The anticipated spike in out-of-pocket health care expenses under the Patient Protection and Affordable Care Act (PPACA) has not materialized.

The average patient spent 3.5 percent more over the past year, according to a new study by the Robert Wood Johnson Foundation. This translates into about $1 per visit, including copayments and deductibles.

However, deductibles increased by an average of $8 for every type of physician visit. The deductible for a primary care visit increased from $14 to $20, while orthopedics increased from about $27 to $35. Researchers warned that rising out-of-pocket costs could cause some patients to forego care, although the study shows that co-pays and deductibles did not increase as sharply as some critics had predicted.

The modest increases likely are a result of a greater focus on preventive care and of a strategy by insurers to encourage primary care instead of costlier specialty care, according to Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation.

The study also found that primary physicians saw slightly higher rates of reimbursement compared to doctors overall. These increases are “consistent with low overall price increases for health care services that have been reported elsewhere,” she said.

At the same time, however, reimbursements for specialty care dropped substantially in 2014.

The study included data from about 15,000 physicians.

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