Neither Canada nor Japan cracked the top 10 and the United States finished a dismal 35th, according to a much anticipated ranking of health care quality in 195 countries, released Friday.

Among nations with more than a million people, top honors for 2015 went to Switzerland, followed by Sweden and Norway, though the health care gold standard remains tiny Andorra, a postage stamp of a country nestled between Spain (No. 8) and France (No. 15).

Iceland (No. 2), Australia (No. 6), Finland (No. 7), the Netherlands (No. 9) and financial and banking center Luxembourg rounded out the first 10 finishers, according to a comprehensive study published in the medical journal The Lancet.

The Health Care Access and Quality Index, based on death rates for 32 diseases that can be avoided or effectively treated with proper medical care, also tracked progress in each nation compared to the benchmark year of 1990.