García-Ramírez, Jorge AlejandroThomson, SarahUrbanos Garrido, Rosa MaríaBouckaert, NicolasCzypionka, ThomasBlümel, MiriamEvetovits, TamásWHO Regional Office for Europe2025-07-092025-07-092025-03-19https://hdl.handle.net/20.500.14352/122371A 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.engAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/other3079-8019https://www.who.int/austria/publications/i/item/9789289061858open accessAffordable accessAustriaBelgiumCoverage policyFinancial protectionGermanyHealth financingOut-of-pocket paymentsSpainUniversal health coverageUser charges (co-payments)Ciencias Sociales53 Ciencias Económicas32 Ciencias Médicas