User charges for health care—such as co-payments for doctor visits, hospital stays, or medicines—can create significant barriers to accessing necessary services, particularly for people with low incomes. To mitigate this, some countries in Europe have adopted protective policies that place caps on the amount individuals must pay out-of-pocket each year. A few go further, linking these caps to income levels to enhance fairness and ensure that financial protection is targeted where it is needed most.
This policy brief, Using income-based caps to protect people from user charges for health care: lessons from Austria, Belgium, Germany and Spain, examines the design and implementation of income-based caps in these four countries. It highlights how linking caps to income can reduce inequalities, improve the efficiency of public spending, and lessen the financial burden on health systems. The document offers key lessons for countries seeking to improve affordable access to health care while managing user charges in a more equitable and sustainable way.