Since the reform of state-approved contracts (contrats responsables) in 2014, complementary insurance plans, except in rare cases, cover all forms of co-payment. While the numerous levels of co-payments may reduce the transpar ency of the system for households, the systematic acceptance of co-payments by state-approved contracts helps reduce the number of people foregoing treatment. In addition, access to care is facilitated by the fact that use of the direct payment system (tiers payant) is obligatory when dealing with fragile populations (CMU-C (complementary universal health coverage), ACS (vouchers) and AT-MP (occupational risks), but also ALD (long-term illnesses) and persons receiving maternity care since 2017).