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 4.50 years, and the French lived three more healthy years. Yet Japan spends just $1,750 per person on health and France $2,100.

''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, 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. (From USA TODAY)