For those individuals, out-of-pocket expenses average 78% of average annual income in rural areas, even with the new insurance system. For most of the decade to 2003, the number of visits to township medical centres (hospitals) had been falling, while in urban areas a similar institution did not exist. The two new insurance-based schemes were accompanied by a strategy to orient people to existing township centres and to create new urban community health centres at the level of the neighbourhood committee.