OECD Health Division head Francesca Colombo challenges healthcare spending rankings, 20% waste, workforce shortages, and prevention across 38 nations.

Roy Bejarano speaks with Francesca Colombo, Head of the OECD Health Division, about what international healthcare comparisons actually reveal. Drawing on the OECD's 2025 Health at a Glance report, they examine GDP spending, prices versus utilization, fiscal sustainability, quality outcomes, and why the OECD does not rank entire health systems from best to worst. They also explore healthcare waste, dependence on foreign-trained clinicians, workforce productivity, unequal access despite universal coverage, and why prevention still represents a small share of healthcare spending.

What You’ll Learn

• Why healthcare spending as a percentage of GDP cannot, by itself, measure performance
• How prices, utilization, fiscal sustainability, and outcomes complicate U.S.–OECD comparisons
• Why the OECD avoids simplistic overall rankings of national healthcare systems
• What an earlier OECD estimate of roughly 20% potentially wasteful health spending means
• Why international recruitment cannot solve structural workforce shortages indefinitely
• How universal coverage can coexist with access inequalities
• Why productivity, digital health, and prevention matter as populations age

Key Timestamps

(01:10) What the OECD Health Division measures across 38 countries

(03:31) GDP spending and the 2025 OECD findings

(06:10) Why there is no ideal healthcare spending level

(07:01) Fiscal sustainability and measuring outcomes

(09:03) Limitations of life expectancy and quality indicators

(14:05) Price versus volume in international spending comparisons

(15:22) The estimate that 20% of health spending is waste

(23:00) Why spending alone cannot rank performance

(26:12) Why the OECD does not publish an overall country ranking

(29:40) Foreign-trained clinicians and workforce productivity

(37:56) Hospital quality, patient safety, and avoidable admissions

(41:43) Unequal access despite universal coverage

(47:21) Aggregate versus granular health data

(50:33) Why prevention remains underfunded

Key Takeaways

• Healthcare spending as a percentage of GDP is not automatically proof of better or worse care.
• Prices and service volumes must be separated before interpreting international expenditure gaps.
• The OECD emphasizes specific outcomes rather than an overall health-system league table.
• Waste and preventable safety problems create opportunities to redirect resources toward patient outcomes.
• International recruitment can relieve short-term staffing gaps but does not replace domestic workforce planning.
• Aging populations make productivity improvements and technology-enabled models increasingly important.
• Universal coverage can coexist with access disparities, while prevention has yet to gain a larger share of spending.

Guest Bio

Francesca Colombo leads the OECD Health Division, overseeing work comparing health system performance and policy challenges across 38 member countries. An economist by training, she focuses on how health systems use resources, improve outcomes, and respond to challenges including workforce supply, quality, affordability, and sustainability.

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