While the share of direct OOP payments has decreased slightly over the past decade following a series of government measures to put a threshold on the amount of out-of-pocket payments for services covered by the NHI and to reduce co-payment rates from 10% to 5% for cancer patients and people w ith cardiovascular diseases, direct OOP payments as a share of total health expenditure remained in 2013 almost two times higher (37%) than the average across OECD countries (19%). This raises concerns in terms of access to care, notably for people with income below the average. There may be numerous barriers to access to health care, including for financial reasons (if the cost of health care is considered by some people as being too high) or geographic barriers (if there are too few doctors and other health care providers in certain geographic areas).