Determinants of outpatient health service utilization in Russia: influence of place of residence

The purpose of the study is to assess the overall scope of health services utilization by the population; to exam the individual demographic and socio-economic determinants of health services utilization; to compare the level of medical services utilization in rural and urban areas; to estimate the relative importance of factors affecting the health services utilization among in rural and urban inhabitants. Comprehensive observation of living conditions of the population, conducted by Rosstat in 2018, was used as an information base for the study. The statistical analysis was carried out using multivariate logistic regression models both for the population in the sample as a whole as well as separately for urban and rural residents. Health care services utilization was defined as visits to outpatient facilities or seeking advice from health professionals without visiting health facilities during the previous 12 months before the survey. The results of the study indicated that the rate of health care services utilization was 46.6%. Taking into account demographic and socio-economic factors, rural residents were less likely to use health care services compared to urban residents. Three predisposing factors (gender, age, marital status), seven enabling factors (education, income, employment status, car ownership, three factors of individual social capital), a need factor (self-reported health), and two personal health care factors (smoking, alcohol use) were independently and statistically significantly associated with healthcare service utilization. Female sex, poor/very poor health rating, old age were the strongest predictors of health service utilization. Among the enabling factors the most important were the high level of education and unemployment. Among personal health care factors - ex-smoking. Urban and rural residents showed different patterns of health care service utilization. In urban settlements compared to rural the influence of gender, age, employment status, per capita income, and smoking were the strongest determinants of health care service utilization. In rural areas - health, marital status, education, car ownership, alcohol use.