Substitution of occupational care (which is partly financed by employers) or private care (with large co-payments) 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 cost-shifting between activities financed through different channels, which lead to sub-optimal decisions regarding the provision of care and large inequalities in access between socio-economic groups with different coverage and financial resources, and regions with varying health care supply.