PHILADELPHIA -- The price of family health insurance didn't go up all that much last year, but most people who get their insurance through work would never know that.

As premiums rose 3 percent, employers kept their contribution flat while upping the worker share by 14 percent, according to an annual survey released Thursday by the Kaiser Family Foundation and the Health Research and Education Trust, an affiliate of the American Hospital Association.

That doesn't include the costs that workers have to pay when they need to see a doctor; those went up, too. Twenty-seven percent of workers now have annual deductibles of at least $1,000, up from 22 percent in 2009. Such high-deductible plans are far more common in small companies. Co-payments also went up.

During a conference call on the report, Drew E. Altman, Kaiser's president and chief executive officer, said he expects the trend of rising burdens for employees to continue. Eventually, he said, that can become a financial hardship and a barrier to care.

While health reform efforts focused on helping people without insurance, he said the country should pay more attention to the fact that the "nature of insurance" is changing. "We should have a clearer national discussion on what we actually think health insurance should be in this country," he said.

The survey's results make clear why so many workers feel increasingly pinched by insurance costs: Since 1999, inflation has risen by 31 percent, while worker pay has gone up by 42 percent. The cost of health care premiums went up 138 percent. The worker share of that cost rose by 159 percent.

The employee's share had been relatively constant for much of the past decade, but rose last year. Dr. Altman hypothesized that the recession forced businesses to choose between shifting costs to workers and laying workers off.

The average cost of an employer-provided family plan is now $13,770, up 114 percent from $6,438 in 2000. The employer contribution has risen by 102 percent, to $9,773, while the worker share is up 147 percent, to $3,997.

The trend is even more pronounced for workers who get individual insurance. There, the average total cost rose 104 percent, from $2,471 in 2000 to $5,049 in 2010. The employer share rose 94 percent, to $4,150, while the worker contribution rose 169 percent, from $334 to $899.

Officials of the two survey organizations said few companies were taking advantage of data that would allow them to choose insurance on the basis of quality. They also said this year's relatively modest price increase was likely an anomaly related to the recession and concerns about the political climate during the health reform debate. "I don't expect these very low rates of increase to continue," Dr. Altman said.

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