[Ethical and legal aspects of health care coordination. SESPAS Report 2026]

The quality, equity, and sustainability of health systems depend in part on effective health care coordination, which raises ethical and legal challenges that go beyond purely operational concerns. In decentralized systems such as the Spanish one, inadequate coordination is associated with fragmented care, increased risk of iatrogenesis, inefficient use of resources, rising costs, and loss of public trust, placing fundamental ethical values such as justice, responsibility, transparency, and beneficence under strain. This article presents a narrative review of a conceptual and normative nature that examines the ethical and legal aspects of health care coordination in Spain, distinguishing between interorganizational coordination within the National Health System and intraorganizational coordination within health care organizations. The analysis shows that although the legal framework provides formal coordination mechanisms, their effectiveness largely depends on ethical governance practices, responsible leadership, and deliberation among actors with diverse interests and values. From an ethical perspective, the article argues that health care coordination involves principles of distributive justice, equity, efficiency, and transparency, and that health care organizations should be recognized as moral agents responsible for the consequences of their decisions. As a result, an ethical framework for decision-making in health care coordination is proposed, highlighting the role of organizational ethics committees as deliberative spaces, with implications for health care management, clinical practice, and public policy aimed at reducing inequities and improving system quality.