It was possible that the community health workers undergo more stress, burnout and
competition in the big city (Shenyang) than those in the small city (Benxi). The special policy “unlinked lines of revenue and expenditure” which is a widely used model of payment in order to reduce health expenditures was first implemented by the Shenyang local government at the end of 2007. Community residents become the biggest beneficiaries, while community health workers’ personal income and the efficiency of health care service have been weakened. It also increased the stress and competition with the health care work force.