OBJECTIVES: The implementation of the New Rural Cooperative Medical Scheme (NRCMS) has been spreading fast since a county pilot trial began in September 2003. The purpose of this survey was to guide policy-makers of Huxian county and ultimately improve the current national NRCMS policy. METHODS: Cross-sectional survey of the attitudes of farmers towards the NRCMS conducted in 2005. A total of 1978 farmers living in 50 villages in Huxian Shaanxi Province were surveyed using a door-to-door questionnaire. The survey asked farmers questions regarding their awareness of the NRCMS and their opinions of the scheme, including methods of reimbursement and raising funds and concerns regarding the scheme’s sustainability. RESULTS: Most farmers hold a positive attitude towards the NRCMS. There are issues, however, in regard to the farmers’ trust in the scheme and preferred payment methods. Farmers place more trust in village doctors rather than village cadres for fund collection. More than two thirds of farmers visit county-level hospitals directly when they require inpatient treatment. Not all hospitals and doctors fully comply with the NRCMS rules, and supplier-induced demand is still widespread. More than half the farmers stated that they worry that the NRCMS is unable to be sustained. Importantly the survey showed a high enrolment rate of 92% (95% CI, 91; 93) in a voluntary insurance scheme. CONCLUSIONS: Despite a high voluntary enrolment rate in the NRCMS a number of issues have been identified in the survey. Three key remedial actions in health financing, planning and management to counteract the identified issues are proposed: 1) Enacting legislation and setting up a risk fund to ensure sustainability of the NRCMS; 2)The main rights and responsibilities of related parties in the NRCMS should be clarified to improve the incentive mechanism; and 3) Integrate disease prevention and the reform of township hospitals.