The medical spending pie is growing; but the consumer slice is, unexpectedly, getting smaller.

Consumer-driven medical spending may be the second-biggest story in health care, after the Affordable Care Act. As employers give workers more skin in the game through higher costs from purse and paycheck, the thinking goes, they'll seek more efficient treatment and hold down overall spending.

But consumers may not be as invested as experts thought, new government figures show. Despite rapid growth in high-deductible health plans and rising employee contributions for insurance premiums, consumers' share of national health spending continued to fall in 2011, slipping to its lowest level in decades.

"I'm surprised," says Jonathan Gruber, a health economist at the Massachusetts Institute of Technology. "All the news is about the move to high-deductible health plans. Based on that logic ... I would have expected it to go up."

True, medical costs are still pressuring families. Household health expense has outpaced sluggish income growth in recent years, says Micah Hartman, a statistician with the Department of Health and Human Services, which calculates the spending data.

But from a wider perspective, consumer health costs continued a trend of at least a quarter-century of taking up smaller and smaller parts of the health-spending pie. Household expense did go up. But other medical spending rose faster, especially for the government Medicare and Medicaid programs.

Economists measure three kinds of consumer health costs: insurance premiums paid through payroll deductions or for individual policies; out-of-pocket costs for deductibles and co-pays; and Medicare payroll taxes. Such outlays fell to 27.7 percent of the health care economy in 2011, down from 28 percent in 2010 and from 32 percent in 2000, according to the national health expenditures report issued by HHS last week.

That's despite the fact that one in three workers is covered by a plan with a deductible of at least $1,000 -- up from one in 10 in 2006 --according to the Kaiser Family Foundation. Among small firms, half the workers are now in high-deductible plans.

One factor holding down costs even for families with consumer plans has been patent expirations for expensive, commonly used medicines such as Prevacid and Flomax.

"People these days are spending a lot less out-of-pocket on prescription drugs," said Peter Cunningham, director of quantitative research at the Center for Studying Health System Change. "A lot of that has to do with the shift from brand name to generics."

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Patients' Share of Health Care Costs Is Actually Shrinking