Natixis Global Asset Management released its third annual Global Retirement Index on Tuesday, and while some of the top 20 countries traded places in the index, there was very little change in who was leading in retirement security.

The index uses data from the World Bank and United Nations to score countries based on health care spending, access to care and life expectancy; the state of the nation’s finances, including government debt, the solidity of financial institutions and old-age dependency ratio; the quality of life for the populace, including the level of pollution and climate change policies in effect; and material well-being, with a focus on per-capita income, employment and income equality.

In the three years that Natixis has sponsored the index, the United States has ranked in the top 20, but just barely. This year was no exception.

“While the U.S. spends more per capita on medical care than any other nation, this has not yet translated to improved life expectancy,” Tracy Flaherty, senior vice president of retirement strategies for Natixis Global Associates told ThinkAdvisor on Monday.

Flaherty added that although per capita income is high, there’s a relatively wide gap between the wealthiest and poorest Americans. Moreover, “deep government debt, high taxes and an aging population” put the sustainability of Medicare and Social Security at risk. “Even though the United States has seen economic growth and improved environmental policies, which can aid seniors, we’re still seeing a gap between some of our spending and how that translates into quality of life,” Flaherty said.

Another problem is that “while today’s retirees are certainly in OK shape relative to pension plans and Social Security, when you look out there is great concern about what the next generation will see as it relates to those programs. Many Americans lack clear direction — we’ve seen in our surveys that 79% of investors rely on gut feeling when making investment decisions.”

Natixis has found that only 27% of investors are confident about their financial plan, but those who work with advisors contribute about two percentage points more to their 401(k) plans than those who invest on their own, Flaherty said. “We really believe that financial advice can give workers insight and guidance that they can’t get elsewhere.”

While there were several shake-ups in the top 10, most countries moved only a few spots from the ranking in the index last year. There were no dramatic shifts this year, Flaherty said, which she attributed to “what’s going on in the global economy. Some of these factors are within a country’s control and some are not, and every country is coming from a different spot,” Flaherty said.

Retirement is a global challenge, she said. “The details are a little different depending on where you live, but managing this large demographic is a challenge all over the world.”

(Check out Top 20 Countries for Retirement Security: 2014.)

Keep reading for this year’s Top 20 Countries for Retirement Security:

The Eiffel Tower in Paris.

20. Slovenia (2014: 21)

  • Health: 78%
  • Finances: 57%
  • Quality of life: 79%
  • Material well-being: 73%

19. United States (2014: 19)

  • Health: 80%
  • Finances: 65%
  • Quality of life: 78%
  • Material well-being: 64%

18. France (2014: 15)

  • Health: 86%
  • Finances: 57%
  • Quality of life: 80%
  • Material well-being: 66%

17. Japan (2014: 27)

  • Health: 84%
  • Finances: 54%
  • Quality of life: 75%
  • Material well-being: 76%

The Grand Place in Brussels (Photo: AP)

16. Belgium (2014: 12)

  • Health: 82%
  • Finances: 58%
  • Quality of life: 75%
  • Material well-being: 76%

15. Czech Republic (2014: 16)

  • Health: 81%
  • Finances: 61%
  • Quality of life: 76%
  • Material well-being: 74%

14. South Korea (2014: 17)

  • Health: 75%
  • Finances: 69%
  • Quality of life: 67%
  • Material well-being: 83%

13. Finland (2014: 8)

  • Health: 81%
  • Finances: 55%
  • Quality of life: 87%
  • Material well-being: 76%

Cologne Cathedral and Hohenzollern Bridge in Germany.

12. Canada (2014: 14)

  • Health: 76%
  • Finances: 68%
  • Quality of life: 81%
  • Material well-being: 72%

11. Luxembourg (2014: 10)

  • Health: 84%
  • Finances: 58%
  • Quality of life: 78%
  • Material well-being: 84%

10. New Zealand (2014: 9)

  • Health: 84%
  • Finances: 63%
  • Quality of life: 88%
  • Material well-being: 95%

9. Germany (2014: 7)

  • Health: 87%
  • Finances: 59%
  • Quality of life: 82%
  • Material well-being: 79%

The Rijksmuseum in the center of Amsterdam. (Photo: AP)

8. Austria (2014: 3)

  • Health: 88%
  • Finances: 53%
  • Quality of life: 86%
  • Material well-being: 84%

7. Denmark (2014: 6)

  • Health: 82%
  • Finances: 69%
  • Quality of life: 91%
  • Material well-being: 78%

6. Sweden (2014: 4)

  • Health: 81%
  • Finances: 64%
  • Quality of life: 89%
  • Material well-being: 75%

5. Netherlands (2014: 13)

  • Health: 84%
  • Finances: 62%
  • Quality of life: 83%
  • Material well-being: 81%

A cable train makes its way up the Weissfluhjoch mountain in Davos, Switzerland. (Photo: AP)

4. Iceland (2014: 11)

  • Health: 81%
  • Finances: 63%
  • Quality of life: 86%
  • Material well-being: 81%

3. Australia (2014: 5)

  • Health: 81%
  • Finances: 73%
  • Quality of life: 80%
  • Material well-being: 76%

2. Norway (2014: 2)

  • Health: 84%
  • Finances: 63%
  • Quality of life: 88%
  • Material well-being: 95%

1. Switzerland (2014: 1)

  • Health: 83%
  • Finances: 70%
  • Quality of life: 91%
  • Material well-being: 85%

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