PhD candidate Ari Bronsoler wants to transform health care delivery in his native Mexico. The economist’s work addresses pressing issues in his home country, including diabetes, sugary beverage consumption, and communication efficiency.
Bronsoler works at MIT with economics professor Jonathan Gruber ’87. Gruber was intrigued by Bronsoler’s prior work in diabetes analysis, studying pay-for-performance contracts and concocting algorithms to improve diagnostic efficiency—as well as, in Gruber’s words, by “his incredible work ethic and general devotion to attacking really important questions.”
It is urgent work: Diabetes is a health care crisis in Mexico. Bronsoler notes that 18% of Mexico’s medical resources are spent on diabetes treatment. Stunningly, the number of diabetes patients in Mexico is predicted to nearly double by 2045, passing the 21 million mark.
The Mexico Fund for Graduate Students largely enables Bronsoler’s research in this critical area. The fellowship was funded by Pedro Aspe PhD ’78, Mexico’s former minister of finance, to support promising economics students from Mexico.
With diabetes, “Mexico has three main problems: prevention culture, diagnosis capabilities, and early treatment,” Bronsoler explains. “Many people end up not getting tested or confirmed with a diabetes diagnosis when they should, and around half of the diabetics in Mexico are undiagnosed. Further, many patients who are diagnosed don’t comply with the recommended treatment or don’t have access to it, leading to an increase in complications, hospitalizations, disabilities, and deaths later on.”
This is largely the result of a fragmented health sector, lack of prevention culture, and overburdened public institutions that cannot keep up with the increasing demand, he says. Bronsoler’s groundbreaking undergraduate research provided IMSS—the country’s largest health care provider, with more than 58 million beneficiaries—with data to enable it to detect high-risk patients using a predictive algorithm. In fact, IMSS now uses the risk calculator he developed and has made it publicly available online.
Now, he is working on diabetes treatment research in Monterrey, Mexico, where he has partnered with Eli Lilly and Clinicas del Azucar, a low-cost suite of clinics created by Javier Lozano MBA ’10. These private clinics have introduced evidence-based algorithms to diagnostics and care, offering unlimited consultations for an annual fixed fee. When they visit, patients receive comprehensive evaluations by multiple specialists in less than two hours.
Bronsoler is conducting a three-year randomized control trial to estimate the effect that this one-stop shop model of diabetes care could have on health outcomes and to understand what drives patient adherence and how it could be improved by varying different aspects of incentives. Such a system could reduce the IMSS burden. “It may be reasonable to have entities like this treat a large portion of the Mexican diabetic population that is currently being treated in the public system. It could induce savings and help free up constrained resources to treat other diseases,” he says.
If it works, the government might choose to institute a public policy to incentivize people to visit the clinics and adhere to treatment, Bronsoler adds. “If there is an improvement, it will lead to better control of the disease. Then there will be fewer hospitalizations and probably less overall spending,” he says. Meanwhile, Bronsoler is also studying the impact of Mexico’s sugary beverages tax on health outcomes, analyzing consumption and health care data throughout the country.
“Taxing high-calorie foods has become a common strategy to fight obesity and non-communicable diseases around the globe,” he says. “However, the literature has mainly focused on estimating what the effect of the tax is on consumption—there is no reliable estimate about a high-calorie tax effect on health.” Regardless of its outcome, his research aims to provide evidence that allows policymakers to make more informed decisions about a tax that has inspired heated debate.
Finally, Bronsoler is studying the use of information and communication technologies (ICT) in Mexico City IMSS hospitals, focusing on how technology can speed the transfer of cardiac patients from lower-capability hospitals to specialized ones. Bronsoler’s research focuses on Código Infarto (CI), a program that has improved the treatment of cardiac patients and implemented better ICT to facilitate hospital transfers. He is utilizing case-level data from Mexico City emergency rooms to track overall improvement in the survival rate from hospitals that use CI versus those that don’t.
“I hope to prove that efficient reallocation of existing resources and improved organization in developing countries may help dramatically improve quality of service provided at the countries’ institutions. Attention to heart attacks is the first example of this,” he says.
Bronsoler hopes his work as a Mexico Fund Fellow can have long-range effects on health care delivery in his home country and potentially the whole world.
“The Mexico Fund changed my life. It’s been an amazing opportunity for me to learn as much as I’ve been learning and to be able to explore different ideas around improving the health of my own country. I’m grateful, I’m enjoying it—and I hope I can contribute in return,” he says.
The Mexico Fund for Graduate Students
Pedro Aspe PhD ’78 has maintained a distinguished career at the pinnacle of finance and economics. Mexico’s former minister of finance is now president of real estate investment company Insignia Capital. He has held other high-level teaching and government positions in Mexico, including chairman of the economics department at Instituto Tecnológico Autónomo de México (ITAM) and secretary of budget and secretary of the treasury.
That professional trajectory started at MIT, Aspe says, and he was driven to give back to an institution that gave him so much.
“The economics department was just outstanding, with teachers who were just brilliant. It was the best I could find in the world,” he says, noting that he studied under legendary Nobel Prize-winner Franco Modigliani. Future Nobel laureate Paul Krugman PhD ’77 was also a classmate.
“The interaction among faculty and students was superb. And because I’ve been so lucky, I wanted to set aside assets to return to the institutions that have helped me,” Aspe says.
Fellowships fully cover a recipient’s tuition and health insurance and include a stipend for living expenses. The Mexico Fund is devoted to supporting Mexican citizens pursuing a PhD at MIT, with a preference for students in the Department of Economics. Ari Bronsoler is the first beneficiary.
Aspe praises Bronsoler’s work ethic and devotion to Mexico. He hopes that Bronsoler makes the most of the funds—but, most of all, that he savors his MIT years.
“This is the opportunity of your lifetime. Enjoy it! Grab hold of all the things you can,” Aspe says. “Those were the best years of my life: I learned from teachers, I learned alone in the library, and I learned from my fellow students. It was just magnificent.”