This three-year project at $150,000 is a quasi-experimental study conducted in four rural townships in Chongqing Municipality that aims to develop and test two interventions aimed at improving the integration and effectiveness of rural health care services. The interventions include 1) improved coordination of services between county hospitals, township hospitals and rural clinics; and 2) the adoption of a DRG payment system. To assess the effectiveness of the interventions patients with hypertension, stroke, coronary heart disease and diabetes will be followed for 3 years and the course and outcome of their illness will be compared between the intervention and control sites.