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The evolution of inequality: Socio-economic factors in access to Russian healthcare (2011—2021)
https://doi.org/10.32609/0042-8736-2025-11-102-121
Abstract
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.
References
1. Buzin V. N. (2022). Availability and quality of medical care in Russian healthcare during the pandemic. The second year with COVID-19: Тhe opinion of the population. Russian Journal of Preventive Medicine, Vol. 25, No. 5, pp. 37—45. (In Russian). https://doi.org/10.17116/profmed20222505137
2. Vyalykh N. А. (2015). Factors of social inequality reproduction in the sphere of medical services consumption. Sotsiologicheskie Issledovaniya, No. 11, pp. 126—132. (In Russian).
3. Gimpelson V. E., Monusova G. A. (2024). Does inequality make you angry? Voprosy Ekonomiki, No. 3, pp. 73—95. (In Russian). https://doi.org/10.32609/0042-8736-2024-373-95
4. Davitadze A. P., Rodionova T. I., Khabibullina A. R., Aleksandrova E. A. (2024). Unmet needs for health care in Russia: Findings from the 2022 Public health monitoring survey. Demographic Review, Vol. 11, No. 1, pp. 20—36. (In Russian). https://doi.org/10.17323/demreview.v11i1.20930
5. Zasimova L. S., Khusainova A. G. (2023). Inequality in spending on medicines and dietary supplements in Russia: An empirical analysis. Monitoring of Public Opinion: Economic and Social Changes, Vol. 178, No. 6, pp. 118—143. (In Russian). https://doi.org/10.14515/monitoring.2023.6.2473
6. Selezneva E.V., Sharepina E.A., Kareva D. E. (2023). Availability of medical care during the COVID-19 pandemic for the elderly population of Russia. Research Digest, No. 12. Moscow: HSE Unoversity. (In Russian).
7. Shishkin S. V. (ed.) (2021). Inequality in health care: Analytical report. Moscow: HSE Publ. (In Russian).
8. Abel Z. D. V., Roope L. S. J., Duch R. Clarke P. M. (2024). Access to healthcare services during the COVID-19 pandemic: А cross-sectional analysis of income and user-access across 16 economically diverse countries. BMC Public Health, Vol. 24, article 2678. https://doi.org/10.1186/s12889-024-20147-y
9. Allin S., Grignon M., Le Grand J. (2010). Subjective unmet need and utilization of health care services in Canada: What are the equity implications? Social Science and Medicine, Vol. 70, No. 3, pp. 465—472. https://doi.org///10.1016/j.socscimed.2009.10.027
10. Allin S., Masseria C., Mossialos E. (2009). Measuring socioeconomic differences in use of health care services by wealth versus by income. American Journal of Public Health, Vol. 99, No. 10, pp. 1849—1855. https://doi.org/10.2105/AJPH.2008.141499
11. Andersen R. M. (1968). Families’ use of health services: A behavioral model of predisposing, enabling and need components. Ph.D. dissertation, Purdue University.
12. Anderson L. M., Scrimshaw S. C., Fullilove M. T., Fielding J. E., Normand J. (2003). Culturally competent healthcare systems: A systematic review. American Journal of Preventive Medicine, Vol. 24, No. 3, pp. 68—79. https://doi.org/10.1016/s0749-3797(02)00657-8
13. Azad A. D., Charles A. G., Ding Q., Trickey A. W., Wren S. M. (2020). The gender gap and healthcare: Аssociations between gender roles and factors affecting healthcare access in Central Malawi, June—August 2017. Archives of Public Health, Vol. 78, article 119. https://doi.org/10.1186/s13690-020-00497-w
14. Babitsch B., Gohl D., von Lengerke T. (2012). Re-revisiting Andersen’s behavioral model of health services use: А systematic review of studies from 1998—2011. Psycho-social Мedicine, Vol. 9, article 11. https://doi.org/10.3205/psm000089
15. Balabanova D., McKee M., Pomerleau J., Rose R., Haerpfer C. (2004). Health service utilization in the former Soviet Union: Еvidence from eight countries. Health Service Research, Vol. 39, No. 6p2, pp. 1927—1950. https://doi.org/10.1111/j.1475-6773.2004.00326.x
16. Berkman N. D., Sheridan S. L., Donahue K. E., Halpern D. J., Crotty K. (2011). Low health literacy and health outcomes: Аn updated systematic review. Annals of Internal Medicine, Vol. 155, No. 2, pp. 97—107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005
17. Bertakis K. D., Azari R., Helms L. J., Callahan E. J., Robbins J. A. (2000). Gender differences in the utilization of health care services. Journal of Family Practice, Vol. 49, No. 2, pp. 147—152.
18. Carr W., Wolfe S. (1976). Unmet needs as sociomedical indicators. International Journal of Health Services, Vol. 6, No. 3, pp. 417—430. https://doi.org/10.2190/MCG0UH8D-0AG8-VFNU
19. Cohen S. A., Greaney M. L. (2023). Aging in rural communities. Current Epidemiology Reports, Vol. 10, pp. 1—16. https://doi.org/10.1007/s40471-022-00313-9
20. Cook L. (2015). Constraints on universal health care in the Russian Federation: Inequality, informality and the failures of mandatory health insurance reforms, UNRISD Working Paper, No. 2015-5.
