This research compared healthcare services utilization among older persons living in urban and rural Vietnam and determined the key factors contributing to their differences. A nationally representative sample of 3,049 older Vietnamese people in 2019 was used with multivariate logistic regressions and Poisson regressions to identify factors influencing the probability and frequency of service utilization. The standard concentration index (CI) and Erreygers concentration index (EI) were applied to measure the differences. The extension of the Oaxaca-Blinder decomposition was used to examine the rural-urban differences in healthcare services utilization and quantify factors contributing to the differences. CIs and EIs were relatively small and nearly zero, meaning that both inpatient service utilization and outpatient service utilization were equally distributed across all household wealth quintiles, regardless of their residence of living. Oaxaca-Blinder decomposition analysis results revealed statistically significant differences between rural and urban older persons in outpatient service utilization, in terms of its probability and frequency. Rural persons had 4.9% lower in the probability of outpatient services utilization than their urban counterparts. Similarly, rural residents had 3.033 times lower in the frequency of outpatient services utilization than urban residents. The use of health insurance during medical treatments and poor health status were two significant determinants explaining the urban-rural differences in healthcare utilization among older adults. Based on the crucial findings, continual development of the health insurance scheme and investment is recommended to support the rural older population in accessing healthcare. Future research opportunities include exploring a more comprehensive understanding of this field, such as examining the factors influencing the choice of healthcare facilities, reimbursement rates, and out-of-pocket expenses for older individuals in urban and rural areas. Additionally, longitudinal studies are recommended to investigate causal relationships in healthcare service utilization among older Vietnamese.