OBJECTIVES Taiwan's single payer national health insurance system provides generous coverage and patients' full freedom to access different tiers of medical facilities. Government's attempt to divert outpatient care utilisation into primary care by largely increasing co-payment only showed limited effects. To determine the relative importance of factors (attributes) associated with patients' choices of accessing different tiers of medical facilities, we conducted a qualitative study on outpatients with gastroesophageal reflux disease (GERD), who generally do not need aggressive treatment. METHODS Focus groups were conducted on outpatients with GERD from different tiers of medical facilities in Southern Taiwan. RESULTS Seven focus groups were held in medical centers (2), regional hospitals (2), physician clinics (2), and local community (1), recruiting 35 participants from cities and an off-shore island. Reputation of doctors and scale of medical facilities are the highest priorities and unanimous considerations of all participants. Distance (transportation convenience) is also an important attribute for accessing medical care. Information sources for making decision includes consultation with relatives and friends, searching internet information, or rank of hospitals and doctors from media. Participants generally thought the current out-of-pocket payment (OPP) is expensive, especially when accessing medical centers, but they still preferred and felt worthy to visit higher tiers of medical facilities due to their trust on quality (better medical cares, drugs and equipments), and also doctors may use cost-saving strategies such as continuous prescriptions to help them. CONCLUSIONS The attributes for GERD outpatients' choices of accessing medical facilities have been identified. Participants with different socioeconomic backgrounds in Southern Taiwan are aware of the increasing OPP, but the current OPP does not seem to impact on the affordability and accessibility of treatment. Future study is going to determine the relative importance of attributes and how different OPP can influence on decision making.