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 outofpocket payments for services covered by the nhi and to reduce copayment rates from to for cancer patients and people w ith cardiovascular diseases direct oop payments as a share of total health expenditure remained in almost two times higher than the average across oecd countries 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