The evolution of inequality: Socio-economic factors in access to Russian healthcare (2011—2021)

The paper focuses on the socio-economic determinants of inequality in access to healthcare in Russia, measuring both realized (utilization) and unrealized access (unmet need). Using binary choice models based on data from the International Social Survey Program (ISSP) for 2011 and 2021, the paper reveals a persistent inequality in access to healthcare, driven primarily by respondents’ health characteristics, gender, and possession of voluntary health insurance (VHI). Women, those in poor health, and those with VHI reported significantly higher rates of health care utilization and a higher likelihood of unmet need. Age and parental status were significant predictors of healthcare utilization but were not associated with the experience of unmet need. In 2021, against the backdrop of the COVID-19 pandemic, inequalities in access to care intensified and became significantly associated with income, educational attainment, and place of residence. This study concludes that future research on access to economic benefits should incorporate the dual concepts of realized and unrealized access to provide a more comprehensive understanding of health inequality.