Parak Yusuf, Davis Razaan, Barnard Michelle, Fernandez Amanda, Cloete Keith, Mukosi Matodzi, Pitcher Richard D
Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Department of Radiodiagnosis, Tygerberg Hospital, Cape Town, South Africa.
SA J Radiol. 2022 Jul 22;26(1):2464. doi: 10.4102/sajr.v26i1.2464. eCollection 2022.
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.
An analysis of public sector MR utilisation in South Africa's Western Cape province (WCP).
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).
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.
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.
不同国家和医疗体系之间磁共振成像（MR）设备可及性的差异已有充分记录。但对于同一医疗体系和地理区域内获取机会不平等的决定因素，人们了解甚少。
对南非西开普省（WCP）公共部门MR设备的使用情况进行分析。
对2013年和2018年WCP的MR设备及人口数据进行回顾性研究。计算每年全省以及“西部”和“东部”转诊路径每10人拥有的MR设备数量、检查次数以及每10人接受的检查次数，并按年龄（0 - 14岁、>14岁）分层。
2013年至2018年期间，WCP人口增长了8%（从46.3万增至50.8万），而MR设备资源未变（“西部” = 2台；“东部” = 1台），这相当于全省（每10人拥有的设备数量从0.65降至0.59；-9.2%）、“西部”（从0.97降至0.9；-7.2%）和“东部”（从0.39降至0.35；-10.3%）转诊路径的可及性下降。2013年，40%（4005/10090）的检查在服务于55%（2066079/4629051）人口的“东部”转诊路径进行。2013年至2018年期间，“东部”人口增长（=286781）比“西部”（=168469）多70%（=118312）。到2018年，38%（7939/12848）的检查在“东部”转诊路径进行，此时该路径服务于56%（2849753/5084301）的人口。在0 - 14岁儿童中，“西部”的使用率（每10³人接受的检查次数）在整个期间比“东部”高出约2.4倍。在14岁以上患者中，在研究期间使用率差异从1.78增至1.98。
要在同一医疗平台上确保公平服务，需要持续监测资源和人口分布情况。MR设备的可及性可作为高度专业化服务公平性的一个指标。
