the risk remains that citizens forego effective care that can have longterm adverse health outcomes a further aspect of copayments 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 copayments 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 copayments become distortionary and act as barrier to efficient care provision the strongest evidence can be found in the rate of hospital admissions