Using income-based caps to protect people from user charges for health care. Lessons from Austria, Belgium, Germany and Spain

A small number of countries in Europe protect people from user charges for health care by setting a limit – a cap – on co-payments. Some of these countries go a step further and link the cap to income, so that it gives greater protection to people with lower incomes. Linking caps to income enhances equity and efficiency in the use of public funds and softens the impact of the cap on the health budget. This brief summarizes the use and impact of income-based caps in Austria, Belgium, Germany and Spain and draws lessons for the four countries and for other countries concerned about the negative effects of user charges on affordable access to health care.