Objectives To investigate the awareness of new rural cooperative medical system (NRCMS) among resi-dents in Anhua county, a national-level poverty-stricken county in Hunan province, and to reveal problems during the implementation of NRCMS so as to propose suggestions for its improvement. Methods Questionnaire on know-ledge of NRCMS was used to investigate patients who were visiting the doctors in 4 RCMS-designated hospitals in Anhua during the survey. Local NRCMS officials were interviewed about the achievements and problems during NRCMS implementation. Results Residents' awareness of NRCMS was correlated with age and occupation. The problems during NRCMS implementation were foundation risk, insufficiency of essential drug spectrum, inappropriate allocation of foundation for different diseases, stagnation of rural medical network construction, and tedious procedure of reimbursement. Local residents' suggestions included simplification of reimbursement procedure, increase of reimbursement proportion and improvement of medical facility. Conclusions Awareness of NRCMS among Anhua residents needs to be improved and problems during NRCMS implementation need to be solved and improved.