Money can’t buy everything — including great health care.

The U.S. spends the most of any country on its health care system, and yet it ranked the lowest out of 11 industrialized nations in overall healthcare quality, according to a report published Monday by the Commonwealth Fund.

The report, which covered the years 2011-2013, compared more than 80 indicators of U.S. health care spending, quality and performance to the likes of Australia, the United Kingdom, France, Canada, Germany, New Zealand, and Sweden, among other developed nations.   

The UK, which was ranked highest, blew the U.S. out of the water, despite the fact that the country spends less than half as much on health care per capita ($3,406 on average, compared to $8,508 in the U.S.). The U.S. also spends the most on health care as a percentage of GDP (17%) than any other other nation.

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Source: The Commonwealth Fund

Lead author Karen Davis, of Johns Hopkins Bloomberg School of Public Health, says the findings were disappointing, but not surprising. This is the fifth time in a row that the U.S. has landed at the bottom of the heap in the semi-annual report, in large part due to the fact that, until recently, access to affordable health care was severely lacking.

The data in the report pre-date the full implementation of the Affordable Care Act and the establishment of the healthcare marketplace earlier this year, so there’s a good chance the U.S. will land higher on the list next time. Since the healthcare marketplace opened in October 2013, more than 8 million uninsured Americans have signed up.

“With enactment of the Affordable Care Act… the U.S. performance on access to care should begin to improve, particularly for low-income Americans,” Davis says. “The Affordable Care Act is also expanding the availability and quality of primary care, which should help all Americans have better care and better health outcomes at lower cost.”

Beyond basic affordability, however, the U.S. suffered as well from a deeply fragmented health care system, Davis says.

“[Our low ranking] is also related to time and administrative hassles that come from dealing with health insurers, trying to resolve billing disputes, administrative issues,” she says. “Even doctors report that they spend a lot of time getting [treatments] approved by insurance companies.”

Here’s where the U.S. health care system is failing:

Death rates: The U.S. ranked lowest among other nations in infant mortality rates and  deaths that could have been preventable with timely access to health care. The country also had the second-lowest life “healthy expectancy age” at 60.

Access to affordable care: Low-income people in the U.S. were far likelier to ignore medical issues because of cost than other nations. Nearly 40% of American adults with below average incomes said they did not visit a doctor or fill a prescription due to costs, compared to less than 10% in of adults in the U.K., Sweden, Canada, and Norway. Low-income people in the U.S. were also more likely to wait longer to see a specialist than high-income patients. Even doctors take notice. In the report, nearly 60% of U.S. doctors admitted that health care affordability was a problem for their patients.

Health care quality: Quality was one of the few measures the U.S. showed strength in the Commonwealth report. The U.S. had relatively high scores (4th place) in effective care and patient-centered care (care delivered with the patient’s needs and preferences in mind), but it suffered from low scores in safe and well-coordinated care.

Efficiency: With so much money pumped into health care and so little to show for it, it’s no wonder the U.S. ranked last in efficiency. It scored lowest in reports of administrative hassles (e.g., dealing with insurers), timely access to records and test results, and re-hospitalization. Forty percent of U.S. adults who went to the E.R. in 2011 said their condition could have been treated by a regular physician but could not be seen in time — more than twice the rate in the U.K. The U.S. also scored lowest in communication among healthcare providers and duplicate medical testing.

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