substitution of occupational care which is partly financed by employers or private care with large copayments for public care reduces costs for municipalities user choice which has so far been very limited in the public system is thereby expanded at a limited cost for public finances however the system produces incentives for costshifting between activities financed through different channels which lead to suboptimal decisions regarding the provision of care and large inequalities in access between socioeconomic groups with different coverage and financial resources and regions with varying health care supply