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

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/10 people, studies, and studies/10 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 × 10 people) while MR resources were unchanged ('western' = 2 units; 'eastern' = 1), equating to decreasing access (units/10 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 ( = 286 781) exceeded 'western' ( = 168 469) by 70% ( = 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.