This study analyses the effect of location of residence on hospital utilisation and outcomes using geocoded hospital morbidity and mortality data for the Western Australian population from 1994 to 1999. Compared to highly accessible areas, the overall hospital admission rate ratio was 2.27 (95% CI 2.19-2.36) for those in moderately accessible areas and 2.35 (95% CI 2.23-2.47) for those in remote areas. The corresponding ratios for total length of stay were 1.19 (95% CI 1.17-1.20) and 1.25 (95% CI 1.23-1.27) and the hazard ratios for risk of readmission at 30 days were 1.06 (95% CI 1.04-1.07) and 1.17 (95% CI 1.15-1.19). This study represents an important advance in describing the effects of remoteness on health service utilisation and outcomes. (c) 2005 Elsevier Ltd. All rights reserved.