New results from a survey indicate that wellness and primary care — keystones of health care reform — are getting neglected.

Close to one-fifth of privately insured people are not taking full advantage of their coverage, according to the survey of about 1,000 people conducted by the Associated Press-NORC Center for Public Affairs Research.

Granted, it’s early in the transition, but patient insurance usage patterns will have to improve if the new models of care under development are going to succeed. Nineteen percent of privately insured respondents are not going to the doctor when they’re sick or injured, 18 percent are not getting primary care checkups or preventive care and 17 percent are not getting recommended tests or treatments. Primary care and wellness efforts won’t work if that many people aren’t participating.

“What we are seeing from these data is that health insurance in general doesn’t insulate everyone from some of the impacts that health care costs can have on their decisions about their own utilization and about their finances more generally,” says Jennifer Benz, senior research scientist for AP-NORC and one of the survey study authors. “And those problems are particularly acute for those who tell us they have a high deductible health plan,” Benz says.

The results for those covered by the increasingly popular high deductible health plans are alarming. Twenty-nine percent didn’t go to the doctor when sick, 24 percent avoided a routine physical or preventive care and 23 percent skipped a test or treatment.

Financially, some HDHP plan participants have taken an especially big hit from a major medical event, according to the survey. For example, 16 percent say they sometimes or often had difficulty paying for basic necessities like food due to health care costs, 24 percent used up all or most of their savings and the same number had difficulty paying other bills.

“Clearly, people are concerned about these costs,” Benz says.