It’s not news that American healthcare isn’t the best in the world, but a new report by the Commonwealth Fund says it’s actually the worst. In a survey that analyzed the healthcare systems of 11 countries, the nonprofit organization concluded that American healthcare is officially the most expensive and worst performing among them.

In the latest edition of the organization’s report, Mirror, Mirror On The Wall, researchers ranked the United Kingdom, Switzerland, and Sweden in the top three spots, respectively. Australia, Canada, France, Germany, the Netherlands, New Zealand and Norway were the other countries surveyed for the report. The study concluded that there was one factor that greatly contributed to America’s shameful spot on the list.

“The most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage,” the report reads.

Other nations ensure the accessibility of care through universal health systems and through better ties between patients and the physician practices that serve as their medical homes.”

The study goes on to say, though, that The Affordable Care Act, or “Obamacare,” is addressing this problem slowly by increasing the number of Americans who have access to healthcare, but the data from the report was collected prior to the implementation of the law.

Other problems widely apparent in the U.S. healthcare system include difficulties in coordinating quality patient care, poor performance on national health expenditures and administrative cost measures, and low scores on indicators of overall American health. The U.S. also ranked very low on measures of equity, with the report’s findings showing that one-third or more lower-income adults in the U.S. said they went without needed care in the past year because of costs.

Though all the countries surveyed have room for improvement, the researchers made one point that puts the United States to further shame: They all spend much less on healthcare per person and as a percentage of GDP, but still rank higher.

Even so, there might be hope. Through newly-adopted health information technology programs and mandatory affordable healthcare coverage, the U.S. is, however, making an effort to close the gap in its lackluster healthcare system. Researchers say that new initiatives like the Affordable Care Act and the Recovery and Reinvestment Act will surely help physicians to improve the quality and efficiency of their care to more Americans — and taking a note from other countries who are doing it right will also help.

Many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, but the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care and a team approach to management of chronic conditions. Based on these patient and physician reports, and with the enactment of health reform, the United States should be able to make significant strides in improving the delivery, coordination, and equity of the health care system in coming years.”