Some published reports cast doubt on the effectiveness of the New Cooperative Medical Scheme (NCMS) in achieving its stated goals of assuring affordable access to basic health care, increasing financial risk protection and improving health status. Although the coverage rates of rural residents have continually increased, the overall benefit package varies from county to county and is very limited, with many mechanisms to control moral hazards such as deductibles and reimbursement ceilings. This four-year project proposes to use a merging mechanism to enlarge the risk pool of the NCMS from county level to the prefecture-municipality level to improve equity in access to health care and the suitability of the scheme. A situational analysis of NCMS will be carried out in order to understand the existing characteristics, strengthening of its schemes and feasibility of merging schemes; this will be done through document reviews, qualitative and quantitative methods and surveys. A merge plan will be designed and implemented in two pilot counties and qualitative and quantitative methods will be used for evaluating the before and after of the merge intervention. The merge plan will be modified based on the results of the pilot counties and implemented at the municipality level. Expected results from these pilot studies are to gain an understanding of the characteristics and performance of the existing schemes, the factors influencing the performance, merge plans and performance enhancements after merging in terms of coverage rates, satisfaction, health care utilization and financial protection. The principal investigator for this project is Professor Dong Hengjin.