This case study examines EtxeTIC, a public service developed by the Provincial Council of Biscay, Spain, to support home-based care for vulnerable people. The service combines relational support from community proximity centres with technology-enabled home monitoring, early risk detection and personalised care plans. The analysis examines EtxeTIC through the lens of the OECD Digital Government Policy Framework, presenting how the initiative embeds a user-driven approach (personalised plans, career training, free access) and a proactive orientation (anticipatory monitoring and preventive alerts), while identifying areas for further work such as stronger data governance, interoperability between health and social services, and outcome measurement.
Enhancing Biscay’s home‑based care with digital technologies
Abstract
Digital technologies and data can make care services more responsive, proactive and user-centred, sustaining quality and coverage while improving the effectiveness and efficiency of care policies (OECD, 2023[1]). The Provincial Council of Biscay in Spain offers a compelling case in point. Under the Basque Country's social services framework, rooted in the fiscal autonomy of the Economic Agreement and the foral competences stated in the Basque Social Services Law of 2008 (Ley 12/2008), responsibility for long-term care has been devolved to the provincial (foral) level (BEHATUZ, 2021[2]). Biscay operates its own social services system and finances it independently, holding direct competence for dependency services, residential care, and support for older people. This arrangement creates both the capacity and the incentive to innovate in care delivery: the province that bears the fiscal responsibility for meeting rising demand from its population is also the one empowered to design the response.
To respond to the demographic and policy context, Biscay developed EtxeTIC, a free public service supporting long-term and home-based care (Diputación Foral de Bizkaia, 2025[3]). It targets people with recognised dependency and/or disability regardless of age, together with their carers, predominantly family members. It is directed in particular at beneficiaries of the allowance for care in the family environment (PECEF) residing within the surrounding areas of the EtxeTIC centres. Delivered from nearby community centres, the service combines in-person attention with digital technologies as a complementary tool. Each household receives a personalised care plan encompassing home monitoring and risk detection through technological devices, social, psychological and physical support, specific training for carers, and referral to specialised resources such as day centres or temporary residential stays.
The deployment followed a phased territorial strategy, with six existing day centres reconverted to the EtxeTIC model from September 2024, followed by new centres in Mungia and Basauri in early 2025. The service completed its territorial deployment in 2025, reaching 11 operational centres serving close to 2,000 households, with capacity for up to 5,000 (Diputación Foral de Bizkaia, 2025[3]). Partial financing through Spain’s Recovery and Resilience Plan (Next Generation EU) supported the initial investment, though the free-of-charge service model shifts long-term sustainability pressure onto the provincial budget (Gobierno Vasco, 2023[4]).
The service model blends three interconnected components (Figure 1):
relational support from community proximity centres (including face-to-face carer training and psychosocial assistance),
technology-enabled monitoring (sensors, alerts and early risk detection in the home),
personalised care plans tailored to each household’s specific needs.
Source: Own elaboration based on (BEHATUZ, 2021[2])
This case study analyses the EtxeTIC digital system through the lens of the OECD Digital Government Policy Framework (OECD, 2020[5]), which identifies six dimensions of a fully digital government initiative: digital by design, data-driven public sector, government as a platform, open by default, user-driven, and proactiveness. It does not assess Biscay’s social care policy, nor the impact of the EtxeTIC system on it.
EtxeTIC embeds digital technology at the core of long-term care in Biscay through a hybrid delivery model that combines digitally-enabled in-person attention at community centres with remote support in the user’s home. In the new-generation EtxeTIC centres, people in situations of dependency and their carers are provided with a home-care support plan that includes assistive technologies (such as tablets and activity bands) that help monitor and prevent risks through periodic follow-up. From resilience and service continuity perspectives, EtxeTIC leverages the digital infrastructure, cybersecurity policies and technological support of Lantik, Biscay’s public company and IT service provider. Lantik has put in place policies, technology and measures to secure the continuity and reliability of EtxeTIC given its mission critical role in supporting Biscay’s digital transformation (OECD, 2026[6]).
