Modeling Consumer Choice between Public and Private Health Care in Russia

Abstract

Demand for public and private health care services is formed through consumer decision-making in two situations: to seek or not to seek medical help and which medical institution to attend. Theory suggests that choices in these situations occur sequentially and are explained by Andersen's behavioral model. This study tests these theoretical assumptions using three econometric approaches on the Russian National Health Telephone Survey 2022 data: (1) two separate probit regressions, (2) sample selection probit, and (3) nested logit. Nested logit confirmed the relevance of all demand-side characteristics (Andersen's model factors). Being male, older, and having health problems were associated with decreased probability of seeking health care and choosing private clinics. Being married, having a high level of education, being employed, having a medium or high monthly income, and living in larger cities were associated with increased probability of seeking health care and attending private clinics. Robustness check of the nested logit model accounted for the varying levels of availability of health care facilities in different cities. Despite the differences in the availability of public and private medical organizations, trends in consumer behavior remained the same. The author proposes to expand the practice of using nested logit models to analyze the behavior of consumers of medical services using data from Russia and other countries. Recommendations for increasing the efficiency of the Russian health care system and reducing inequality in its use by different consumer groups include transforming attitudes of Russians to their own health and promoting the accessibility of health care.