What is more, out-of-pocket payments represent 3.8% of final household consumption, compared to the EU average of 2.3%, the seventh highest among Member States. Out-of-pocket payments include co-payments for a wide range of NHS services,including primary care visits. In Portugal, 5.4% of people from low-income households reported going without a medical examination when needed for financial reasons in 2015 (above the EU average of 4.1%) (Figure 13) and significantly higher than the rate for the highest income group (0.4%), although WHO estimates show modest levels of catastrophic expenditures from private spending on health in Portugal (Barros & Borges, 2017, forthcoming).