As medical costs continue to rise, employers continue to increase deductibles and other out-of-pocket payments made by health care plan enrollees, according to a survey released Monday.

Twenty-seven percent of employers imposed deductibles of least $400 this year for in-network services for their health care plans with the largest enrollment, while 16% imposed deductibles of at least $1,000, according to a PricewaterhouseCoopers L.L.P. survey of 674 employers.

In 2009, only one in five employers imposed a deductible of at least $400 for in-network services, and only 11% set employee deductibles at $1,000 or more, according to the survey.

Cost-shifting is even greater for employees receiving out-of-network services.

For example, 29% of responding employers said they imposed deductibles of at least $1,000 this year for services delivered by out-of-network providers, up from 20% last year.

The reason employers are boosting deductibles and other employee cost-sharing requirements is obvious, said Michael Thompson, a principal in PwC’s New York office.

“Employers cannot afford to absorb medical cost increases,” Mr. Thompson said.

Additionally, by boosting cost-sharing requirements, employees are more likely to become more prudent consumers of health care services, he said.

Employers are taking other steps to shift costs to employees. For example, 53% now impose a coinsurance requirement in which employees pay a percentage of a bill for each hospital admission, up from 37% last year.

In addition, 32% of employers now impose coinsurance for specialty drugs, up from 23% in 2008, while 33% do so for brand-name drugs, up from 26% in 2008.

Coinsurance usually means employees pay a larger share of a bill compared with copayments, in which employees pay a flat amount not tied to the amount of a charge.

“By requiring workers to spend more out-of-pocket at the point of care, employers believe they’ll rein in utilization of services and drugs,” the PwC survey concludes.

Still, employers are doing more than shifting costs to employees.

Just more two-thirds say they plan to expand their wellness plans, while just less than one-quarter intend to add a high-deductible health insurance plan linked to health savings accounts.

In addition, 14% say they intend to implement a value-based health care plan design. Under such a design, cost-sharing requirements are set very low for services, such as annual physicals, that employers want to encourage in the belief that their use will reduce costs.

At the same time, more employees are opting to enroll in high-deductible plans, such as HSA-linked plans.

While such plans expose participants to more costs when services are used, employee premiums are much lower than in more traditional plan designs.

This year, 13% of respondents said their high-deductible plan had the highest number of enrollees, up from 8% last year. By contrast, only 9% of employers reported that their health maintenance organization plan had the highest enrollment, down from 14% last year.

Meanwhile, PwC projects that medical costs will go up 9% in 2011 compared with 9.5% in 2010. One factor that could slow cost increases is the loss of patent protection next year for costly name-brand drugs, allowing the introduction of lower-cost generics.

“About $26 billion in drugs are expected to go off patent in 2011, including the world’s best-selling drug, Lipitor,” the survey notes.

Several factors, though, are likely to inflate costs, according to PwC. For example, certain changes in Medicare payment rates will in some cases reduce payments that hospitals receive from Medicare. In response, those hospitals may try to offset those cuts by boosting charges for commercial payers.

Also, medical provider mergers and consolidations are expected to increase, which will give providers more bargaining power to seek higher rates, PwC said.

The survey and an accompanying report are available at www.pwc.com/us/medicalcosts2011 and www.pwc.com/us/touchstone2010.