Challenges to Diabetes Care Innovation. The Case of a Major Public Institution in Mexico

The Mexican Institute of Social Security (IMSS) is strengthening diabetes care through piloting the Chronic Disease Preventive Model (CDPM) that includes intensive diabetes education, interdisciplinary care teams, and intensification of insulin therapy and of HbA1c monitoring. To address CDPM implementation challenges, we analyzed care bottlenecks and facilitators and barriers in the internal and external institutional contexts. The CDPM planning process is facilitated by clinical protocols, role redefinition, and an incremental approach to implementation. However, the overly large size of IMSS together with its verticality, excessive bureaucratic control, and limitation of autonomy at the primary care level restrain staff motivation, coordination, and the alignment of interests along the innovation value chain. CDPM implementation faces weak support by governance at the highest levels within IMSS while patients expect IMSS to be a provider of medications rather than to be a partner in the provision of comprehensive care. For CDPM to be fully implemented, IMSS would have to increase by 16.2% the total number of family physicians while increasing by more than 1000% the number of professionals in clinical psychology and nutrition. CDPM would require a 335% increase in diabetes care spending, mostly for increased insulin treatment and human resources. Spending for diabetes would have to increase from the current 14.3% of total health spending to 20.6%. Spending on diabetes-related complications, however, would decrease. Reforms should be developed with universities, professional associations, and the IMSS workers’ trade union as well as with the pharmaceutical industry to ensure breakthroughs in new professional and technical profiles and less costly pharmaceuticals. Reforms should be supported on digital innovation to reduce treatment costs while improving adherence, quality of care, monitoring, and evaluation. Reforms should include a national diabetes care policy to empower persons living with diabetes.