As Americans, we like to think of ourselves as leading the world in practically everything, but here’s one list we’d be better off not topping: Senior citizens here are sicker than their counterparts in 10 other high-income nations, according to a recent survey. To make matters worse, they face greater financial challenges regarding their health care than those in the other nations.

In The Commonwealth Fund survey, 36 percent of Americans 65 and older reported having three or more chronic conditions. By comparison, only 13 percent of seniors in New Zealand reported that many illnesses. Nearly one in four older Americans said that in the last year, they had not visited a doctor when sick, skipped a recommended test, did not fill a prescription or skipped doses — all because of the costs. In France, Norway, the United Kingdom and Sweden, that number was 5 percent.

The cost of health care is a huge issue, despite Medicare. Nearly 25 percent of Americans surveyed said they spent more than $2,000 each year on out-of-pocket medical expenses. Among the other countries surveyed, only one topped 10 percent.

The researchers said many seniors had gaps in their health insurance coverage during their working years and were lax in preventive care, leaving them with unmanaged chronic conditions.

The takeaways were that Americans nearing retirement should look into plans to supplement their Medicare coverage, should get serious about exercising more and eating better, and should kick bad habits like smoking and excessive drinking.

If you need an example of how well this can work for you, just look across the border. Canada is one of the countries surveyed that fared much better than the U.S.