Before you start

Padrón certificate from the Ayuntamiento de Bilbao
Social security number (NUSS), through employment or autónomo registration
TIE or NIE
An assigned centro de salud in your district

Step-by-step

1
Register on the padrón first
Municipal registration is the prerequisite for the Osakidetza card. Without it the health centre cannot assign you, regardless of your social security status.
In personWho: YouWeek 1–2
2
Get your social security number
Social security remains a Spanish state system even here. If employed, your employer registers you. If self-employed you register as autónomo and pay contributions monthly, on an income-based scale. The NUSS is what establishes entitlement.
In personWho: You
3
Apply for the Osakidetza card at your centro de salud
Take the padrón certificate, your social security document and your TIE to the health centre for your address. The card is issued by the Basque health service and is what you present for every appointment and prescription.
In personWho: You
4
Set up the Osakidetza app and online account
The Basque service's digital tools are among the better ones in Spain — appointments, results, prescriptions and your record are accessible online. Setting this up early saves a great deal of telephone queueing later.
Mobile appWho: You
5
Meet your assigned médico de familia
You are allocated a family doctor by address, and they are the gateway to specialists. Self-referral is not how the system works. Basque primary care access is comparatively good, so this relationship is more useful here than in regions where getting a GP appointment is itself difficult.
In personWho: You
6
Understand the prescription co-payment
Spain charges an income-linked percentage co-payment on prescriptions, taken at the pharmacy. The Basque Government has at times applied its own supplementary arrangements. It is not free as in Scotland or Wales, but for a working-age employee it is generally modest.
In personWho: You

Documents you’ll need

Padrón certificate
Social security number document
TIE or NIE
Passport
Vaccination and medical records from your home country, ideally translated

Things most newcomers don’t know

Osakidetza is genuinely better than the Spanish average, and that is a real reason to be here.

The Basque health service consistently places at or near the top of Spanish inter-regional comparisons on waiting times, primary care access and health outcomes, supported by higher per-head spending. Access to a family doctor is materially easier than in several southern regions. It is one of the strongest practical arguments for the Basque Country and it almost never appears in relocation content, which tends to lead with the Guggenheim.

Source: Ministerio de Sanidad — indicadores del Sistema Nacional de Salud

The card is Basque, the entitlement is Spanish, and they are separate administrations.

Unlike tax, social security was not devolved under the Concierto Económico. So your contributions and your entitlement run through the Spanish Seguridad Social, while the service delivering your care is Basque. Two portals, two sets of credentials, two bodies to call when something is wrong. Knowing which one owns a given problem saves a lot of time in the first year.

Source: Seguridad Social

Private insurance is less necessary here than elsewhere in Spain.

A large minority of Spaniards hold private cover mainly to shorten specialist waiting times. Where the public waits are short, the argument weakens considerably. Basque residents hold private policies at lower rates than the Spanish average, and for most newcomers here the money is better kept than spent — which is not the advice you would give someone moving to Málaga or Alicante.

Source: community-reported

The damp is a health factor in older housing stock.

Bilbao's oceanic climate means high humidity year-round, and the older flats in Casco Viejo, Deusto and Santutxu were not built with modern insulation or ventilation. Condensation and mould are common in poorly maintained buildings and drive respiratory problems, particularly in children. When viewing, look at the corners of external walls and behind furniture, and treat visible damp as a repairing obligation rather than a feature of an old building.

Source: community-reported

Common mistakes to avoid

Assuming a TIE alone gives you access to Osakidetza.
Delaying the padrón and blocking the health card behind it.
Confusing the Basque health service with the Spanish social security system when chasing a problem.
Buying private insurance out of habit without checking the local public waiting times first.
Accepting visible damp in an older flat as normal rather than as a repairing obligation.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.