voprecotestВопросы экономикиVoprosy Ekonomiki0042-8736Voprosy Ekonomiki, NP10.32609/0042-8736-2025-11-102-121voprecotest-5498Research ArticleЭКОНОМИКА ТРУДА И СОЦИАЛЬНОЙ СФЕРЫLABOR AND SOCIAL ECONOMICSЭволюция неравенства: социально-экономические факторы доступа к российскому здравоохранениюThe evolution of inequality: Socio-economic factors in access to Russian healthcare (2011—2021)https://orcid.org/0000-0002-1278-9091ЗасимоваЛ. С.ZasimovaL. S.

Засимова Людмила Сергеевна - к. э. н., доцент департамента прикладной экономики факультета экономических наук, руководитель лаборатории экономических исследований общественного сектора (ЛЭИОС) Центра фундаментальных исследований НИУ ВШЭ.

Москва

Liudmila S. Zasimova

Moscow

lzasimova@hse.ruНациональный исследовательский университет «Высшая школа экономики»РоссияHSE UniversityRussian Federation202507112025011102121Copyright © Voprosy Ekonomiki, NP, 20252025Voprosy Ekonomiki, NPVoprosy Ekonomiki, NPhttps://www.vopreco.ru/jour/about/submissions#copyrightNoticehttps://www.vopreco.ru/jour/article/view/5498

Проанализированы социально-экономические детерминанты неравенства в доступе к здравоохранению в России, измеренные при помощи реализованного (использование медицинской помощи) и нереализованного доступа (неудовлетворенной потребности). При помощи вероятностных моделей бинарного выбора на данных Международной программы социальных обследований (ISSP) за 2011 и 2021 гг. выявлено сохраняющееся неравенство доступа к медицинским услугам, обусловленное главным образом характеристиками здоровья респондентов, их полом, а также наличием ДМС. Женщины, люди с плохим здоровьем, обладатели полиса ДМС сообщали о значительно более высоких показателях использования медицинской помощи при более высокой вероятности неудовлетворенной потребности. Возраст и наличие детей были связаны с использованием медицинской помощи, но не с неудовлетворенной потребностью. В 2021 г. на фоне пандемии COVID-19 неравенство в доступе к медицинской помощи обострилось и стало ассоциироваться с доходами населения, уровнем образования и местом проживания. Сделан вывод, что в будущих исследованиях доступа к медицинским услугам следует рассматривать не только реализованный, но и нереализованный доступ для лучшего понимания социально-экономических механизмов неравенства.

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.

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The authors declare that there are no conflicts of interest present.