OBJECTIVES:  Chronic diseases and associated co-morbidities are highly prevalent among older people and are associated with an increase in health services utilization which in turn raises health care expenditures throughout industrialized societies. However, health care utilization in older people is still inadequately understood, particularly regarding the differences among European jurisdictions and the (endogeneous) relationship between long-term care provision and health care utilization. In our article, we use dataset of Wave 5 of Survey of Health, Ageing and Retirement in Europe (SHARE) survey to study the utilization of health care in older Europeans in 15 European countries. METHODS:  We investigate relationships between factors such as age, gender, income, education and health variables and the utilization of various types of health services. We apply econometric modeling (causal, DAG-based, analysis using novel constructed instrumental variables) to study the determinants of health utilization (different socioeconomic and health variables) of older people and relationship between long-term care provision and health care utilization. RESULTS:  We show some significant differences between determinants of health utilization in terms of probability and frequency of usage. We also explore patterns between welfare regimes, taking Eastern European jurisdictions as a reference category. Finally, we show in a causal model that the provision of formal and/or informal homecare serves as a substitute to utilization of health care services, with significant differences across the jurisdictions. CONCLUSIONS:  Results of our article are important for the management of health care facilities in terms of health care usage by older people, and can be of value to health care providers and policy makers in the field.