The total expenditure on healthcare as a proportion of GDP in 2013 was 8.5%, below the OECD average of 8.9% and considerably less than comparable economies such as France (10.9%), Germany (11.0%), Netherlands (11.1%), Switzerland (11.1%) and the USA (16.4%). The percentage of healthcare provided directly by the state is higher than most European countries, which have insurance-based healthcare with the state providing for those who cannot afford insurance. In 2017 the UK spent £2,989 per person on healthcare, the second lowest of the Group of Seven, but around the median for members of the Organisation for Economic Co-operation and Development. The NHS has a reasonable claim to be the most efficient healthcare system in the world. The 2018 OECD data, which incorporates in health a chunk of what in the UK is classified as social care, has the UK spending £3121 per head, France £3471, Australia £3892, Germany £4057 and Sweden £4877.