• Ansley Smoak, Young-Il Kim, Sylvia Peral, and Isabel Scarinci.
• From the School of Medicine, the Division of Preventive Medicine, and the Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham.
• South. Med. J. 2022 Jul 1; 115 (7): 414-419.

ObjectivesIncreasing healthcare access is a Healthy People 2030 priority. This study examined healthcare access from the residents' perspective in the two most rural counties in the United States and compared the findings with data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) in rural and urban counties in Alabama.MethodsWe conducted an in-person population-based survey using cluster sampling within census tracts assessing health insurance coverage, having a usual primary care provider, having had a routine healthcare visit within the past year, and barriers to care.ResultsAmong the 395 participants, 81.4% indicated having health insurance coverage, which was slightly lower than the BRFSS data for rural (87.6%) and urban counties in Alabama (87%); 89.6% of respondents indicated having a usual primary care provider compared with 84.3% of rural and 77.2% of urban residents; and 83.2% of participants indicated having had a routine healthcare visit in the last year compared with 77.3% of rural and 77.6% of urban residents. These indicators varied significantly across age, sex, and educational attainment and were consistent with BRFSS findings.ConclusionsHealthcare access, as indicated by health insurance coverage and healthcare utilization, among residents in the two most rural US counties is comparable to access among rural and urban Alabamians. Primary care is a highly used resource in rural areas, and further research should characterize other social/behavioral factors that may explain the poor health outcomes seen in rural areas. In addition, BRFSS data continue to offer a reliable picture of healthcare access in rural areas.

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