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

• Integrated care combines primary health care with hospital support through coordinated clinical, organizational, and policy changes. This approach reduces fragmentation and improves service efficiency, patient experience, and health outcomes. • A conceptual map organized into dimensions was developed to categorize the reviewed literature on integrated care policy instruments from a primary care perspective. • Evidence on the potential impact of integrated care on outputs and health outcomes was found to be scarce, and studies aiming to show the effect suffered from methodological limitations and were rarely generalisable. While integrated care models show promise when comprehensive, patient-centered, and bundled-payment schemes are used, the overall evidence on their effectiveness remains inconclusive due to contradictory findings and significant heterogeneity in how integrated care is measured and implemented. • Successful healthcare integration in Spain requires embedding interventions within systemic reforms, coordinated multi-level care, strong primary care leadership, patient empowerment, and political commitment to scale pilot programs into sustainable system-wide changes. • Successful implementation of integrated care faces significant knowledge and structural barriers – there are substantial research gaps regarding specific implementation tools, comparative regional analyses, and efficiency evaluations, while political will alone is insufficient without alignment of values among professionals and institutions, adequate resources, deep structural reforms, and coordination across multiple sectors to produce meaningful improvements. 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. Evaluar si los instrumentos de política de atención integrada, desde la perspectiva de la atención primaria, mejoran los productos y los resultados de la atención, e identificar lecciones para el Sistema Nacional de Salud (SNS) español. Revisión de alcance de 18 revisiones (sistemáticas, de alcance, narrativas y metaanálisis) centrada en instrumentos de atención integrada independientes de la enfermedad, incluidos modelos de coordinación, estructuras de incentivos, distribución de recursos, competencias profesionales, canales de comunicación y gobernanza. Además, se analizaron documentos de política y estudios adicionales referidos al SNS. La revisión identificó estudios que abordaban aspectos parciales de la atención integrada y que con frecuencia carecían de métodos robustos para establecer asociaciones significativas con los resultados de la atención. En general, los instrumentos de atención integrada se asociaron con mejoras modestas en la prestación de servicios y en la experiencia de los pacientes, con evidencia limitada sobre su impacto en los resultados de salud. Algunos instrumentos (coordinación multidisciplinaria, gestión de casos, pagos agrupados) mostraron mayor relevancia, mientras que otros (distribución de recursos, uso de tecnologías de la información, formación profesional y participación de los pacientes) no mostraron asociaciones consistentes. En España, los instrumentos normativos sólidos facilitaron la implementación, pero no garantizaron una transición sostenida de un modelo fragmentado a uno integrado. El desarrollo de sistemas de información específicos parece clave para apoyar esta transición, mientras que la falta de datos de acceso público y de evaluaciones independientes limita la comprensión del impacto real de la atención integrada. La evidencia disponible no confirma que la atención integrada mejore los resultados de salud, pero algunos instrumentos pueden favorecer mejoras en determinados productos de la atención. Para informar la toma de decisiones, los estudios futuros deberían adoptar enfoques multifacéticos y metodologías más robustas.