Lawmakers touted Health Savings Accounts yesterday as tools to slow the spiral in health-care costs and improve the quality of care.

But other speakers at a briefing at the Sheraton Station Square Hotel on the relatively new insurance concept warned that such promises depended on fundamental changes in the behavior of health-care providers and consumers.

The accounts, enacted by Congress as part of the expansion of Medicare, were cited by President Bush throughout last year's presidential campaign as the central element of his administration's effort to expand health care coverage while blunting cost increases.

They provide tax-sheltered savings for medical expenses coupled with high-deductible coverage for catastrophic health expenses. The maximum annual deductible and co-payment for most health expenses is $5,100 for an individual and $10,200 for a family. Tax-free contributions to Health Savings Accounts can be as much as $2,650 for individuals and $5,250 for families. Unused portions of the savings account can be accumulated over time.

"I believe it is necessary to get the consumer back involved in their health-care decisions,'' said U.S. Sen. Rick Santorum, who noted that he has advocated the health savings concept since 1992. "[The current system] buffers people from the true cost of health care.''

Santorum, R-Pa., argued that the prospect of out-of-pocket expenses will prod consumers to make more informed decisions about health-care costs and which treatments to seek -- "factors that are involved in every other place in our economic life,'' he said.

But Santorum was greeted with some skepticism over whether such informed choices were a realistic expectation in a marketplace in which costs and options are often hidden from view.

Santorum described the paucity of cost information as a "chicken-and-egg problem'' and predicted that as the adoption of HSAs "ramps up, one of the things that will ramp is transparency ... because there is a demand for it."

Kate Begley, mid-Atlantic manager for Aetna Insurance, said that people in Western Pennsylvania, a region with a relatively "benefit rich'' tradition for workers, had been slower to adopt HSAs, compared to such regions as the Southwest, where acceptance of health plans with high deductibles and co-pays was more widespread.

Kim Bellard, a vice president of Highmark Blue Cross Blue Shield, described 2005 as a transition year for the new accounts.

He said he expected their growth, on a percentage basis, to be rapid, but said that in the near term, they would remain a relatively small share of the overall health insurance market in the region.

Bellard noted that Highmark covers some 3 million people overall, with only about 10,000 enrolled in the savings account plan. By 2007, he said, "that could easily triple."

Asked if major changes in consumer behavior and resultant changes in provider patterns were likely to result from the relatively new insurance option, he said, "The jury is still out.''