one possible weak point is that there is a ceiling only on charges for the chronically ill widening this ceiling to the population at large would potentially reduce the risk of lowincome households particularly large ones from being dissuaded from accessing the healthcare system finally copayments for nhi services should not be the sole focus as direct payments linked to either shaban or commercial insurance may well also be significant for those households who spend a substantial share of their incomes on healthcare services one approach is to base eligibility on whether individuals or households receive the national insurance institute s nil s income support benefit or the income supplement in the case of pensioners however the eligibility criteria for this support are so stringent that a significant share of lowincome households does not receive these benefits clearly access to health care would be strengthened if access to them was itself widened as has been suggested in other oecd analysis oecd a b and b