Background <p>Unmet healthcare needs is an important concern in India’s social development, which limit progress towards the goal of health equity and achieving SDG-3, i.e., good health and well-being.</p> Objectives <p>This paper examines the factors behind rural-urban disparity in unmet healthcare needs in Eastern India.</p> Methods <p>75th round of the National Sample Survey (NSS) on Social Consumption: Health (July 2017-June 2018) has been used. The study involves four East Indian states, i.e., Bihar, Jharkhand, Odisha, and West Bengal. Binary percentage distribution, binary logistic regressions, and Fairlie’s decomposition technique (1999) have been applied. Anderson’s healthcare use model has been applied as a framework of analysis.</p> Results <p>Logistic regression result shows, besides the place of residence, social groups, age, state, religion, nature of ailment, and spells of ailments are major determinants of unmet needs in Eastern India. Decomposition technique shows that economic status, social strata, and the nature of ailments significantly contribute to the rural-urban gap (6.9%).</p> Discussion and conclusion <p>Both structural determinants (predisposing and enabling factors), as well as the nature and severity of diseases (need factors), play a significant role in shaping the inequality. It also suggests the expansion of health schemes as a policy-relevant modifiable factor to reduce healthcare inequality.</p>