The U.S. healthcare system is the worst in the Western world, according to a new ranking of 11 wealthy nations in terms of “efficiency, equity and outcomes."

The Commonwealth Fund report found the U.S. has the world’s most expensive healthcare system, but those of 10 other nations — France, Australia, Germany, Canada, Sweden, New Zealand, Norway, the Netherlands, Switzerland, and the U.K. — were all judged to be superior based on various factors.

Those factors include quality of care, access to doctors, and equity throughout the country, Time reports.

One key conclusion: The high rate of expenditure for insurance does not appear to improve either the satisfaction of patients or the quality of service. High out-of-pocket costs and gaps in coverage “undermine efforts in the U.S. to improve care coordination,” the report said.

“Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home,” the report concluded.

A lack of universal health care was noted as the key difference between the U.S. and the other industrial nations.