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

Abstract

Background: There has been considerable focus on the uninsured from national and state levels. There are also many Americans who have health insurance but are unable to afford their recommended care and are considered underinsured. This purpose of this study was to determine the prevalence of underinsurance among patients seen in primary care clinics.Methods: Patients in 37 primary care practices in 3 practice-based research networks completed a survey to elicit the prevalence of underinsurance among those who had insurance for a full 12 months, including private insurance, Medicare, and Medicaid. Being underinsured was based on patients reporting the delay or omission of recommended care because of their inability to afford it.Results: Of those with insurance for a full year, 36.3% were underinsured. Of those who were underinsured, 50.2% felt that their health suffered because they could not afford recommended care, a rate similar among those who were uninsured.Conclusions: When evaluating underinsurance in primary care offices, using an experiential definition based on self-reports of patients about their inability to pay for recommended health care despite having insurance, the prevalence is quite high. It is important for the primary care physician to understand that a substantial percentage of their patients may not follow through with their recommendations because of cost, despite having insurance. This also has significant implications when considering health care reform, particularly considering that these patients reported that their health suffered at a rate equal to that of the uninsured.

Practice Benefit from Participating in a Practice-based Research Network Study of Postpartum Depression: A National Research Network (NRN) Report

“…[31][32][33][34][35][36][37][38][39] Few studies have addressed potential benefits for the practice that extend beyond the study topic. As PBRN studies move from simply recording events to evaluating new management strategies and systems, the potential benefits to the practices increase.…”

Third Journal of the American Board of Family Medicine Practice-based Research Theme Issue

“…Bennett et al, 11 representing the Interventions to Minimize Preterm and Low birth weight Infants through Continuous Improvement Techniques network, assessed the diagnostic accuracy of a 2-item prescreen for identifying possible depression during pregnancy and the postpartum period, reporting that this efficient screening device could reduce the need for further screening of a majority of women. In perhaps the saddest news for our nation from this issue, Voorhees et al, 9 …”

“…3 One investigation used a large database from many practices 4 and 5 survey studies collected key information from patients to inform our care. [5][6][7][8][9] Two studies provide clinical information to improve practice 10,11 and 2 from New Mexico examine physician behaviors. 12,13 A special feature is a dialogue about Institutional Review Board training from the PBRN listserv sponsored by the Agency for Health Research and Quality.…”

Underinsurance Before the Implementation of the Affordable Care Act: From the Research Involving Outpatient Settings Network (RIOS Net)

“…Underinsurance (UI) exists when patients have to forego or delay needed health care or when out-of-pocket medical costs exceed 10% of household income (5% for low-income families). 1 The ACA aims to provide a continuum of affordable coverage options through Medicaid and new health insurance exchanges. Some reports suggest that UI may decrease under the ACA, 2,3 whereas others suggest it will persist, particularly for those with the ACA Bronze and Silver (lower monthly premium/ higher cost-sharing) plans.…”

“…5 National rates of UI are 16%; however, rates in primary care clinics have been as high as 36%. 1 In anticipation of ACA implementation, the Research Involving Outpatient Settings Network (RIOS Net) conducted a pilot study in New Mexico to estimate the prevalence of UI in academic primary care clinics serving low-income, multiethnic populations.…”