Health care in Taiwan remains one of the best in the world for your money, according to Bloomberg’s annual ranking of health care efficiency. At ninth place, Taiwan’s ranking is part of analysis released on Sept. 19, which indexes medical costs and value for 56 global economies.

Up from 12th place last year, Taiwan’s position at ninth appears just below Australia which moved up two places to eighth, and Japan which moved down two places to seventh. Hong Kong and Singapore retain the top two spots. The United States dropped four positions to 54th and is the most expensive country for health care treatment.

The index ranks countries with average lifespans of at least 70 years, Gross Domestic Product (GDP) per-capita over US$5,000, and a population of at least 5 million. The analysis used 2015 data from the World Health Organization, which was the latest available, except for Taiwan and Hong Kong, where 2014 data was used.

Key metrics in the ranking include life expectancy, the relative costs of health care (total health costs as a percentage of GDP), and the absolute costs (per capita health costs). The Bloomberg analysis notes that total health costs “generally include preventive and curative health services, family planning, nutrition activities, and emergency aid.”

Quality and accessibility of health care are not mentioned as analysis criteria.

Comparing Taiwan with Hong Kong, life expectancy is 79.7 years for Taiwan vs. 84.3 years for Hong Kong, relative cost is 6.2 percent vs. 5.7 percent, and absolute cost is US$1,402 vs. US$2,222.

The analysis acknowledges year-to-year fluctuations in rankings are affected by economies, legislation such as Obamacare, and political actions such as Brexit.