Background:To compare surgical procedure rates between metropolitan and rural/remote residents in Western Australia (WA). Methods: The WA Data Linkage System was used to identify all patients who underwent a procedure for cataract, ureteric calculi or urinary outflow obstruction symptoms for the time periods 1981–2000, 1981–1997 and 1981–1995, respectively. Age-standardized procedure rates were calculated and Poisson regression modelling was used to estimate effects of locality of residence and demographic covariates. Results: Overall, rural/remote patients underwent first-time procedures for cataract (IRR 0.92; 95... CI 0.90–0.94), ureteric calculi (0.76; 0.72–0.80), or urinary outflow obstruction (0.71; 0.69–0.74) less frequently than patients in the metropolitan area. They were also significantly less likely to undergo multiple procedures for cataracts (0.90; 0.88–0.91) and ureteric calculi (0.69; 0.67–0.73). Conclusion: A distinctly reduced level of surgical intervention was found in rural patients for three generally non-life threatening conditions. The reasons for this require further investigation.