Underinsurance in Primary Care: A Report from the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP)

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Figure 1.
Survey response diagram and underinsured sample. *Total number of patients seen on the study day was recorded by each practice except one small practice which provided an average daily patient count (40 patients per day).

Table 1.

Definitions of Insurance Strata

Stratum	Definition
Uninsured	Patient marked “no insurance” during the past 12 months
Partially insured	Patient marked “no insurance” and at least one other type of insurance during the past 12 months
Adequately insured	Patient marked at least one type of insurance during the past 12 months and marked “no” or “don't know” for all indicators of underinsurance
Underinsured	Patient marked at least one type of insurance during the past 12 months and marked “yes” for at least one indicator of underinsurance

Table 2.

Types of Clinics that Participated in this Study (n = 37)

Table 3.

Demographic and Other Characteristics of Survey Respondents (n = 1133)

Characteristic	N (%)
Age (years)
≤17	113 (10.0)
8–39	424 (37.4)
40–64	390 (34.4)
≥65	206 (18.2)
Sex
Male	285 (25.2)
Female	615 (54.3)
Unknown	233 (20.6)
Race/ethnicity
White (non-Hispanic)	672 (59.3)
African-American (non-Hispanic)	60 (5.3)
Other (non-Hispanic)	48 (4.2)
Hispanic	317 (28.0)
Unknown	36 (3.2)
Income
<$25,000	522 (46.1)
$25,000–$49,999	220 (19.4)
≥$50,000	239 (21.1)
Unknown	152 (13.4)
General health status
Good, very good, or excellent	734 (64.8)
Fair or poor	342 (30.2)
Unknown	57 (5.0)
Insurance Type
Medicare only	86 (7.6)
Medicaid only	193 (17.0)
Private only	213 (18.8)
All others	480 (42.4)
No insurance	112 (9.9)
Missing	49 (4.3)

Table 4.

Demographic Characteristics of Underinsured Patients Compared with Those of Adequately Insured Patients*

Characteristic	Insured		Uninsured (n = 112)
Characteristic	Underinsured (n = 344)	Adequately insured (n = 604)	Uninsured (n = 112)
Age^†
≤17	22 (6.4)	57 (9.4)	7 (6.3)
18–39	166 (48.3)	176 (29.1)	57 (50.9)
40–64	130 (37.8)	197 (32.6)	45 (40.2)
≥65	26 (7.6)	174 (28.8)	3 (2.7)
Insured Patients	344 (36.3)	604 (63.7)
Sex^†
Male	66 (19.2)	158 (26.2)	63 (56.3)
Female	228 (66.3)	296 (49.0)	25 (22.3)
Unknown	50 (14.5)	150 (24.8)	24 (21.4)
Race/ethnicity^†
White (non-Hispanic)	189 (54.9)	411 (68.1)	46 (41.1)
African-American (non-Hispanic)	27 (7.9)	22 (3.6)	7 (6.3)
Other (non-Hispanic)	12 (3.5)	31 (5.1)	4 (3.6)
Hispanic	112 (32.6)	134 (22.2)	55 (49.1)
Unknown	4 (1.2)	6 (1.0)	0 (0)
Income^†
<$25,000	184 (53.5)	230 (38.1)	79 (70.5)
$25,000–$49,999	87 (25.3)	111 (18.4)	12 (10.7)
≥$50,000	51 (14.8)	179 (29.6)	5 (4.5)
Unknown	22 (6.4)	84 (13.9)	16 (14.3)
Health suffered from inability to get care because of cost^†
Yes	173 (50.3)	8 (1.3)	52 (46.4)
No/don't know	156 (45.3)	577 (95.5)	52 (46.4)
Unknown	15 (4.4)	19 (3.2)	8 (7.1)
General health status^†
Good, very good, or excellent	202 (58.7)	445 (73.7)	54 (48.2)
Fair or poor	134 (39.0)	136 (22.5)	53 (47.3)
Unknown	8 (2.3)	23 (3.8)	5 (4.5)
Insurance Type
Medicare only	28 (8.1)	58 (9.6)
Medicaid only	83 (24.1)	110 (18.2)
Private only	73 (21.2)	140 (23.2)
All others	160 (46.5)	296 (49.0)

All values shown as n (%).
* Does not include the partially insured (those who had insurance but not for the entire year, which was an additional 73 patients).
† P < .01 for unadjusted χ² test. Analysis for this table did not adjust for practice as a random effect.

Table 5.

Underinsured Versus Adequately Insured: Odds Ratios of Being Underinsured by Patient Demographic and Insurance Characteristics

Demographic Variable	Underinsured Versus Adequately Insured (n = 948)
Demographic Variable	Odds Ratio (95% CI)	P
Sex
Female	2.25 (1.56–3.24)
Unknown	1.28 (0.80–2.05)	<.001
Male	1.00 (1.00–1.00)
Age
≤17	2.51 (1.31–4.81)
18–39	6.18 (3.86–9.92)	<.001
40–64	4.39 (2.74–7.04)
≥65	1.00 (1.00–1.00)
Race/ethnicity^*
African-American (non-Hispanic)	2.63 (1.44–4.83)
Hispanic	1.76 (1.26–2.45)	.001
Other (non-Hispanic)	0.84 (0.42–1.69)
White (non-Hispanic)	1.00 (1.00–1.00)
Rural
Yes	0.85 (0.56–1.29)	.462
No	1.00 (1.00–1.00)
Annual income
<$25,000	2.70 (1.85–3.94)
$25,000–$49,999	2.69 (1.76–4.10)	<.001
Missing	0.92 (0.52–1.62)
≥$50,000	1.00 (1.00–1.00)
General health status
Poor/fair	2.15 (1.59–2.89)
Missing	0.85 (0.37–1.94)	<.001
Good/excellent	1.00 (1.00–1.00)
I pay or a family member pays for my insurance
Yes	1.01 (0.76–1.34)	.967
No	1.00 (1.00–1.00)
My employer or a family member's employer pays for my insurance
Yes	0.65 (0.46–0.90)	.010
No	1.00 (1.00–1.00)
Government pays for my insurance
Yes	0.95 (0.72–1.26)	.722
No	1.00 (1.00–1.00)
Health suffered from inability to get care because of cost^*
Yes	79.21 (38.34–163.64)	<.001
No/don't know	1.00 (1.00–1.00)
Medicaid
Yes	1.21 (0.89–1.64)	.219
No	1.00 (1.00–1.00)
Medicare
Yes	0.47 (0.34–0.64)	<.001
No	1.00 (1.00–1.00)

* Bolded values indicate statistical association at α = 0.01.
Note: Estimated odds ratio and 95% CI are large when underinsured versus insured respondents are compared. This is because of the small number of insured respondents (n = 8) who reported that their health suffered because of high costs.