | 121 | 120 | 119 | 80 | 140 | 141 |
| Mauritania | 158 | 163 | 169 | 141 | 151 | 162 |
| Mauritius | 78 | 77 | 90 | 69 | 113 | 84 |
| Mexico | 55 | 65 | 51 | 55 | 63 | 61 |
| Moldova | 88 | 64 | 91 | 108 | 106 | 101 |
| Monaco | 9 | 30 | 18 | 12 | 12 | 13 |
| Mongolia | 131 | 148 | 136 | 145 | 138 | 145 |
| Morocco | 110 | 111 | 94 | 99 | 17 | 29 |
| Mozambique | 180 | 190 | 185 | 160 | 168 | 184 |
| Myanmar | 139 | 162 | 175 | 136 | 129 | 190 |
| Namibia | 177 | 173 | 165 | 66 | 189 | 168 |
| Nauru | 136 | 51 | 75 | 42 | 166 | 98 |
| Nepal | 142 | 161 | 160 | 170 | 98 | 150 |
| Netherlands | 13 | 15 | 8 | 9 | 19 | 17 |
| New Zealand | 31 | 16 | 26 | 20 | 80 | 41 |
| Nicaragua | 117 | 96 | 101 | 104 | 74 | 71 |
| Niger | 190 | 184 | 188 | 185 | 177 | 170 |
| Nigeria | 163 | 188 | 184 | 176 | 175 | 187 |
| Niue | 85 | 100 | 102 | 127 | 108 | 121 |
| North Korea | 137 | 145 | 149 | 172 | 153 | 167 |
| Norway | 15 | 4 | 3 | 16 | 18 | 11 |
| Oman | 72 | 59 | 59 | 62 | 1 | 8 |
| Pakistan | 124 | 183 | 133 | 142 | 85 | 122 |
| Palau | 112 | 66 | 63 | 47 | 125 | 82 |
| Panama | 47 | 93 | 70 | 53 | 67 | 95 |
| Papua New Guinea | 145 | 157 | 150 | 137 | 146 | 148 |
| Paraguay | 71 | 57 | 73 | 91 | 52 | 57 |
| Peru | 105 | 103 | 115 | 78 | 119 | 129 |
| Philippines | 113 | 50 | 54 | 124 | 126 | 60 |
| Poland | 45 | 5 | 34 | 58 | 89 | 50 |
| Portugal | 29 | 34 | 32 | 28 | 13 | 12 |
| Qatar | 66 | 55 | 47 | 27 | 53 | 44 |
| Romania | 80 | 78 | 72 | 107 | 111 | 99 |
| Russia | 91 | 69 | 100 | 75 | 127 | 130 |
| Rwanda | 185 | 185 | 171 | 177 | 181 | 172 |
| Saint Kitts and Nevis | 86 | 91 | 98 | 51 | 122 | 100 |
| Saint Lucia | 54 | 86 | 87 | 86 | 54 | 68 |
| Saint Vincent and the Grenadines | 43 | 89 | 92 | 90 | 38 | 74 |
| Samoa | 97 | 81 | 82 | 121 | 131 | 119 |
| San Marino | 11 | 9 | 21 | 21 | 5 | 3 |
| Sao Tome and Principe | 132 | 139 | 138 | 167 | 117 | 133 |
| Saudi Arabia | 58 | 70 | 61 | 63 | 10 | 26 |
| Senegal | 151 | 105 | 118 | 143 | 132 | 59 |
| Seychelles | 108 | 73 | 83 | 52 | 83 | 56 |
| Sierra Leone | 191 | 186 | 191 | 183 | 183 | 191 |
| Singapore | 30 | 29 | 27 | 38 | 14 | 6 |
| Slovakia | 42 | 39 | 39 | 45 | 88 | 62 |
| Slovenia | 34 | 23 | 29 | 29 | 62 | 38 |
| Solomon Islands | 127 | 117 | 108 | 134 | 20 | 80 |
| Somalia | 173 | 179 | 189 | 191 | 154 | 179 |
| South Africa | 160 | 128 | 151 | 57 | 182 | 175 |
| South Korea | 51 | 37 | 35 | 31 | 107 | 58 |
| Spain | 5 | 11 | 19 | 24 | 6 | 7 |
| Sri Lanka | 76 | 80 | 80 | 138 | 66 | 76 |
| Sudan | 154 | 159 | 148 | 169 | 149 | 134 |
| Suriname | 77 | 94 | 105 | 72 | 77 | 110 |
| Swaziland | 164 | 140 | 164 | 116 | 184 | 177 |
| Sweden | 4 | 28 | 4 | 7 | 21 | 23 |
| Switzerland | 8 | 10 | 2 | 2 | 26 | 20 |
| Syria | 114 | 107 | 112 | 119 | 91 | 108 |
| Tajikistan | 120 | 124 | 127 | 126 | 145 | 154 |
| Tanzania | 176 | 172 | 158 | 174 | 180 | 156 |
| Thailand | 99 | 74 | 57 | 64 | 102 | 47 |
| Togo | 159 | 170 | 156 | 180 | 159 | 152 |
| Tonga | 75 | 84 | 85 | 73 | 114 | 116 |
| Trinidad and Tobago | 57 | 75 | 56 | 65 | 79 | 67 |
| Tunisia | 90 | 114 | 77 | 79 | 46 | 52 |
| Turkey | 73 | 109 | 96 | 82 | 33 | 70 |
| Turkmenistan | 128 | 131 | 130 | 128 | 152 | 153 |
| Tuvalu | 119 | 116 | 120 | 151 | 128 | 136 |
| United Arab Emirates | 50 | 62 | 44 | 35 | 16 | 27 |
| Uganda | 186 | 138 | 162 | 168 | 179 | 149 |
| United Kingdom | 14 | 2 | 9 | 26 | 24 | 18 |
| Ukraine | 70 | 47 | 60 | 111 | 101 | 79 |
| United States | 24 | 32 | 15 | 1 | 72 | 37 |
| Uruguay | 37 | 68 | 50 | 33 | 50 | 65 |
| Uzbekistan | 100 | 144 | 109 | 120 | 112 | 117 |
| Vanuatu | 135 | 127 | 134 | 132 | 120 | 127 |
| Venezuela | 52 | 76 | 65 | 68 | 29 | 54 |
| Vietnam | 116 | 104 | 140 | 147 | 130 | 160 |
| Yemen | 141 | 165 | 146 | 182 | 82 | 120 |
| FR Yugoslavia | 46 | 90 | 95 | 113 | 47 | 106 |
| Zambia | 188 | 171 | 174 | 148 | 190 | 182 |
| Zimbabwe | 184 | 98 | 147 | 110 | 191 | 155 |

