State tourism officials have been saying for the past year that visitor arrivals and spending have been slowing.

Local businesses clearly felt the impact in the fourth quarter as credit and debit card sales edged up just 2.3 percent from the year-earlier period, according to First Hawaiian Bank’s quarterly business activity report that was to be released widely today.

The percentage increase in sales for companies open at least a year was the smallest for any quarter since the bank began producing its business activity reports in 2010.

The gain of 6.9 percent for all of 2013 was the second-smallest annual gain in the short history of the report and followed increases of 9.8 percent in 2012, 8.6 percent in 2011 and 6.4 percent in 2010.

But the numbers were still encouraging to Bob Harrison, president and chief executive officer of First Hawaiian Bank.

"I can’t be anything but still positive because overall spending continues to go up," Harrison said in a telephone interview. "You’re comparing it to a very strong quarter in the fourth quarter of 2012, so it’s really a comparison issue."

Medical services, for the first time, was the fastest growing of 16 sectors tracked by the bank. Card transactions at hospitals, clinics and other care facilities rose 22.7 percent to $34.4 million from $28 million in the fourth quarter of 2012. It was the first time since the report began that medical services had a double-digit-percentage increase.

Kalihi-Palama Health Center, which primarily caters to low-income residents, and moderate-income residents who have several dependents, saw a double-digit-percentage increase in health care transactions over the previous year’s fourth quarter. Most of the center’s patients use cash or checks to make payments, but the center saw its pharmacy transactions spike nearly 30 percent, according to Dr. Emmanuel Kintu, CEO and executive director of the center.

Kintu said increased transactions primarily were due to more patient utilization of services ahead of the implementation of the federal Affordable Care Act.

"Based on the input we are receiving from patients and clients seeking social services, a significant portion of the increase is attributable to anxiety in the patient population," Kintu said. "Many patients reported that they were uncertain about their health care benefits in 2014. The avalanche of information, for and against the Affordable Care Act, had an impact on our patient population in the fourth quarter."

Several QUEST (Medicaid) patients expressed concerns that based on what they were hearing — most of which was misinformation, Kintu said — their health care benefits could be taken away. So they made a concerted effort to seek care before Jan. 1, he said.

With the state’s housing market improving, it’s no surprise that home improvement and home furnishing had the next two largest percentage increases during the quarter. Home improvement was up 12.9 percent, and home furnishing rose 10.5 percent.

But in a sign of the visitor slowdown, hotel transactions dipped 1.3 percent, retail declined 3.4 percent and travel agencies decreased 7.9 percent. Overall, five of the 16 sectors showed decreases in the quarter.

"Tourism certainly has an impact with arrivals being down and the yen getting a little bit weaker," Harrison said. "It’s certainly going to affect how much visitors have to spend when they come."

Still, First Hawaiian adviser Jack Suyderhoud, a professor of business economics at the University of Hawaii and adviser to First Hawaiian, said he wasn’t going to "throw himself off the cliff" because of the fourth-quarter numbers, pointing out that the value of transactions was still growing.

"Any time you’ve got positive growth, it’s positive," said Suyderhoud. "The fourth quarter of 2012 also was particularly strong, so trying to improve on that is hard to do. If you look at the fourth quarter of 2012 compared to the fourth quarter of 2011, it’s up over 11 percent overall. These latest numbers aren’t particularly unexpected because we did observe a slowdown in visitors in September, October and November, particularly October and November."

Visitor arrivals and spending in November declined for the third straight month but still are on track to post new annual highs after setting records in 2012, according to the latest data from the Hawaii Tourism Authority. The slowdown also contributed to hotel occupancy being down 1.7 percentage points to 72.7 percent in October, according to the most recent report by Hospitality Advisors LLC.

Despite the tourism slowdown, the $738 million in card transactions processed by First Hawaiian’s local merchants during the fourth quarter was the most during the October-to-December period since the bank began issuing its quarterly study in 2010.

First Hawaiian, the largest bank in Hawaii with $16.7 billion in assets, is able to track the economic pulse of the state through its card processing services. The bank is the largest local processor of debit and credit card transactions in the state. It has nearly 7,000 merchants on its network, with most of those in Hawaii.

Hotels, which always produce the greatest card sales volume of the 16 sectors, once again led the way with $128.6 million worth of transactions in the fourth quarter. Restaurants represented the only other sector with more than $100 million in transactions at $115.3 million, up 2.3 percent from the fourth quarter of 2012.

For the year, hotels posted the largest sales volume increase at 12 percent, followed by medical services with an 11.5 percent gain. Hotels also had the highest transaction volume at $571.6 million, with restaurants next at $462.5 million.