There’s been considerable focus on health insurance cost-shifting to covered individuals and families since the passage of the Affordable Care Act. But much of the shift occurred before Americans started looking to insurance exchanges for less costly coverage.

That’s what a research team composed primarily of University of Michigan scholars found when insurance records for 2009 to 2013 were examined. The study found that inpatient hospitalization costs paid by patients rose 37 percent from 2009 to 2013, to the point that the average insured individual was paying more than $1,000 annually in shared costs.

The biggest driver of the increase were deductibles, which rose a staggering 86 percent during that period. Coinsurance was the second largest factor, rising 33 percent during that time.

Individuals bore a greater share of the cost increase than did those with family coverage, the study said.

“In 2013, total cost sharing was highest for enrollees in individual market plans ($1875 per hospitalization) and consumer-directed health plans ($1219). Cost sharing varied substantially across regions, diagnoses, and procedures,” the researchers reported.

But it wasn’t just the average amount that the research team found troubling. Some among the insured were hit much harder than others by out-of-pocket costs, and that bears further investigation.

“Wide variability in out-of-pocket spending merits greater attention from policymakers,” the report concluded.

Additionally, more attention should be paid to cost-sharing trends among those with insurance rather than focusing just on the uninsured, the study’s lead author Emily Adrion told Fortune.

“There have been so many stories about how much hospital costs are for the uninsured and underinsured, but what’s lost is how much people with insurance are paying,” she said.

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Study quantifies skyrocketing copays for the insured

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