BackgroundBy evaluating equity and effectiveness, this study provides evidence-based knowledge for scientific decision-making and the optimization of magnetic resonance imaging (MRI) configuration and utilization at the provincial level.MethodsUsing data from 2017, we applied a Gini coefficient to analyze the equity of MRI services in 11 sample cities in Henan province. An agglomeration degree was then applied to measure equity from the perspective of population and geography, and a data envelopment analysis was used to evaluate MRI efficiency.ResultsThe overall Gini coefficient of MRI allocation by population in the 11 sample cities is 0.117; however, equity varies considerably among the sample cities. The sample’s comprehensive efficiency is only 0.732, indicating the overall ineffectiveness of provincial MRI utilization. The pure technical and scale efficiencies of four sample cities are below 1, indicating lower MRI effectiveness than the rest.ConclusionsAlthough the overall equity of configuration at the provincial level is relatively good, equity varies at the municipal level. Our results demonstrate a low MRI utilization efficiency; accordingly, policymakers should dynamically adjust the policy based on equity and efficiency.