Abstract
BACKGROUND: Despite national efforts to improve insurance coverage, access to medical care in rural U.S. communities remains limited. While insurance is a well-established enabler of healthcare utilization, its relationship to perceived access among rural adults is underexplored. OBJECTIVE: To examine whether insurance status is associated with perceived access to needed healthcare among rural adults in Connecticut, adjusting for predisposing, enabling, and need-based factors using Andersen's Behavioral Model of Health Services Use (ABMHSU). METHODS: This cross-sectional secondary analysis used the 2012-2013 Connecticut Health Care Survey data. The analytic sample included 593 unweighted cases (weighted N = 256,725). Weighted logistic regression assessed the association between insurance and perceived access, adjusting for social and health covariates. RESULTS: Insurance coverage was significantly associated with greater perceived access (OR = 1.38, 95% CI [1.35, 1.42], p < 0.001). Other significant predictors included gender, age, marital status, employment, and chronic conditions. The model explained 19.8% of the variance and correctly classified 76% of cases. CONCLUSIONS: Insurance is a critical enabling factor for perceived healthcare access among rural adults, but it alone cannot ensure equitable care. Addressing both insurance gaps and the broader structural challenges, such as provider shortages, transportation barriers, and system navigation, will be essential to achieving meaningful improvements in rural healthcare access and equity.