Universal healthcare is a deceptive term. There are still many countries that do not implement it, so just how useful is universal healthcare if it is in place – in theory – but there’s no money spent on it? Health is an expensive business. For example, the National Health Service of the UK (NHS) alone costs more than £127 billion ($211 billion) each year. British citizens benefit from largely free health care – a hefty proportion of their taxes ensures they needn’t worry about health insurance.
This top 10 list has been sorted by the amount of money governments spend on health care represented as a percentage of their Gross Domestic Product (GDP) – arguably a more honest representation of a nation’s commitment to health care than the simple volume of money spent. Obviously a country like China, with a GDP north of $8 trillion, will spend much more money as a physical amount on healthcare than a country like Switzerland which only has a GDP of $631 million. However, when taken as a percentage figure, Switzerland spends 10.9 percent of its GDP helping keep its 8 million people healthy, whereas China only offers a measly 5.2 percent of its GDP for its 1.3 billion potential patients. Of course, this list is largely populated by smaller nations; those are the nations which, typically, don’t need to spend so much of their GDP on things like maintaining a huge military or a wide range of sophisticated infrastructure.
The data used to compile this list, the most recent available, is provided by the World Health Organization (WHO) as of 2012; these are the top 10 countries by Total Health Expenditure (THE) by percentage of GDP.
10. Lesotho: 11.55 percent
The tiny southern African nation of Lesotho, which is completely surrounded by South Africa, spends a huge percentage of its GDP on health; more than Canada (10.93), Japan (10.07) or the UK (9.44). However, the nominal GDP for this poverty-stricken country is just over $2.6 billion, a pittance compared to a developed country. The average life expectancy in Lesotho is one of the lowest in the world, at 52.65 years (Chad is the worst at 49.44 years). Lesotho has a huge HIV/AIDS problem to deal with, which may explain the high proportion of health care spending.
9. Republic of Moldova: 11.72 percent
Moldova is a country in East Europe that was once part of the Soviet Union. It is a poor country compared to its neighbors, with a low nominal GDP of just $7.2 billion. The average life expectancy is at a level of 70.12 years, considerably higher than the African countries on this list. Health expenditure in the country has risen over the years; it was just 4.2 percent of GDP in 2009. This landlocked nation has struggled with tuberculosis outbreaks over the last couple of decades.
8. France: 11.75 percent
The first country on this list with a truly powerful nominal GDP, France is one of the richest countries in the world with $2.86 trillion Gross Domestic Product. Unsurprisingly, the life expectancy rate in this popular tourist destination is also high, currently reaching an average of 81.66 years. The quality of healthcare in France is very high with the World Health Organization claiming the country offered the overall best healthcare available in the world. Although obesity is starting to become an issue with the famously gastronomic nation, obesity levels are still far behind countries such as the US and UK.
7. Netherlands: 12.44 percent
Famed for its modern methods of governing and liberal freedom, the Netherlands spends a large portion of its GDP on caring for the people. A nominal GDP of $800 billion helps Dutch people reach an average life expectancy of 81.12 years. The healthcare system in the Netherlands is also highly rated and is paid for through a combination of obligatory state insurance, taxes, private health insurance providers and other means.
6. Federated States of Micronesia: 12.79 percent
This island nation, scattered some 1,802 miles north-east of Australia, has a nominal GDP of $277 million and a population of just 106,104. The country, which enjoys a Compact of Free Association with the US, has an average life expectancy of 72.35 years. This means Micronesians can expect to live longer than Russians (70.16 years), Indians (67.80 years) and Pakistanis (67.05 years).
5. Sierra Leone: 15.08 percent
Sierra Leone is a tiny country on the west coast of Africa which has a nominal GDP of $3.7 billion, meaning its 6.1 million population have to manage on barely $600 a year. The average life expectancy in this turbulent nation is depressingly low at 57.39 years. Free healthcare is offered to certain elements of the population (such as pregnant women) but the country also suffers from one of the highest maternal death rates in the world: 890 deaths per 100,000 people.
4. Tuvalu: 15.43 percent
A Polynesian country that can be found about halfway between Australia and Hawaii, stranded in the middle of the Pacific Ocean. A small population of just 10,837 people, generating an equally small GDP of $36 million, manages to spend over 15 percent of that figure on healthcare. The average life expectancy in Tuvalu is 65.81 years and there is only one hospital available to Tuvaluans. However, the country does not have a military and therefore incurs no expenses maintaining a defense force.
3. Liberia: 15.53 percent
Liberians are some of the poorest people on the planet; the nominal GDP per capita stands at $436. Two recent civil wars have torn the nation apart, destroying the infrastructure and killing hundreds of thousands of people. The percentage of GDP spent on health seems high, but as the total GDP is just $1.7 billion for a country with over 4 million people, the actual monetary sum spent on health is low. Average life expectancy is just 58.21 years and by the time the Second Liberian Civil War had ended, in 2003, around 95 percent of the country’s healthcare facilities had been destroyed.
2. Marshall Islands: 15.62 percent
Another Pacific Ocean island nation occupies a spot on this list. The Republic of the Marshall Islands consists of over 1,000 islands which are home to 68,480 people (similar population to the city of Youngstown, Ohio). The nominal GDP is estimated at $115 million, but as the USA offers defense for the country, there is no military expenditure. Life expectancy is quite high, at 72.58 years, although the Marshallese people are one of the few populations in the world that have to worry about the health effects of nuclear radiation. One of the atolls in the Marshall Islands is the world-famous Bikini Atoll, famous for having a swimsuit named after it – and for the fact it was a nuclear weapons testing site. Sixty-seven US nuclear weapons were tested in the Marshall Islands, with hundreds of millions of dollars later being paid in compensation to the locals.
1. USA: 17.91 percent
It may be something of a surprise to see the USA in the top spot for this particular subject, considering the prevalence of poor African countries and remote Pacific Island nations. But the USA spends a huge amount of money on healthcare, more than a sixth of the nominal GDP of $17.4 trillion, to look after its population of 317 million. Average life expectancy is 79.56 years, lowered by the obesity problems that the country is facing (Japanese people can expect 84.46 years). The US also spends the most money on healthcare per capita at $8,508, much higher than second-placed Norway on $5,669 and more than double the per capita spending of France at $4,118.