Health coordination policy to overcome fragmentation in Spain: SESPAS 2026 report

Issue

Fragmentation between health and social care in the Spanish National Health System (SNS) is a structural problem affecting vulnerable populations with complex needs, causing duplications, avoidable readmissions, higher costs, and inequity. Existing coordination initiatives are generalist, unevenly institutionalised, and fail to reach the most vulnerable.

Description

The SESPAS 2026 Report (Spain) addresses coordination as public health policy (2025-2026).

Objectives

diagnose fragmentation, identify successful models, and propose institutionalisation strategies.

Methods

multidisciplinary expert review, scoping review, and legal-ethical analysis. Key questions: Why does institutionalisation fail? Which instruments truly integrate care? How to scale local experiences?

Results

1) Three barriers: weak primary care as coordinator, governance problems, and insufficient home/social care resources. 2) Effective instruments: multidisciplinary case management, bundled payments, interoperable systems, and shared leadership. 3) Successful Spanish models: chronic care programmes (Basque Country, Catalonia), cardio-renal units (Granada), and community coordination (Barcelona PIAISS). 4) Coordination is a legal and ethical imperative. Without systemic institutionalisation, fragmentation persists.

Lessons

SESPAS 2026 shows the need to move from pilot experiences to systemic institutionalisation. Recommended actions: strengthen primary care as coordination node, implement interoperable digital records, align financial incentives, and mandate intersectoral governance. Lessons for other countries: political will requires strong regulatory instruments, independent evaluation, and community participation. Innovation: the report integrates ethics, economics, and communication as structural axes for sustainable coordination policy.

Key messages

• Health coordination in Spain requires institutionalisation beyond pilots. Key barriers: weak primary care, governance gaps. Effective: case management, interoperable systems.

• Spanish SNS fragmentation persists without systemic policy. SESPAS 2026 recommends: primary care as node, aligned incentives, ethical governance. Transferable to decentralised systems.