21. Farzianpour F., Byravan R., Amirian S. (2015). Evaluation of patient satisfaction and factors affecting it: A review of the literature. Health, Vol. 7, No. 11, article 1460. https://doi.org/10.4236/health.2015.711160
22. Frey A., Tilstra A. M., Verhagen M. D. (2024). Inequalities in healthcare use during the COVID-19 pandemic. Nature Communications, Vol. 15, article 1894. https://doi.org/10.1038/s41467-024-45720-2
23. Grossman M. (1972). On the concept of health capital and the demand for health. Journal of Political Economy, Vol. 80, No. 2, pp. 223—55. https://doi.org/10.1086/259880
24. Hatzenbuehler M. L., Phelan J. C., Link B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, Vol. 103, No. 5, pp. 813—821. https://doi.org/10.2105/AJPH.2012.301069
25. Hawkins R. B., Charles E. J., Mehaffey J. H. (2020). Socio-economic status and COVID-19-related cases and fatalities. Public Health, Vol. 189, pp. 129—134. https://doi.org/10.1016/j.puhe.2020.09.016
26. Kiil A., Houlberg K. (2014). How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011. European Journal of Health Economics, No. 15, pp. 813—828. https://doi.org/10.1007/s10198-013-0526-8
27. Levesque J. F., Harris M. F., Russell G. (2013). Patient-centred access to health care: Сonceptualising access at the interface of health systems and populations. International Journal for Equity in Health, Vol. 12, article 18. https://doi.org/10.1186/1475-9276-12-18
28. Link B. G., Phelan J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, Extra Issue, pp. 80—94. https://doi.org/10.2307/2626958
29. Liberati A., Altman D. G., Tetzlaff J., Mulrow C., Gøtzsche P. C., Ioannidis J. P. A., Clarke M., Devereaux P. J., Kleijnen J., Moher D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Journal of Clinical Epidemiology, Vol. 62, pp. e1—e34. https://doi.org/10.1016/j.jclinepi.2009.06.006
30. Maleki M., Smith-Colin J. (2025). How do transportation barriers affect healthcare visits? Using mobile-based trajectory data to inform health equity. Transportation Research Interdisciplinary Perspectives, Vol. 30, article 101345. https://doi.org/10.1016/j.trip.2025.101345
31. Moynihan R., Sanders S., Michaleff Z. A., Scott A. M., Clark J., To E. J., Jones M., Kitchener E., Fox M., Johansson M., Lang E., Duggan A., Scott I., Albarqouni L. (2021). Impact of COVID-19 pandemic on utilisation of healthcare services: A systematic review. BMJ Open, Vol. 11, No. 3, article e045343. https://doi.org/10.1136/bmjopen-2020-045343
32. Nikoloski Z., Cheatley J., Mossialos E. (2022). Financial risk protection and unmet healthcare need in Russia. International Journal of Health Policy and Management, Vol. 11, No. 9, pp. 1715—1724. https://doi.org/10.34172/ijhpm.2021.72
33. Nikoloski Z., Somanathan A., Shkolnikov V. M., Sheiman I., Mossialos E. (2024). Unmet need for healthcare in the Russian Federation: Subnational retrospective modelling analysis (2014—2018). BMJ Public Health, Vol. 2, article e000173. https://doi.org/10.1136/bmjph-2023-000173
34. O’Lawrence H. (2019). Lack of insurance coverage affect access to healthcare. European Journal of Environment and Public Health, Vol. 3, No. 1, article em0021. https://doi.org/10.20897/ejeph/3945
35. Oosterhoff M., Kouwenberg L., Rotteveel A. H., van Vliet E. D., Stadhouders N., de Wit G. A., van Giessen A. (2023). Estimating the health impact of delayed elective care during the COVID-19 pandemic in the Netherlands. Social Science and Medicine, Vol. 320, article 115658. https://doi.org/10.1016/j.socscimed.2023.115658
36. Peters S. A. E., Woodward M., Jha V., Kennedy S., Norton R. (2016). Women’s health: A new global agenda. BMJ Global Health, No. 1, article e000080. https://doi.org/10.1136/bmjgh-2016-000080
37. Rahman M. M., Rosenberg M., Flores G., Parsell N., Akter S., Alam A., Rahman M. M., Edejer T. (2022). A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people. Health Economics Review, No. 12, article 60. https://doi.org/10.1186/s13561-022-00398-4
38. Sen G., Östlin P. (2008). Gender inequity in health: Why it exists and how we can change it. Global Public Health, Vol. 3, Sup. 1, pp. 1—12. https://doi.org/10.1080/17441690801900795
39. Schoen C., Davis K., DesRoches C., Donelan K., Blendon R. (2000). Health insurance markets and income inequality: Findings from an international health policy survey. Health Policy, Vol. 51, No. 2, pp. 67—85. https://doi.org/10.1016/S01688510(99)00084-6
40. Thiede M., Akweongo P., McIntyre D. (2007). Exploring the dimensions of access. In: D. McIntyre, G. Mooney (еds.). The economics of health equity. Cambridge; New York: Cambridge University Press, pp. 103—123. https://doi.org/10.1017/CBO9780511544460.007
41. Zazdravnykh E. A., Aistov A. V., Aleksandrova E. A. (2021). Total expenditure elasticity of healthcare spending in Russia. Russian Journal of Economics, Vol. 7, No. 4, pp. 326—353. https://doi.org/10.32609/j.ruje.7.76219
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For citations:
Zasimova L.S. The evolution of inequality: Socio-economic factors in access to Russian healthcare (2011—2021). Voprosy Ekonomiki. 2025;(11):102-121. (In Russ.) https://doi.org/10.32609/0042-8736-2025-11-102-121
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