Despite the uncertainties about national health care reform, the credit card industry seems assured of a major and lucrative role.

Card use for deductibles and copayments is already rising, noted Les Mann, Visa U.S.A.'s vice president of health care marketing. If the program Hillary Rodham Clinton's committee is hammering out extends coverage to the 37 million uninsured Americans, credit card transactions are bound to rise, he said.

"All of the trial balloons have focused on a managed-care program with some kind of cost sharing by the patient," Mr. Mann said.

Many uninsured people are cardholders, he said, and many of them would probably use a credit card to pay a deductible in national health coverage.

Mastercard and Visa cards are being used for about $6 billion a year in medical expenses, representing about 5% of Americans' out-of-pocket health care expenditures.

Growth in this type of transaction, which did not exist a few years ago, was the result of the promotion of a form that authorizes physicians and dentists to charge up to a preset amount to a patient's credit card.

Mr. Mann said the form streamlines billing procedures for doctors and dentists, who otherwise must wait for an insurance settlement before sending a final bill to the patient.

"We help them get paid sooner, and allow them to run their office a lot more efficiently," he said.

With more than 176,000 heath care locations accepting credit cards, Visa is focusing on getting consumers into the habit of using cards for such expenses.

The association recently launched a promotion that gives consumers discounts when they use Visa cards to purchase; health-related products ranging from Medic Alert medical identification tags to eye care.

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