Lessons for better integrated care in the Spanish National Health System. SESPAS Report 2026

This paper assesses whether integrated care policy instruments, from a primary care perspective, improve care outputs and outcomes, identifying lessons for the Spanish National Health System (SNS).

A scoping review of 18 reviews (systematic, scoping, narrative, and meta-analyses) focused on disease-agnostic integrated care instruments, including care coordination models, incentive structures, resource distribution, professional competencies, communication channels, and governance. Additional policy documents and studies referring to the SNS were also analysed.

Overall, the review identified studies addressing partial aspects of integrated care that frequently lacked robust methods to establish meaningful associations with care outcomes. Integrated care instruments were generally associated with modest improvements in service delivery and patient experience, with limited evidence of impact on health outcomes. Some instruments (multidisciplinary coordination, case management, and bundled payments) appeared more relevant, whereas others (resource distribution, use of information and communication technologies, professional training, or patient engagement) showed no consistent association. In Spain, strong regulatory instruments facilitated implementation but did not ensure a sustained transition from fragmented to integrated care. The development of fit-for-purpose information systems seems essential to support this transition, while the lack of publicly available data and independent evaluations limits understanding of the real impact of integrated care.

Current evidence does not confirm that integrated care leads to better health outcomes; however, some integrated care instruments may improve certain care outputs. To better inform decision-making, future studies should adopt multifaceted approaches and more robust methodologies.