Being ranked number one isn't always a good thing, as U.S. health care officials found out this week. A new report issued by the World Health Organization (WHO) shows America spends the most for its health care system, but barely made the top 40 when compared to the quality of services delivered by 190 other nations.

European nations received the highest marks for both the amount spent per person and the quality of service delivered to the majority of citizens. France had the best quality of health care on average, according to the World Health Report 2000 - Health Systems: Improving Performance.

Rounding out the top five were Italy, San Marino, Andorra and Malta. Italy and Spain also did well, and the Middle Eastern nation of Oman was a surprising eighth -- surprising because the tiny nation had a staggeringly high infant-mortality rate in the 1970s and spends little per-capita for health care, the New York Times reports.

The United Kingdom -- which spends proportionally less per citizen than other European nations -- was ranked 18th overall.

The rankings were based on five criteria: health and life expectancy; life expectancy "as measured across various populations within a country"; performance rankings of a nation's health care system by its citizens; "fairness in responsiveness" for all population groups; and fairness in the distribution of funding for various population groups.

While the U.S. spends the most for health care and scored near the top in terms of average health care, it fails in terms of delivering quality care across its population and distributes the costs "relatively unfairly," the Times reports.

The full version of the World Health Report 2000 is available online, although a copy of Adobe Acrobat Reader is required to view it.

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