A critical review of the OECD’s annual report (Health at a Glance 2025) provides enough nuanced answers to the title’s question—though not “the truth”—by compelling us to examine the failure of timely access.
In 2025, even in countries with high spending and cutting-edge medicine, the issue lies in how much of that medicine translates into actual, timely, continuous care without pushing people into parallel circuits.
Key Findings
The data that best captures the shift in times is not an average health spending figure or a load indicator; it’s unmet medical needs experienced daily. In the OECD countries analyzed, the percentage of population reporting unmet medical needs increased between 2019 and 2024, with waiting lists being the prominent reason (OECD, 2025a).
In simpler terms, rights aren’t formally denied but are deferred. When delayed, access changes nature: universalism remains a principle while daily access becomes conditional.
Grouping Countries by Adjustment Mechanisms
To avoid a simplistic moral fable, it’s crucial to categorize countries based on their dominant adjustment mechanism rather than ideology, considering factors like fiscal margin, pre-existing architecture, complex federalism, accumulated labor wear, and political decisions.
Countries like Denmark have reconstructed their systems from the ground up, strengthening primary care and correcting regional access disparities. In 2025, general medicine is recognized not as a “cheap entry” but as clinical infrastructure preventing the system from becoming an emergency factory.
Ireland treats waiting lists as a public policy issue, not an occasional tragedy. When a government decides to manage the list as an ongoing intervention, it stops managing the scandal and starts addressing the problem. This doesn’t guarantee automatic success but changes the type of response.
Norway exemplifies the most significant 2025 shift in the daily contract with labor. When primary care enters crisis, real reform is making the job sustainable, retainable, and attractive. Reducing the population without a general practitioner and improving recruitment safeguards the only place where the system can be continuous, not episodic.
Spain illustrates the contemporary form of decline in wealthy nations: silent rationing through waiting lists. The OECD highlights uncomfortable comparisons, showing countries with reasonable average wait times for common procedures and others where waits transform rights into practicality.
Latin American OCDE Members
It’s essential not to confuse categories; these countries aren’t “not reading” the message but face challenges with low fiscal margins and high fragmentation, where every mistake costs double, and each reform yields less.
The region confronts a distinct form of conditional right: less “universalism by waiting list” and more universalism by pocket and affiliation.
Mexico, for instance, has a high out-of-pocket spending (41% of health expenditure), surpassing Chile (30%) and the OCDE average (18%). This is how universalism becomes conditional when public funding falls short, shifting the adjustment to households.
Moreover, Latin American countries struggle with lower health personnel densities compared to the OCDE average, especially in nursing. Mexico must sustain its primary care with fewer nurses per population than most club members, and Chile fares only slightly better (OCDE, 2025b).
Looking Ahead: 2026 and Beyond
The crisis is now visible and politically unavoidable, with waiting lists, primary care, labor force, and community care transitioning from technical topics to lived experiences. Successful reordering examples exist, offering learning opportunities.
However, silent rationing’s adaptability poses a significant challenge: if the system learns to operate with structural delay, it governs by waiting, shifting debate from rights to administrating delays.
The most honest response to the “turn or roadblock” dilemma might be that 2025 was a turn for those who transformed diagnosis into capacity, even partially, and a roadblock for those hindered by narrow margins or institutional inertia.
The 2026 question is straightforward: who will convert the crisis into capacity? More importantly, who will dare assert that the right to health isn’t merely about coverage or affiliation but also about not having to pay—with money or time—for what’s already promised?
References
• OECD. (2025a). Health at a Glance 2025: OECD indicators. OECD.
• OECD. (2025b). OECD Health Statistics 2025 [Data set]. OECD.
*The author is a Tenured Professor in the Department of Public Health, Faculty of Medicine, UNAM and an Emeritus Professor in the Department of Health Measurement Sciences, University of Washington. The opinions expressed in this article do not represent the position of the institutions where the author works. [email protected]; [email protected]; @DrRafaelLozano
