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We might like to think that healthcare in America is some of the best in the world, but that doesn’t mean it’s a particularly efficient system. According to the latest figures released by the Bloomberg Health-Care Efficiency Index, America’s healthcare system is one of the least efficient in the world, ranking 50^th out of the 55 countries surveyed. In dead last was Russia, followed by Brazil, Azerbaijan, Columbia and Jordan. Countries with the most efficient healthcare systems included Hong Kong, Singapore, Spain, South Korea and Japan.

So What do These Rankings Mean?

To measure healthcare efficiency, the researchers compared life expectancies, healthcare spending per capita and relative spending as a portion of a country’s gross domestic product (GDP). Based on these metrics, the study found that, despite spending a disproportionate amount of money on healthcare, America’s average life expectancy is fairly average. Countries that have more efficient healthcare systems tend to spend less per capita while maintaining high average life expectancies.

And What Makes America’s System so Inefficient?

According to Paul Ginsburg, director of the Center of Health Policy at the Brookings Institute in Washington our system “tends to be more fragmented, less organized and coordinated, and that’s likely to lead to inefficiency.”

Bear in mind that the most recent data the researchers had available was from 2014 – the first year that the Affordable Care Act (ACA) went into effect. Because it will likely take years for the impact of the ACA to play out, the researchers are eager to see what effect it will have on the U.S. healthcare system’s rankings in the future. For now, however, it appears that healthcare efficiency in the United States has some serious room for improvement.