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This study was designed to measure the performance of county health systems in central and western China utilizing routine healthcare data.Drawing on a literature review and expert consultation,the study established a theoretical framework and an indicator system for performance review.Questionnaires were designed and disseminated to collect empirical data on health system performance in four counties of two central and western provinces.Quantitative data were subjected to descriptive statistical analysis through SPSS12.0.Three dimensions were introduced in the performance review framework-health outcomes,financial risk protection and consumer and provider satisfaction.Health outcomes were assessed from four secondary indicators:infant mortality rate;maternal mortality rate;under-5 child mortality rate;and the incidence of Class A and Class B notifiable diseases.Financial risk was assessed using two secondary indicators:the proportion of the cost of inpatient care that was reimbursed under the New Cooperative Medical System(NCMS) insurance scheme,and the rate of NCMS funds utilization.The assessment of satisfaction was made using two secondary indicators:the overall satisfaction of local residents with healthcare services,and the satisfaction of health practitioners at the township and village level.The study indicated better health system performance in the two counties in Chongqing than those in Shanxi.It was concluded that outcome framework scores can fairly reveal performance differences among county health systems in central and western China,and can provide practical evidence for optimizing the operation and inputs of county health systems.Caution needs to be exercised in generalizing such performance outcomes as many factors such as spending and organization that contribute to county health system performance were not included in the study.