WASHINGTON (AP) --

The United States spends more per person on health care than any other country, yet in overall quality its care ranks 37th in the world, says a World Health Organization analysis. It concluded that France provides the globe's best health care.

Italy ranked No. 2, says the World Health Report, being published Wednesday -- a highly contentious first attempt to compare the world's health systems.

Tiny countries with few patients to care for -- San Marino, Andorra, Malta -- crowd onto the World Health Organization's surprising best list. Singapore, Spain, Oman, Austria and Japan round out the top-10.

That doesn't mean the French and Italians are the world's healthiest people. Japan actually won that distinction.

Instead, the WHO report basically measures bang for the buck: comparing a population's health with how effectively governments spend their money on health, how well the public health system prevents illness instead of just treating it and how fairly the poor, minorities and other special populations are treated.

When each country's measurements were added together, even study co-author Dr. Christopher Murray, a Harvard health economist and the health organization's chief of health policy evidence, was surprised. He had expected Scandinavian countries or Canada to be the world's best, because they're always presented as models.

Instead, Norway hit No. 11, Canada 30.

Britain, with its much-debated free national health service, came in 18th.

The report sparked immediate controversy.

"Any set of rankings that puts Finland at 31 and Italy at 2, or even France at No. 1, raises questions," said Nick Bosanquet, health policy professor at London University's Imperial College, noting that previous studies have been highly critical of Italy.

"They are obviously getting an olive oil effect," he added, referring to the famed Mediterranean diet.

Italians themselves have expressed dissatisfaction with health care, said a surprised E. Richard Brown, director of the University of California, Los Angeles, Center for Health Policy Research.

It's long been clear "the U.S. is woefully lacking," Brown said. Proof, he said, is in the 40 million uninsured Americans amid a patchwork of different quality private insurance and government programs.

While good at expensive, heroic care, Americans are very poor at the low-cost preventive care that keeps Europeans healthy, said Princeton University health economist Uwe Reinhardt. Take prenatal care, vital to a healthy start in life. Reinhardt called France the world's role model, while many poor Americans never get prenatal care.

Regardless of debate over rankings and what criteria to use, the World Health Organization won wide praise for establishing a way countries' improvement, or worsening, can be measured.

The United States spends a stunning $3,724 per person on health each year. But measuring how long people live in good health -- not just how long they live -- the Japanese beat Americans by 4{ years, and the French lived three more healthy years. Yet Japan spends just $1,759 per person on health and France $2,125.

"That's a pretty big gap," noted Murray. "For the money we're spending, we should be able to do a lot better."

How did Oman, which spends just $334 per person on health care, rate No. 8?

Previous analyses have looked just at how healthy people are, "and you're left with the image that the rich (countries) do well because they're rich," said study co-author Dr. Julio Frenk. This new analysis praises health systems "that utilize few resources very well."

Twenty years ago, one in four children in Oman died before their fifth birthday. Today that has plummeted to 15 deaths per 1,000 children, Frenk said. He also cited 24-hour clinics and a new tax-funded universal care system.

Indeed, who pays the cost of health care, and how fair payments are, are important to WHO's rankings. In most of the world the poor pay a disproportionate share, particularly in "out-of-pocket" expenses that drive families into bankruptcy just when someone's sick, the report said.

No country that spends less than $60 a person on health care does well, the report added. Yet 42 countries spent less than that -- like Somalia, at $11.

Many of the worst-faring countries are in sub-Saharan Africa. Largely because of the AIDS epidemic, healthy life expectancy for babies born this year in many of those nations has dropped to 40 years or less, WHO said.

Worst in the 191-country ranking: Sierra Leone, Myanmar, Central African Republic, Democratic Republic of the Congo and Nigeria.

WHO recommended that countries extend health insurance to as many people as possible. That doesn't mean endorsing government-run insurance, Frenk stressed. He said countries with good mixes of private and public programs do well.

But "the worst way to pay for care is out of pocket at the time of illness," he said. The World Health Organization's ranking of the world's health systems:

Rank Country

1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 United Kingdom
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States
38 Slovenia
39 Cuba
40 Brunei
41 New Zealand
42 Bahrain
43 Croatia
44 Qatar
45 Kuwait
46 Barbados
47 Thailand
48 Czech Republic
49 Malaysia
50 Poland
51 Dominican Republic
52 Tunisia
53 Jamaica
54 Venezuela
55 Albania
56 Seychelles
57 Paraguay
58 South Korea
59 Senegal
60 Philippines
61 Mexico
62 Slovakia
63 Egypt
64 Kazakhstan
65 Uruguay
66 Hungary
67 Trinidad and Tobago
68 Saint Lucia
69 Belize
70 Turkey
71 Nicaragua
72 Belarus
73 Lithuania
74 Saint Vincent and the Grenadines
75 Argentina
76 Sri Lanka
77 Estonia
78 Guatemala
79 Ukraine
80 Solomon Islands
81 Algeria
82 Palau
83 Jordan
84 Mauritius
85 Grenada
86 Antigua and Barbuda
87 Libya
88 Bangladesh
89 Macedonia
90 Bosnia-Herzegovina
91 Lebanon
92 Indonesia
93 Iran
94 Bahamas
95 Panama
96 Fiji
97 Benin
98 Nauru
99 Romania
100 Saint Kitts and Nevis
101 Moldova
102 Bulgaria
103 Iraq
104 Armenia
105 Latvia
106 Yugoslavia
107 Cook Islands
108 Syria
109 Azerbaijan
110 Suriname
111 Ecuador
112 India
113 Cape Verde
114 Georgia
115 El Salvador
116 Tonga
117 Uzbekistan
118 Comoros
119 Samoa
120 Yemen
121 Niue
122 Pakistan
123 Micronesia
124 Bhutan
125 Brazil
126 Bolivia
127 Vanuatu
128 Guyana
129 Peru
130 Russia
131 Honduras
132 Burkina Faso
133 Sao Tome and Principe
134 Sudan
135 Ghana
136 Tuvalu
137 Ivory Coast
138 Haiti
139 Gabon
140 Kenya
141 Marshall Islands
142 Kiribati
143 Burundi
144 China
145 Mongolia
146 Gambia
147 Maldives
148 Papua New Guinea
149 Uganda
150 Nepal
151 Kyrgystan
152 Togo
153 Turkmenistan
154 Tajikistan
155 Zimbabwe
156 Tanzania
157 Djibouti
158 Eritrea
159 Madagascar
160 Vietnam
161 Guinea
162 Mauritania
163 Mali
164 Cameroon
165 Laos
166 Congo
167 North Korea
168 Namibia
169 Botswana
170 Niger
171 Equatorial Guinea
172 Rwanda
173 Afghanistan
174 Cambodia
175 South Africa
176 Guinea-Bissau
177 Swaziland
178 Chad
179 Somalia
180 Ethiopia
181 Angola
182 Zambia
183 Lesotho
184 Mozambique
185 Malawi
186 Liberia
187 Nigeria
188 Democratic Republic of the Congo
189 Central African Republic
190 Myanmar
191 Sierra Leone