Costa Rica in the World Health Organization's ranking of the world's health systems

The World Health Organization has carried out the first ever analysis of the world's health systems. Using five performance indicators to measure health systems in 191 member states, it finds that France provides the best overall health care followed among major countries by Italy, Spain, Oman, Austria and Japan.

WHO Director-General Dr Gro Harlem Brundtland says:

The main message from this report is that the health and well- being of people around the world depend critically on the performance of the health systems that serve them. Yet there is wide variation in performance, even among countries with similar levels of income and health expenditure. It is essential for decision- makers to understand the underlying reasons so that system performance, and hence the health of populations, can be improved.

The World Health Report says the main failings of many health systems are:

• Many health ministries focus on the public sector and often disregard the frequently much larger private sector health care.
• In many countries, some if not most physicians work simultaneously for the public sector and in private practice. This means the public sector ends up subsidizing unofficial private practice.
• Many governments fail to prevent a "black market" in health, where widespread corruption, bribery, "moonlighting" and other illegal practices flourish. The black markets, which themselves are caused by malfunctioning health systems, and low income of health workers, further undermine those systems.
• Many health ministries fail to enforce regulations that they themselves have created or are supposed to implement in the public interest.

Ranking:

1. France
2. Italy
3. San Marino
4. Andorra
5. Malta
6. Switzerland

36. Costa Rica
37. United States of America