The risk remains that citizens forego effective care that can have long-term adverse health outcomes. A further aspect of co-payments that will require careful monitoring are the potential incentives they create for patients seeking care in parts of the health care system where their costs can be minimised. For example, higher primary care co-payments may increase incentives to seek care in the emergency department. However, these incentives may not always align with delivering care in the most appropriate place. This would entail that the co-payments become distortionary and act as barrier to efficient care provision. The strongest evidence can be found in the rate of hospital admissions.