Routine data analysis of urban-rural differences in health and primary medical care in Scotland
One-fifth of the Scottish population live in rural areas and this has implications for NHS policy. For example, the Arbuthnott allocation formula, recently implemented in Scotland, was the first in the UK to include a cost adjustment for remoteness and rurality. The study explored the relationship between location, health and health care utilisation, after allowing for the potential confounding effects of the different characteristics of the population living in different areas, and in the practices serving these populations. A literature review was conducted to ascertain how rurality and remoteness have been defined previously, and to identify previous studies of the effects of rurality on health, health care utilisation and provision. Routinely available national data were used to explore the relationship between rurality, health and health care utilisation. Allowance was made (wherever possible) for major determinants of health (e.g., population and practice characteristics), when investigating these relationships. The focus was on health and the provision of primary medical care. The analyses found that the population in rural areas has a higher proportion of older (over 65 years) and younger (less than 15 years) people than urban areas. People in rural areas tend to be less deprived but need to travel longer distances to get to their GP surgery than people in urban areas.