Image caption The UK was rated highly on quality of care and access to care

The UK's health care system is the most efficient, says a study of seven industrialised countries.

The Commonwealth Fund report looked at five areas of performance - quality, efficiency, access to care, equity and healthy lives.

The US came last in the overall rankings, which also included data from Australia, Canada, Germany, the Netherlands and New Zealand.

But there is room for improvement in every country, says the report.

The report, which is an update to three earlier editions, includes patients and doctors' ratings of their experiences in their own health care systems.

More than 27,000 patients and primary care doctors were surveyed across all seven countries as part of the study, starting in 2007.

'Short waiting times'

OVERALL HEALTH SYSTEM RANKING 1. The Netherlands 2. United Kingdom 3. Australia 4. Germany 5. New Zealand 6. Canada 7. United States

The Netherlands ranked first overall, closely followed by the UK and Australia.

The UK performed well when it came to quality of care and access to care.

In relation to access, the study says: "The UK has relatively short waiting times for basic medical care and non-emergency access to services after hours, but has longer waiting times for specialist care and elective, non-emergency surgery."

The Netherlands ranked very highly on all waiting times measurements.

When it came to efficiency, the UK and Australia ranked first and second, respectively.

Efficiency was measured by looking at total national spending on health as a percentage of gross domestic product (GDP), as well as the amount spent on health administration and insurance.

Costly care

In contrast, the US consistently underperformed in most areas of health care relative to other countries, says the study report.

These include access to care and quality of care whatever the background or income of the patient. This is despite the fact, the study says, that the US health system is the most costly in the world.

But, notably, the US differs from the other countries studied because it does not have a universal health insurance system.

However, the study authors believe that health reform legislation brought in in February 2009 will start to address this problem.

"The new legislation should begin to improve the affordability of health insurance and access to care when fully implemented in 2014," says the study.

Karen Davis, president of The Commonwealth Fund and one of the report's authors, cautions that there are limitations in assessing countries' performances using the perceptions and experiences of patients and doctors.

"They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data," she said.

"Patients and physicians' assessments might be affected by their experiences and expectations, which could differ by country and culture."