The article is devoted to the development and testing of a methodological approach to the regional assessment of the efficiency of using educational tourism infrastructure based on higher education institutions. The study reveals the role of universities as institutional actors of educational tourism that shape its infrastructural base, event-related offerings, and flows of educational tourists. The necessity of moving from fragmented descriptive characteristics to a comparable quantitative assessment of the efficiency of using university infrastructure at the regional level is substantiated. Tourist flow, the number of implemented educational programs, and the involvement of higher education institutions are used as the basic evaluation indicators. Based on indicator normalization and the application of the CRITIC method, an integral index of the efficiency of using educational tourism infrastructure is developed, which makes it possible to account for regional differences in demand scale, intensity of supply, and institutional coverage. A ranking of the constituent entities of the Russian Federation is conducted, different efficiency models are identified, and a pronounced structural heterogeneity in the development of educational tourism is revealed. It is shown that a high tourist flow is not always accompanied by high infrastructural efficiency in the absence of broad university involvement and a regularly implemented program portfolio. The obtained results make it possible to identify imbalances between coverage, activity, and demand, and also provide a basis for substantiating managerial decisions in the field of educational tourism development. The proposed index can be used in regional strategic planning, monitoring the efficiency of university infrastructure utilization, and self-assessment by educational organizations of their performance in the field of educational tourism.