Imperial College London


Faculty of MedicineSchool of Public Health

Honorary Senior Research Fellow







Charing Cross HospitalCharing Cross Campus





Publication Type

10 results found

qin VM, McPake B, Raban M, Cowling T, Alshamsan R, Chia KS, Smith PC, Atun R, Lee TYet al., 2020, Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample, BMC Health Services Research, Vol: 20, ISSN: 1472-6963

Background Despite improvement in health outcomes over the past few decades, china still experiences striking urban-rural health inequalities. There is limited research on the rural-urban differences in health system performance in China. Method We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. Findings Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR= 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR= 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR=2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR=1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII=7.45 vs 1.64).ConclusionOur findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A

Journal article

Alshamsan R, Lee JT, Rana S, Areabi H, Millett Cet al., 2017, Comparative health system performance in six middle-income countries: cross-sectional analysis using World Health Organization study of global ageing and health, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 110, Pages: 365-375, ISSN: 0141-0768

Journal article

Alshamsan R, Leslie H, Majeed A, Kruk Met al., 2017, Financial hardship on the path to Universal Health Coverage in the Gulf States, HEALTH POLICY, Vol: 121, Pages: 315-320, ISSN: 0168-8510

Journal article

Alshamsan R, 2016, Use of financial incentives in health systems reform, Second Saudi Society for Health Administration conference

Conference paper

Majeed A, El-Sayed AA, Khoja T, Alshamsan R, Millett C, Rawaf Set al., 2014, Diabetes in the Middle-East and North Africa: An update, DIABETES RESEARCH AND CLINICAL PRACTICE, Vol: 103, Pages: 218-222, ISSN: 0168-8227

Journal article

Alshamsan R, Lee JT, Majeed A, Netuveli G, Millett Cet al., 2012, Effect of a UK Pay-for-Performance Program on Ethnic Disparities in Diabetes Outcomes: Interrupted Time Series Analysis, ANNALS OF FAMILY MEDICINE, Vol: 10, Pages: 228-234, ISSN: 1544-1709

Journal article

Dalton ARH, Alshamsan R, Majeed A, Millett Cet al., 2011, Exclusion of patients from quality measurement of diabetes care in the UK pay-for-performance programme, DIABETIC MEDICINE, Vol: 28, Pages: 525-531, ISSN: 0742-3071

Journal article

Alshamsan R, Majeed A, Vamos EP, Khunti K, Curcin V, Rawaf S, Millett Cet al., 2011, Ethnic Differences in Diabetes Management in Patients With and Without Comorbid Medical Conditions: A cross-sectional study, Diabetes Care

Journal article

Alshamsan R, Majeed A, Ashworth M, Car J, Millett Cet al., 2010, Impact of pay for performance on inequalities in health care: systematic review, JOURNAL OF HEALTH SERVICES RESEARCH & POLICY, Vol: 15, Pages: 178-184, ISSN: 1355-8196

Journal article

Alshamsan R, Millett C, Majeed A, Khunti Ket al., 2010, Has pay for performance improved the management of diabetes in the United Kingdom?, PRIMARY CARE DIABETES, Vol: 4, Pages: 73-78, ISSN: 1751-9918

Journal article

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