Strategic design and governance of type 2 diabetes care ecosystems: A cross-national comparative analysis across seven countries

This study aims to examine Type 2 diabetes care as a strategic health ecosystem and to identify how differences in ecosystem design and coordination strategies influence system-level performance across countries. A cross-national comparative strategy analysis is conducted using secondary data from international and national health statistics covering the United States, the United Kingdom, Germany, Japan, China, India, and Taiwan during the period 2015–2024. The analysis is guided by an ecosystem-based strategic framework that integrates contextual system characteristics, core care strategies, and intermediate performance outcomes, including prevention orientation, accessibility of care resources, technological integration, coordination mechanisms, and community engagement. Multi-dimensional analytical and visualization techniques are applied to compare strategic configurations and performance patterns across national care ecosystems. The results reveal a continuous global increase in the prevalence of Type 2 diabetes, alongside substantial heterogeneity in care effectiveness across countries. Stronger ecosystem performance is associated with integrated care strategies, advanced digital coordination, stable primary care structures, and high accessibility supported by universal coverage and community-based networks. The study concludes that effective management of chronic disease depends not only on medical interventions but also on the strategic design and governance of healthcare ecosystems, emphasizing the importance of prevention-oriented strategies, digital maturity, reduction of access disparities, and localized ecosystem activation as critical levers for improving long-term system performance. Key Words: Healthcare strategy, Chronic disease management, Cross-national comparison, Care ecosystem design, Type 2 diabetes