Americans are going to the doctor less often than they were 10 years ago. A census report says lack of insurance may be one reason why. And according to one Wisconsin health co-op, even those with insurance have not increased their trips to the doctor.

Those who've waited in a doctor's office may find it hard to believe but patients are seeing doctors less often. The Alliance is a Madison-based, not-for-profit health co-op. It includes 180 employers in Wisconsin, Illinois and Iowa.  Mark Xistris is vice president of provider relations, "Our data has been relatively flat at roughly two encounters with the medical system per year, for the last six years."

That's visits to the ER, doctor's office and urgent care. Nationally, medical visits for working age adults was higher, 3.9. Part of the reason is methodology. The census data included the uninsured  and those on Medicaid. Both groups generally have more health problems. Xistris says another reason for the difference in doctor visits are things like company wellness programs, "We help them with strategies to help their employee to improve their overall health status so they don't need to go to the doctor’s office as often.”

But fewer doctor’s visits don't mean lower cost. Health care spending has been going up, even if patients are seeing the doctor less often, "I think there is a relationship at some level but while the visits may be going down the intensity of the interaction is going up; means the doctor is billing for more complicated issues."

The census data suggests medical usage is linked to income. Nearly 40 percent of poor people did not visit a doctor in 2010. Only 19 percent of those with higher incomes did not see a doctor.