U.S. employees may be paying more attention to the cost of health insurance and less to flexibility.

The percentage of U.S. workers at small and midsize businesses who identify ability to choose networks, doctors and facilities has dropped to 23%, down from 31%, according to researchers at Principal Financial Inc., Des Moines, Iowa.

The researchers have based those figures on results from a recent survey of 1,154 U.S. employees ages 18 and older who work at U.S. businesses with 10 to 10,000 employees.

The percentage of participants who identify the monthly paycheck deduction as a key factor in choosing among health plan options has increased slightly, to 25%, from 24%.

The percentage of participants who say they base decisions on the plan deductible amount has increased to 18%, from 10%, Principal researchers report.