EtxeTIC reflects a data-driven approach to care: follow-up data collected in the home is used to detect risks early and to tailor each household's support plan, shifting the service from reactive intervention toward prevention. The same data also supports proactive outreach, with the Social Action Department drawing on administrative records it already holds to identify and contact eligible households directly (Provincial Council of Biscay, 2024[7]; Provincial Council of Biscay, 2026[8]). Realising the full potential of this approach, consistent with the data governance framework of the Provincial Council (OECD, 2026[6]), would benefit from strengthened data sharing across the health and social care sectors in the territory. Connecting the eleven EtxeTIC centres to capture real-time performance data on care delivery would, in turn, generate the evidence base needed to monitor outcomes and inform the continuous redesign of the service.
EtxeTIC builds upon the digital infrastructure and shared building blocks developed by the Provincial Council through Lantik (OECD, 2026[6]). The service also drew on public procurement of innovation from the outset: the initial Etxaniz pilot, which later on evolved into EtxeTIC, was commissioned through a process with prior market consultation, framing the challenge as one of care redesign rather than technology supply and attracting solutions that combined technology with service transformation (Bizkaia, 2020[9]). Yet health and social care data interoperability remains under construction. Bridging it will depend on more flexible, standards-based infrastructure, such as application programming interfaces (APIs), that can enable effective, secure data exchange among the institutions involved in long-term care, and the same procurement approach could be applied to developing that layer.
The service shows steady progress towards an open-by-default approach. Its service charter is publicly available, eligibility criteria and service components are set out in accessible terms, and the Provincial Council reports coverage milestones through regular institutional communications. The opportunity now lies in moving from communicating outputs to publishing outcomes: aggregate performance data, an outcome dashboard or open evaluation reports, complemented by the periodic release of anonymised metrics in reusable formats, would allow the service's impact to be tracked and independently assessed.
EtxeTIC was developed using the CiX service design methodology, placing the experience of users and carers at the centre of EtxeTIC’s design (OECD, 2026[6]). This is visible in how the service operates: care plans are personalised and agreed with the beneficiary, respecting their wishes and their right to decide freely and on an informed basis, and are complemented by carer training, psychosocial support and referral to respite resources. Free-of-charge provision removes financial barriers to access. The same design logic extends across Biscay's wider social-care digitalisation through Zaintzapp, a free web application through which people in situations of dependency or disability and their carers can consult the status of their services, contact their case coordinator, request appointments, receive alerts and complete procedures via the digital office.
Proactiveness is embedded in how the service reaches its users, not only in how it operates. Rather than waiting for applications, the Social Action Department used administrative data it already held to identify beneficiaries of the allowance for care in the family environment (PECEF) and their carers, contacting them directly to inform them of their eligibility for this free foral service (Provincial Council of Biscay, 2025[10]). The same logic extends to delivery, where assistive technologies support the monitoring, prevention and early detection of risks in the home, and to communication, with Zaintzapp pushing notices and relevant information to users rather than requiring them to seek it out. Extending this anticipatory approach to service improvement, complementing periodic review with more frequent user and carer feedback, would allow the service to adjust to emerging needs with the same immediacy it brings to identifying them.
Five years in, EtxeTIC has established strong territorial coverage and a growing evidence base. An early-2025 evaluation found the service supporting over 1,600 households (32% of its potential reach), rising to 2,223 by September 2025, with over 70% of these active households drawing on technology for communication, monitoring or activities (Provincial Council of Biscay, 2024[11]; Provincial Council of Biscay, 2025[10]; Provincial Council of Biscay, 2024[7]). The first-year evaluation presented to the Juntas Generales identified a positive impact on users; effects on carer burden were not yet demonstrable within a short observation window, a finding the Provincial Council has used to guide a measured, evidence-informed pace of expansion (Provincial Parliament of Biscay, 2024[12]). Early pilot work points in a promising direction: the Begiraleak cognitive-rehabilitation programme, delivered across five centres, reported preliminary gains in attention, language and personal satisfaction for users and carers alike (Deia, 2026[13]). As the model matures, longer-horizon evaluation, including comparison against alternative care pathways, would offer a valuable opportunity to consolidate the evidence on institutionalisation and carer outcomes.
Biscay's foral autonomy provided distinctive institutional advantages, but the underlying design choices are transferable: embed digital capability within existing service structures, scale progressively, and treat technology as an extension of human care rather than a substitute for it. On this basis, the EtxeTIC experience offers the following lessons for the digital transformation of public services:
Adopt a digital by design approach: EtxeTIC builds on a hybrid relational–digital model with technology-enabled monitoring anchored in community centres with face-to-face carer support avoids the limitations of purely digital solutions. The model is deliberately adaptive so that differing levels of digital readiness shape how the service is delivered rather than who can access it.
