One of the dirty little secrets about the ever-increasing cost of health care is that health care is costing more because we are using more of it. With an aging population, Americans need more services. And with new technology providing ever more advanced tests, procedures and drugs, we demand more services. Especially when it seems like someone else is footing the bill.

There is no free lunch, of course, and there's no free medical care, either. But with employers or the government paying the premiums on our behalf each month, most of us don't see the bill. It's deducted in relatively small chunks from our salaries or taken by the government in taxes.

Now a new kind of health plan that could change that is gaining a foothold in the market, and might soon become commonplace, thanks to a little noticed provision in the recent federal legislation that added a prescription drug benefit to Medicare.

The new wrinkle is called a consumer-driven plan and is designed to engage patients more directly in making decisions about their own care. Consumer-driven plans do this by giving people a financial incentive to learn more about their condition, to take better care of themselves and to shop around for the least expensive options, especially prescription drugs.

The plans emphasize financial security, providing a full-coverage safety net for people with serious medical conditions where annual costs run into the thousands of dollars. But for routine doctor visits and discretionary services and procedures, the plans put consumers back in charge of their own care. Patients choose their own doctors and pay them directly from a tax-free account established by their employer or by the individual if self-employed. Any money they don't use one year can be rolled over to cover future health care costs.

Critics have suggested that these plans will be magnets for the young and healthy, who want insurance for catastrophic events but don't need it much for day-to-day care. That would leave the old and the sick in ever-smaller insurance pools, forced to pay more because there are fewer healthy people to share the risk.

Another concern is that consumers who are made responsible for some of their own care will scrimp unwisely, forgoing needed treatment until their problems get far worse, and ultimately more expensive.

But early experience with the plans suggests that these fears might be unfounded. At a forum last month on the subject sponsored by the Galen Institute, a nonprofit think tank that promotes consumer-driven plans, several insurers who have offered the benefits presented studies they said showed the plans can lower costs without the downsides critics fear.

Definity Health, for example, studied the experience of one of its larger clients, with about 10,000 eligible employees. It found that about 9 percent of those employees enrolled in the consumer-driven plan, and their age and demographic characteristics were similar to those who stayed with traditional plans. And it wasn't only for the healthy. Large-dollar claims - those exceeding $50,000 - were present for 4.6 out of every 1,000 members in the new plans, or twice what would be expected from a standard distribution.

Another early study of a Definity client found that physician visits declined 18 percent, X-ray and lab visits were down 8 percent, and prescriptions were down 6 percent. But so far, none of that reduced usage seemed to affect the health of the client. Hospital stays and surgical procedures, indicators of more serious problems, also declined.

Aetna, meanwhile, said medical costs for members in its consumer-directed plan rose only 1.5 percent in the first nine months of 2003, compared to double-digit increases for a comparable group of patients. This was despite the fact that the group using the new plan actually had more office visits for preventive care than the similar population in a traditional plan.

A big source of savings is in prescription drugs. Aetna members in the new plan used generic drugs more often and saw an overall decline in prescription drug use.

The most encouraging finding in the studies is that patients in consumer-directed plans take more advantage of tools insurers provide to help them manage their own care. Aetna's patients accessed an online physician directory more often and used the company's health information Web site far more frequently than patients in a traditional plan.

The insurers also report that they are designing the new plans to respond to concerns about preventive care and chronic illness. Many, for example, offer benefits that cover mammograms and other routine diagnostic tests, and insulin for diabetics, without forcing patients to dip into their out-of-pocket accounts. The idea, they say, is to encourage consumers to use their own discretion when they can do so without endangering their health. Prescription drug use is probably the best example of that.

Consumer-directed health care might not revolutionize the industry, but it is a promising development. Anything that takes the management of our care away from employers and insurers and gives choice and control back to the individual is bound to be good for our health, and our economy.