Ranking two

The most efficient systems

The lowest money spent per person among the countries with the highest health outcomes. Spending is PPP-adjusted, so it is already corrected for cost of living. The United States is 35th of 35.

PPP international dollars Advanced nations Cuba & Kerala included

Spending, from lowest to highest

All 35 advanced nations · health spending per person, PPP $

Health spending per person

The distance between the United States and the next-highest spender is larger than the entire range of the bottom fifteen countries.

Switzerland, the second-biggest spender, spends $2,871 a head less than the United States. Latvia, at the bottom, spends less than a quarter of the American figure and scores 66.8 against America's 69.9.

The top ten most efficient

Advanced nations scoring 80 or better on health, ranked by lowest spend

Israel, Spain and Japan are the standouts: Israel buys a 94.2 score for $4,033, Spain 95.4 for $4,935, and Japan the best outcomes on earth for $5,365 — 40% of what America spends.
#	Country	Spend / person	Health score	Public share	UHC index	Out-of-pocket

Health score per $1,000 spent

All 64 countries scoring 60 or better on the health composite · higher is better value

Sri Lanka converts spending into health outcomes at roughly 27 times the American rate. On this measure the United States ranks 64th of 64 — last in the world.

Value for money, full field

Every country scoring 60+ on health, ordered best value to worst

Cuba and Kerala

Rich-world results on poor-world budgets — with real caveats on both

Cuba

$2,575 per person buys a life expectancy of 78.3 — statistically indistinguishable from America's 78.9, at one-fifth the cost. It is the most striking number in this research, and it is real.

But the system is in steep decline. Infant mortality has more than doubled since 2016 and now stands at 6.8 — worse than the US. Cuba's registered physician workforce fell by 12,065 between 2021 and 2022, and from 106,131 in 2021 to 75,364 by 2024. Doctors earn roughly $20 a month, and 300 of the 395 medicines produced domestically are out of stock.

Kerala

Roughly $650 PPP per person — about 5% of US spending — for an infant mortality rate of 5, better than the United States' 5.5. Life expectancy is about 75, against India's 72.2.

But Kerala is not a public-financing success: only about 24% of its health spending is government money, and it has the highest out-of-pocket spending of any Indian state. Its achievement rests on public primary-care delivery, female literacy and land reform.

Kerala from India's Sample Registration System (life tables 2018–22, IMR 2023) and National Health Accounts 2021–22, converted at India's PPP factor of ~20.5. Kerala beats the United States on infant mortality at roughly 5% of the spending.
	Kerala	Cuba	India	United States
Life expectancy	~75	78.3	72.2	78.9
Infant mortality	5	6.8	23.3	5.5
Maternal mortality	30	35	80	17
Health spend / person (PPP)	~$650	$2,575	$346	$13,473
Public share of spending	~24%	83.4%	39.0%	54.0%

Before you use the Cuba number

Cuban statistics are contested. Peer-reviewed work in Health Policy and Planning documents doctors reclassifying neonatal deaths as late fetal deaths to meet government targets, and estimates true infant mortality at 7.45–11.16 against the 5.79 officially published. Reported figures for 2025 run to 9.8–9.9, the highest in more than two decades.

The defensible claim: Cuba achieved rich-world life expectancy on a poor country's budget, and that achievement is now eroding fast under economic collapse.

References

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