Phased territorial scaling: Converting existing day centres into EtxeTIC hubs enabled territory-wide coverage without new construction, and the staged rollout allowed operational learning between phases.
Innovative procurement: Pre-market consultation framed the challenge as an organisational and social innovation problem, attracting solutions that combined technology with care redesign.
Build evaluation in from the start. EtxeTIC's first-year evaluation found positive user impact but could not yet demonstrate reduced carer burden within a short observation window. The transferable lesson is to define measurable outcomes alongside coverage targets from the outset, so that evidence accumulates as the service scales.
References
[2] BEHATUZ (2021), Decreto Foral 173/2021, de 21 de diciembre, de la Diputación Foral de Bizkaia, por el que se regula el servicio de apoyo para la permanencia en el hogar EtxeTIC, https://www.behatuz.eus/es/legislacion/ver/decreto-foral-1732021-de-21-de-diciembre-de-la-diputacion-foral-de-bizkaia-por-el-que-se-regula-el-servicio-de-apoyo-para-la-permanencia-en-el-hogar-etxetic/7352/#.
[9] Bizkaia, A. (2020), Diputación ensaya con EtxeTIC fórmulas pioneras de apoyo a la permanencia en el hogar de personas, https://www.azpiegiturak.bizkaia.eus/index.php?option=com_content&task=view&id=718&Itemid=195.
[13] Deia (2026), Cinco centros EtxeTIC de Bizkaia testan con éxito un programa para minimizar el deterioro cognitivo, https://www.deia.eus/bizkaia/2026/04/24/centros-etxetic-bizkaia-exito-deterioro-congnitivo-programa-begiraleak-diputacion-universidad-de-deusto-10983171.html.
[3] Diputación Foral de Bizkaia (2025), Bizkaia completa el despliegue del servicio público pionero etxeTIC con 11 centros para apoyar los cuidados en el hogar, https://www.bizkaia.eus/es/web/comunicacion/noticias/-/news/detailView/26787.
[4] Gobierno Vasco (2023), II Plan Estrégico de Servicios Sociales de la CAPV 2023-2026, https://www.euskadi.eus/contenidos/plan_gubernamental/13_planest_xiileg/es_def/II-PESS-para-enviar-a-CG_CAS.pdf.
[6] OECD (2026), Digital Government Review of Biscay, Spain, OECD Digital Government Studies, OECD Publishing, Paris, https://doi.org/10.1787/ab35c0ea-en.
[1] OECD (2023), Health at a Glance 2023, https://www.oecd.org/en/publications/health-at-a-glance-2023_7a7afb35-en/full-report/component-81.html.
[5] OECD (2020), “The OECD Digital Government Policy Framework: Six dimensions of a Digital Government”, OECD Public Governance Policy Papers, No. 02, OECD Publishing, Paris, https://doi.org/10.1787/f64fed2a-en.
[8] Provincial Council of Biscay (2026), EtxeTIC, https://www.bizkaia.eus/es/etxetic.
[10] Provincial Council of Biscay (2025), Más de 1.600 hogares de Bizkaia ya se benefician del servicio etxeTIC que ofrece la Diputación Foral.
[11] Provincial Council of Biscay (2024), Bizkaia contará con 11 centros de día funcionando con modelo etxeTIC a finales de 2024, https://www.bizkaia.eus/es/web/comunicacion/noticias/-/news/detailView/25500.
[7] Provincial Council of Biscay (2024), La Diputación avanza en el despliegue del servicio etxeTIC con la entrada en funcionamiento de seis nuevos centros en septiembre, https://www.bizkaia.eus/es/web/comunicacion/noticias/-/news/detailView/26215.
[12] Provincial Parliament of Biscay (2024), La Diputación ve ’positivo’ el primer balance anual del modelo EtxeTIC, que seguirá desplegándose según lo previsto, https://jjggbizkaia.eus/es/-/la-diputaci%C3%B3n-ve-positivo-el-primer-balance-anual-del-modelo-etxetic-que-seguir%C3%A1-despleg%C3%A1ndose-seg%C3%BAn-lo-previsto.
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