Health plans that encourage consumers to shop smartly for care are all the rage among employers, but a new survey suggests many employees are less thrilled with the trend.

Furthermore, people enrolled in the plans pay more in out-of-pocket costs and are more likely to forgo care than people in traditional health plans.

The findings, released yesterday by the Washington, D.C-based Employee Benefit Research Institute, shed light on how individuals view the trend toward "consumerism" in health care. More workers are enrolling in high-deductible health plans of $1,000 or more for individuals and $2,000 or more for families that can be combined with tax-preferred savings accounts such as Health Savings Accounts (HSAs) or Health Reimbursement Arrangements (HRAs).

Employers and the Bush administration have been hopeful that these accounts will help contain rising health care costs by giving individuals incentives to shop smartly for health care. The survey found, however, that consumers lack the information needed to make decisions about doctors and hospitals based on cost and quality.

Consumers with high-deductible plans are more sensitive to cost concerns than people in traditional health plans and reduce their use of medical services accordingly, the survey found. But people who are sick or have low incomes were more likely to curtail their medical care, researchers said.

Early evidence suggests that solving the health care cost problem "through blunt, demand-side instruments like high deductibles gives disproportionate responsibility for the problem to the most vulnerable among us," wrote researchers from EBRI and the Commonwealth Fund, a health policy group in New York.

But Karen Ignani, president of America's Health Insurance Plans, a trade group for insurers, said in a statement that Health Savings Accounts play an important role by giving consumers a lower-premium choice. The trade group's research has shown that many who enroll in HSAs were previously uninsured, she said.

The survey of 1,204 people found that 1 percent of privately insured U.S. residents ages 21-64 are enrolled in a consumer-directed health plan, while another 9 percent are enrolled in a high-deductible health plan without an associated savings account. Enrollment in both types of plans are expected to grow next year.

Locally, about 5,000 households are covered through Health Savings Account plans offered by Highmark Inc., the region's dominant health insurer. That number will grow by 1,300 on Jan. 1, as some employees of the insurance company itself and their dependents move into HSAs, said Kim Bellard, a Highmark vice president.

Highmark announced this week that it is joining with Blue Cross and Blue Shield companies across the country in creating a bank in Utah specifically to offer Health Savings Accounts that work in conjunction with high-deductible plans. A spokesman said the company would not disclose how much Highmark is investing in the bank project.

Mr. Bellard characterized the investment as a first step that could lead to more efforts by local insurer to provide financial services to customers.