Expansion of the commercial medical service market in Russia is a risk factor that promotes social inequality. In remote rural areas, social infrastructure, in particular the healthcare system, has been degrading. As a result, patients have widely taken to the use of commercial medical services. In this situation, such behavioral models are demonstrated not only by well-off, but even by needy rural and small-town residents. In this context, research on the formation mechanisms of user practices in the commercial medical service market in remote rural areas and smaller towns gains more relevance. The objective of the study is to assess the behavior of people in the Republic of Karelia (Russia) as users of commercial services. Methodologically, the study employed the household approach and statistical data analysis methods: factor and discriminant analyses. We demonstrate that the active use of commercial medical services by poor population strata is a necessity-driven activity caused by the absence or low availability of free services of this sort, or their low quality at the local level. The findings can help in decision-making on upgrading the social policy in healthcare.