>20 highest ranked healthcare systems are in Europe.

It's not a rank, it's a (bad) efficiency metric, which says that Ukrainian and Kazakhstan HC is "more efficient" than Russian, and that Chilean HC is "more efficient" than that of Denmark.

If you assume this metric shows what's better, it's safe to assume that this metric is garbage. To lazy to dive into the methodology, they weight the date using avg schooling years and other vague staff, but the results rendering this paper totally unsound.

Comparing different countries using a single "performance" metric is nearly always garbage, since all sorts of important nuances are being omitted.