The Use of RUCAS (Version 1.11) in Health Care
The RUCA codes can be used in many different ways
in various types of health related research and program development and implementation.
There are 30 codes. The large number of codes facilitate the aggregation of
the codes to fit specific needs of those using them for health, demographic,
geographic, and other types of uses.
In almost all cases, the RUCA codes should be aggregated for use. For instance,
it may be appropriate to aggregate them into two groups: rural and urban.
In other instances, it may be appropriate to create a specific group for the
purposes of targeting a program (e.g., limiting a telehealth subsidy program
to codes 7.0, 7.4, 8.0, 8.4, 9.0, 9.2, 10.0, 10.3, and 10.5 – the smaller
and less functionally related to urban and large rural places).
The bottom line from below: Under most circumstances suggested
categorizations A, B, and C will be most appropriate for use. There are many
ways to aggregate the codes based on purpose. A few examples follow.
The way in which they have been used most is to aggregate the codes into four
categories. This is a generally useful aggregation that is useful for most
health related work. When this does not fit the bill, the B and C collapsing
of the categories is usually satisfactory. This categorization approximates
the metro/non metro split at the Census tract (ZIP code) level (categorization
A).
Urban focused: 1.0,
1.1, 2.0, 2.1, 2.2, 3.0, 4.1, 5.1, 7.1, 8.1, and 10.1
Large Rural City/Town focused: 4.0, 5.0, and 6.0
Small Rural Town focused: 7.0, 7.2, 7.3, 7.4, 8.0, 8.2, 8.3, 8.4, 9.0, 9.1,
and 9.2
Isolated Small Rural Town focused: 10.0, 10.2, 10.3, 10.4, 10.5
The percentages of the estimated 1998 US population for these groupings are:
urban, 77.6%; large rural, 9.3%; small rural, 6.9%; and isolated, 6.1%. The
advantage of this definition is that it splits urban and rural in approximately
the same way as does the OMB Metro definition but at the sub county level
and it divides rural into three relevant and useful categories. In many studies
and programs, it makes sense to separate the large rural cities/towns (say
a place of 30,000 population with many medical providers) from those places
that have 1000 population and are isolated from urban places. It is clear
that under most circumstances these two types of places differ greatly and
should be considered separately.
Alternatively, the small rural and isolated small rural categories can be
combined to create a single "small" rural category (categorization
B).
Urban: 1.0, 1.1, 2.0, 2.1, 2.2, 3.0, 4.1, 5.1, 7.1,
8.1, and 10.1
Large Rural City/Town: 4.0, 5.0, and 6.0
Small Rural Town: 7.0, 7.2, 7.3, 7.4, 8.0, 8.2, 8.3, 8.4, 9.0, 9.1, 9.2, 10.0,
10.2, 10.3, 10.4, and 10.5
Of course, the four categories can be aggregated. For instance, the three
rural categories can be combined to create one "rural’ category
(this would approximate the standard Metro definition but at the sub county
level) (categorization C).
Urban: 1.0, 1.1, 2.0,
2.1, 2.2, 3.0, 4.1, 5.1, 7.1, 8.1, and 10.1
Rural: 4.0, 5.0, 6.0, 7.0, 7.2, 7.3, 7.4, 8.0, 8.2, 8.3, 8.4, 9.0, 9.1, 9.2,
10.0, 10.2, 10.3, 10.4, and 10.5
Another alternative is to define urban as all places that have 30% or more
of their workers going to a Census Bureau defined Urbanized Area (this is
the same as "C" but with code 3.0 being moved to the rural group)
(categorization D).
Urban: 1.0, 1.1, 2.0,
2.1, 2.2, 4.1, 5.1, 7.1, 8.1, and 10.1
Rural: 3.0, 4.0, 5.0, 6.0, 7.0, 7.2, 7.3, 7.4, 8.0, 8.2, 8.3, 8.4, 9.0, 9.1,
9.2, 10.0, 10.2, 10.3, 10.4, and 10.5
A more complicated approach can is to assign Census tracts (ZIP codes) as
in "A" except use the secondary work commuting flows to assign them
to the largest place where 30% or more of their population commutes (categorization
E).
Urban: 1.0, 1.1, 2.0,
2.1, 2.2, 3.0, 4.1, 5.1, 7.1, 8.1, and 10.1
Large Rural City/Town: 4.0, 5.0, 6.0, 7.2, 8.2, and 10.2
Small Rural Town: 7.0, 7.3, 7.4, 8.0, 8.3, 8.4, 9.0, 9.1, 9.2, and 10.3
Isolated Small Rural Town: 10.0, 10.4, and 10.5
And finally, another example categorization involves defining a group that
in non urban and non large rural (categorization F).
Rural town focused
or weakly related to urban and large rural places: 3.0 6.0, 7.0, 7.3, 7.4,
8.0, 8.3, 8.4, 9.0, 9.1, 9.2, 10.0, 10.4, and 10.5
Not above: all other codes
Of course, there are many variations of these aggregation schemes and other
alternatives. In some demographic studies, all the codes might be used or
simple combining of categories could be used (e.g., combine 10.0, 10.4, and
10.5 to create a very isolated and small rural town/area group). However,
in general it is expected that categorizations A, B, and C will be used most
often.
updated January, 2006