Visa U.S.A. said health care payments made with its card hit $3.2 billion in the first half, a record 38% more than a year earlier.

The rise put Visa even further ahead of rival MasterCard International, which estimates that its own U.S. volume rose 18%, to $2.5 billion.

For June alone, Visa reported $582 million in such transactions. And by yearend the San Francisco-based association expects to reach $6.8 billion.

"With the proliferation of managed care plans, patients' co-payments and deductibles will continue to increase, and so will Visa's phenomenal rate of growth in health care," said Les Mann, senior vice president of health care marketing for Visa.

The previous four years, Visa's health care volume grew an average 20% to 25% said Mr. Mann.

In part, Mr. Mann attributes 1995's greater growth to the increasing use of sophisticated terminals that allow health care providers to file claims electronically as well as capture credit card data.

Visa's least penetrated category, card payments made to physicians, increased 35%. Only 51% of physicians' offices accept Visa cards. Mr. Mann pointed out that physicians, like small businesses, are hard to reach, and that doctors believe that credit card acceptance is not consistent with a professional image.

"Such offices are unlikely to have a high-level management in place that would evaluate (the administrative benefits) of card acceptance," he said.

Payments made to hospitals and dental facilities grew 28% and 41%, respectively.

The Visa brand is accepted at 210,000 health care locations nationwide, including 95% of hospitals, and 80% of dental facilities. The average Visa health care transaction is $140.

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