## Methodology

The rankings are based on an index of five factors:
* Health (50%) : disability-adjusted life expectancy
** Overall or average : 25%
** Distribution or equality : 25%
* Responsiveness (25%) : speed of service, protection of privacy, and quality of amenities
** Overall or average : 12.5%
** Distribution or equality : 12.5%
* Fair financial contribution : 25%

## Criticism

The WHO rankings are claimed to have been subject to many and varied criticisms since its publication. Concerns raised over the five factors considered, data sets used and comparison methodologies have led health bodies and political commentators in most of the countries on the list to question the efficacy of its results and validity of any conclusions drawn. Such criticisms of a broad endeavour by the WHO to rank all the world's healthcare systems must also however be understood in the context of a predisposition to analytical bias commensurate with an individual nation's demographics, socio-economics and politics. In considering such a disparate global spectrum, ranking criteria, methodology, results and conclusions will always be an area for contention.
In over a decade of discussion and controversy over the WHO Ranking of 2000, there is still no consensus about how an objective world health system ranking should be compiled. Indeed, the 2000 results have proved so controversial that the WHO declined to rank countries in their World Health Reports since 2000, but the debate still rages on. With burgeoning and ageing populations, spiralling costs and the recognition by most national governments that constant vigilance and periodic healthcare reform are necessary, the appetite for a means of measuring national performance in broader world contexts is ever increasing and all the more relevant. With this in mind, and in lieu of any further ranking information from the WHO since 2000, there are many analytical bodies now looking at national healthcare delivery in global contexts and publishing their findings. Bloomberg finds "the U.S. spends the most on health care on a relative cost basis with the worst outcome" and notes Cubans live longer than Americans, but Americans pay more than fourteen times as much for less effective health care. The Commonwealth Fund ranked seven developed countries on health care, the US ranked lowest(AU, CA, DE, NL, NZ, UK, US).