Fears of big out-of-pocket bills may be starting to have a noticeable effect on the way U.S. residents think about buying medical services.

Researchers at the Employee Benefit Research Institute, Washington, and Mathew Greenwald & Associates Inc., Washington, have published figures supporting that conclusion in a summary of results from a recent telephone survey of 1,000 U.S. residents ages 21 and over.

Participants in the 2007 Health Confidence Survey reported being about as satisfied with their own health coverage as participants in previous surveys in the series had reported.

About 88% of the participants said they are somewhat, very or extremely satisfied with their current plans, down only slightly from 89% in 2006.

When the researchers asked about changes in health care usage resulting from cost increases, survey participants reported a number of positive changes.

The percentage of participants who said they are trying to take better care of themselves increased to 81% this year, from 80% in 2006, and the percentage who say they are talking to doctors more carefully about treatment options and costs has increased to 66%, up from 57%.

But the percentage of participants who say they are delaying going to the doctor has increased to 50%, from 44%, and the percentage who say they are not filling prescriptions or skipping doses has increased to 28%, from 22%.

Participants expressed positive feelings about employer-sponsored wellness programs but less positive views about programs that use financial incentives to boost participation.

About 61% of the participants said they are extremely or very comfortable with the idea of providing workers with low-cost opportunities for health screenings and health improvement programs, such as weight-loss programs.

Only 44% of the participants said they are extremely or very comfortable with the idea of offering reduced insurance rates for healthy workers and workers who agree to take steps to lower their level of health risk.

Jerry Ripperger, a health insurance executive at Principal Financial Group Inc., Des Moines, Iowa, says he thinks the results show consumers are starting to realize that adopting healthier behavior can help lower health care costs.

At Principal, “we’re seeing a sharp increase in the number of workers taking advantage of wellness programs,” Ripperger says.