[Healthcare coordination from a health economics perspective. SESPAS Report 2026]

Health care coordination, understood as a managerial function aimed at efficiently integrating system resources and actors, is a key component for enhancing the performance and value generation of health systems. This article analyzes the theoretical foundations that allow for the identification of the costs, benefits, and limitations of coordination, addressing three main analytical approaches: transaction costs arising from contractual and organizational designs; economic incentives shaping the behavior of agents; and agency theory, which focuses on information and power asymmetries. It is argued that coordination should not be assumed as a normative or voluntarist ideal, but rather as a function that requires political will, effective governance structures, aligned financial instruments, and interoperable information mechanisms. The analysis of health systems, based on their organizational and contractual designs, reveals that integrated models tend to present lower administrative costs and better performance than fragmented or decentralized ones. Additional costs at the macro (institutional), meso (allocation and provision interface), and micro (clinical units) levels are examined, and targeted strategies for minimizing them are identified. Finally, the specific challenges of health and social care coordination are discussed, constrained by institutional, cultural, and sectoral path dependency factors. The article concludes that effective coordination must be grounded in robust organizational architectures, appropriate contractual frameworks, and incentive mechanisms consistent with the public interest and social efficiency.