to minimise cost shifting to parts of health systems not covered by caps they have often been complemented with global and supplementary spending ceilings on ambulatory care and pharmaceuticals many countries where health care systems are financed through social insurance contributions eg belgium france luxembourg feature relatively mild budgetary constraints in this setting budget caps have tended to provide indicative rather than binding targets targets are set in relation to expected social insurance contributions and the government has limited direct control over them as social security rates are determined to a different extent across countries by the social security funds paris and devaux