Rural Remote Health. 2026 Mar;26(1):9712. doi: 10.22605/RRH9712. Epub 2026 Mar 26.
ABSTRACT
INTRODUCTION: Pathways aimed at increasing the medical workforce in regional and rural areas in Aotearoa New Zealand have been implemented in universities, such as the Regional and Rural Admission Scheme (RRAS) at Waipapa Taumata Rau | The University of Auckland, to address urban-rural variations in health outcomes. A recent review of the university’s scheme suggested the program was not providing equitable opportunities for students from a rural background as originally intended. Therefore, an updated RRAS was required to be developed to address these inequities, creating a more genuine scheme that may more strongly contribute to developing the regional and rural workforce in New Zealand.
METHODS: We developed a methodological framework to identify and evaluate candidate rural definitions for the purposes of developing a new RRAS for the university. Following an extensive literature review, we utilised two sets of criteria to select candidate rural definitions, which were then evaluated using visual evaluation (mapping) and exploratory analysis. Candidate definitions were modified to use a three-group (rural-regional-urban) version to be suitable for use as an updated RRAS. We used a de-identified student dataset of applicants enrolled for the MBChB medical program at the University of Auckland from 2017 to 2023 (inclusive) and population counts from the New Zealand 2018 Census to investigate differences in potential admission numbers under each candidate definition. The New Zealand Index of Multiple Deprivation 2018 was used to assess the distribution of potential admission numbers by area-level socioeconomic status. We also examined the suitability of the candidate definitions by ethnicity, specifically for students of Māori ethnicity.
RESULTS: We selected two candidate definitions for exploratory analysis: Geographic Classification for Health (GCH) developed by the University of Otago, and the urban accessibility classification 2020 (UA 2020) by Stats NZ. We found that the three-group modified version of the UA 2020 definition consistently classified a higher proportion of students as regional and rural compared to the current RRAS and the alternative candidate definition, the three-group GCH. The modified UA 2020 was found to classify a higher number of Māori students and those living in less-deprived neighbourhoods as rural when compared to the other definitions. Therefore, our final recommendation is to update the existing RRAS using a three-group modified version of the UA 2020 by Stats NZ. Our proposed version will refocus attention to address the under-representation of rural students admitted to professional health programs at the University of Auckland, while not disadvantaging regional students.
CONCLUSION: The updated RRAS will assist in supplementing the future professional rural medical workforce, and subsequently help to reduce health outcome variations between rural and urban areas in New Zealand. The modified UA 2020 is likely to be updated regularly by Stats NZ, and therefore the RRAS can be kept up to date in the future.
PMID:41888043 | DOI:10.22605/RRH9712
