In a ranking of health care efficiency by country, can you guess where the U.S. falls?

Want medical care without quickly draining your fortune? Try Singapore or Hong Kong as your healthy havens.

The U.S. will cost you the most for treatment, both in absolute terms and relative to average incomes, while life expectancy of Americans — about 79 years — was exceeded by more than 25 countries and territories, according to an annual Bloomberg analysis in almost 200 economies.

A health-efficiency index was then created to rank those with average lifespans of at least 70 years, GDP per-capita exceeding $5,000 and a minimum population of 5 million.

Related: Americans’ health care costs rise again, now $28k per family

Americans aren’t getting their medical money’s worth, according to each of the categories.

The U.S. had the second-highest per-capita spending on health care at $9,536. Switzerland’s average based on gross domestic product was $9,818. But that $282 supplement helped deliver an extra 4.2 years of life — with the average Swiss lifespan of almost 83.

Compared to residents of the Czech Republic — which had an average life expectancy almost at parity with the U.S. — Americans spent more than double on health care relative to GDP, 16.8 percent versus 7.3 percent. Health spending is the U.S. is estimated to increase to 18 percent of GDP in the U.S., according to estimates from the Altarum Institute.

The latest reading of the Bloomberg index reflects the second full year of “Obamacare,” the short name for the U.S. Affordable Care Act, which expanded access to health insurance and provided payment subsidies starting on Jan. 1, 2014. The latest health-efficiency gauge used 2015 data, as that’s the most-recent for most economies from the World Health Organization.

That lag time also puts the spotlight on the U.K., which fell out of Europe’s top 10 in the health ranking based on 2015 data. The nation voted in favor of Brexit the following year, with costs and efficiency of the National Health Service a key issue for British voters.

Spain’s health system efficiency ranked third behind Hong Kong and Singapore, followed by that of Italy, which moved up two spots from a year earlier. Italy ranked as the world’s healthiest country in a separate Bloomberg gauge.

Thailand moved up 14 places to No. 27, the biggest annual improvement, as per-capita spending declined 40 percent to only $219, while life expectancy advanced to 75.1 years. Medical tourism industry is among Thailand’s fastest-growing industries.

Chile, highest-ranked from Latin America last year, tumbled 23 positions, out of the top 10 to 31st, well behind Mexico and Costa Rica. The Chilean government spent 28 basis points more on health expenditure relative to annual GDP, while longevity of its citizens fell more than two years.

Israel and the U.A.E. ranked highest among Middle East economies, with both remaining in the top 10 from last year’s survey.

Costa Rica, Ireland, Lebanon and New Zealand were added to the final index this year, having reached the population threshold — all now ranking among the top 25.

Rankings can change substantially year-over-year because of such things as recession, currency fluctuations and volatile spending patterns relative to the slow pace of improvement in life expectancy.

Check out the full index here:

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