Christopher Murray, a researcher at the University of Washington, and his collaborators looked at 32 causes of death in 195 countries from 1990 to 2015 to create a health-care quality index they used for rankings. Murray described the findings as “disturbing.”

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“Having a strong economy does not guarantee good health care,” he said. “Having great medical technology doesn’t, either. We know this because people are not getting the care that should be expected for diseases with established treatments.”

The top country on their list is Andorra, the microstate in the Pyrenees mountains with a population of about 85,000 and an economy is based on tourism. The lowest is the Central African Republic, the landlocked country in the middle of the continent where violence by armed groups against the civilian population has broken out in recent days.

As might be expected, many highly developed nations, such as Norway, Australia and Canada, scored well. Those in more-remote areas in sub-Saharan Africa, South Asia, Latin America and the Caribbean scored poorly. In the map below, the higher the health-care quality index, or HAQ, the better the level of care, according to the study.

The world's superpower doesn't rank where you might expect it to. The United States scores an 80 on the index, which is at the bottom of the second decile and puts it on par with Estonia and Montenegro.

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The United States measures well for diseases preventable by vaccines, such as diphtheria and measles, but it gets almost failing grades for nine other conditions that can lead to death. These are lower respiratory infections, neonatal disorders, non-melanoma skin cancer, Hodgkin’s lymphoma, ischemic heart disease, hypertensive heart disease, diabetes, chronic kidney disease and the adverse effects of medical treatment itself.

“America’s ranking is an embarrassment,” according to Murray, who noted that U.S. health spending per person — $9,000 annually — is more than that of any other country.

The study, published in the Lancet on Thursday evening, offers some models that the United States might want to consider to take steps to improve. It highlights a long list of countries, including Peru, South Korea, Niger and Jordan, that have had health-care quality climb since 1990, meeting or surpassing levels of other countries with similar development.