[Health coordination: a challenge for the National Health System. SESPAS Report 2026]

The Spanish National Health System, founded on the principles of universality and equity, faces structural challenges arising from population ageing, increasing chronicity, and the fragmentation of the care system. This fragmentation represents its main weakness and particularly affects people with complex conditions, characterized by multimorbidity and combined health and social care needs. Although various care integration initiatives have been promoted in recent decades, such as the Integrated Health Organizations in the Basque Country and Catalonia, their results have been uneven and, in many cases, limited. The article argues that the central problem does not lie in the absence of organizational structures, but in the mismatch between existing coordination models and people's actual needs, and it presents four main theses. First, coordination must be adapted to the level of clinical, social, and care complexity, avoiding uniform approaches that are ineffective for the most vulnerable groups. Second, it is necessary to address persistent structural barriers, such as misaligned financing systems and professional hierarchies. Third, coordination facilitators must be specific, operational, measurable, and sustainable, avoiding the transfer of solutions across contexts without proper adaptation. Finally, the article highlights the importance of clearly defining key professional roles. Overall, the text proposes moving toward a person-centered coordination model that acknowledges complexity, strengthens primary care, and contributes to improving health outcomes and system equity.