Original Research

A 6-year audit of public-sector MR utilisation in the Western Cape province of South Africa

Yusuf Parak, Razaan Davis, Michelle Barnard, Amanda Fernandez, Keith Cloete, Matodzi Mukosi, Richard D. Pitcher
South African Journal of Radiology | Vol 26, No 1 | a2464 | DOI: https://doi.org/10.4102/sajr.v26i1.2464 | © 2022 Yusuf Parak, Razaan Davis, Michelle Barnard, Amanda Fernandez, Keith Cloete, Matodzi Mukosi, Richard D. Pitcher | This work is licensed under CC Attribution 4.0
Submitted: 20 April 2022 | Published: 22 July 2022

About the author(s)

Yusuf Parak, Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Department of Radiodiagnosis, Tygerberg Hospital, Cape Town, South Africa
Razaan Davis, Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Department of Radiodiagnosis, Tygerberg Hospital, Cape Town, South Africa
Michelle Barnard, Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Government Health and Wellness, Cape Town, South Africa
Amanda Fernandez, Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Government Health and Wellness, Cape Town, South Africa
Keith Cloete, Western Cape Government Health and Wellness, Cape Town, South Africa
Matodzi Mukosi, Tygerberg Hospital, Cape Town, South Africa
Richard D. Pitcher, Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Department of Radiodiagnosis, Tygerberg Hospital, Cape Town, South Africa


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Abstract

Background: Disparities in MR access between different countries and healthcare systems are well documented. Determinants of unequal access within the same healthcare system and geographical region are poorly understood.

Objective: An analysis of public sector MR utilisation in South Africa’s Western Cape province (WCP).

Methods: A retrospective study of WCP MR and population data for 2013 and 2018. MR units/106 people, studies, and studies/103 people were calculated for each year, for the whole province and the ‘western’ and ‘eastern’ referral pathways, stratified by age (0–14 years, > 14 years)

Results: Between 2013 and 2018, the WCP population increased 8% (4.63 vs 5.08 × 106 people) while MR resources were unchanged (‘western’ = 2 units; ‘eastern’ = 1), equating to decreasing access (units/106 people) for the province (0.65 vs 0.59; –9.2%), the ‘western’ (0.97 vs 0.9; –7.2%) and ‘eastern’ (0.39 vs 0.35; -10.3%) pathways. In 2013, 40% (4005/10 090) of studies were in the ‘eastern’ pathway serving 55% (2 066 079/4 629 051) of the population. Between 2013 and 2018 ‘eastern’ population growth (n = 286 781) exceeded ‘western’ (n = 168 469) by 70% (n = 118 312). By 2018, 38% (7939/12 848) of studies were performed in the ‘eastern’ pathway, then serving 56% (2 849 753/5 084 301) of the population. Among 0–14-year-olds, ‘western’ utilisation (studies/103 people) exceeded ‘eastern’ by a factor of approximately 2.4 throughout. In patients > 14 years, the utilisation differential increased from 1.78 to 1.98 in the review period.

Conclusion: Ensuring equitable services on the same healthcare platform requires ongoing surveillance of resource and population distribution. MR access can serve as a proxy for equity in highly specialised services.


Keywords

radiology; public sector; middle income country; magnetic resonance imaging (MRI); utilisation; equitable access; health equity

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