Healthcare outcomes in the UK remain among the best in the world, but the nation spends slightly more than its peers to achieve them, according to The Economist Intelligence Unit’s Health Outcomes and Spending Index. 

Japan comes top of the Index - which weighs population health in 166 countries against how much they spend on health per head - scoring well on life expectancy and the overall healthiness of its population. The UK is in 23rd place, putting it at the top of six tiers for outcomes, but scoring less well than many other western European countries including France, Germany and Switzerland. UK healthcare spending is lower than in these four countries but higher than in other European countries, such as Italy and Malta, which achieve better outcomes.

Although incomes are affected by other factors beyond healthcare spending – including diet, lifestyles, genetics, climate and wealth levels – this does point to waste or misdirected spending within the NHS, the report comments.

“Cost-cutting measures and reforms have tried to address some of these problems, but the task of maintaining standards will only get more difficult and expensive as the UK population ages,” says the study’s author, Ana Nicholls. For example, UK life expectancy at age 60 is around two years lower than in Japan, and making up that gap will be extremely challenging.

“It is important not to view healthcare spending as a cost but as an investment, and the emphasis should be on getting good value from that investment,” says Ms Nicholls.

The report used World Health Organisation (WHO) figures for 2012 on disability-adjusted life years, health-adjusted life expectancy, life expectancy at age 60 and adult mortality to assess population health outcomes worldwide. It then matched these against 2012 health spending per head in nominal US dollars in the 166 countries, to explore how well their healthcare systems are working.

The results show that health spending generally correlates with population outcomes, but spending accelerates sharply as outcomes improve. There are also wide differences between the amounts spent by countries for similar outcomes.

The regional spread in terms of outcomes is marked. Asia, Europe and North America dominate the higher tiers, with the Middle East, the former Communist belt and Latin America taking up the middle. The bottom three outcome tiers are almost entirely African, with a few poorer Asian nations.

Japan has the best outcomes and scores comparatively well on value for money, but Singapore and South Korea achieve similar outcomes, at even lower cost. The US emerges as a poor-value healthcare system; despite spending the most per head of the 166 countries, at $9,216 in 2012, it ranks 33rd in the outcomes index, behind countries such as Lebanon and Costa Rica.

The poorest outcomes are in Sierra Leone and Lesotho, spending $96 and $138 per head annually, respectively. But other countries with similar HIV and infant mortality profiles, such as Mozambique and Malawi, are achieving better outcomes with far lower spending levels.

Other countries have low outcomes compared with their economic peers; these include South Africa, due to the HIV/AIDS epidemic, and Russia, with its short life expectancy, particularly for men. Among the wealthier countries, Denmark has disappointing outcomes, particularly for cancers.