Objective To analyze the effects of essential drug zero-profit sales policy on village doctors' income in village clinic,patients' medical expenses and workload in village clinic. Methods Wanglanzhuang town,Tangfang town and Nansunzhuang village,whose the number of service person and income per capita are similar,are selected as pilot township and non-pilot township of essential drug zero - profit sale. Village doctors' income, outpatient expenditure per capita, monthly outpatient amount of pilot township and non -pilot township were collected,and difference -in -difference was adopted to calculate the net change of village doctors' income,outpatient expenditure per capita,average monthly outpatient amount after essential drug zero-profit sales policy of the village clinic was carried out and hypothesis testing was conducted. Administrative staff and village doctors of health clinics in towns and townships and villagers were chosen to conduct key persons interview,the contents of which includes their feelings of the effects of essential drug zero-profit sales policy of village clinics. Results Before and after the implementation of essential drug zero-profit sales policy in pilot health clinics in villages and towns,the rate of change in village doctors'income was -45. 84%,outpatient expenditure per capita was -35. 94%,average monthly outpatient amount was 40. 14%;and before and after the implementation of essential drug zero -profit sales policy in non -pilot health clinics in villages and towns,the rate of change in village doctors' income was-1. 09%,outpatient expenditure per capita was-3. 85%,average monthly outpatient amount was -1. 56%. The results of difference-in-difference method showed that:the implementation of essential drug zero-profit sales policy resulted in 17 960 yuan decrease of village doctors' income,30. 350 yuan decrease of outpatient expenditure per capita,135. 067 people increase of average monthly outpatient amount,which was of statistical significance(P﹤0. 05). The results of interviews showed that:after the implementation of essential drug zero profit sales policy,medical expenditure of villagers decreased,but the drug types in village clinics reduced;and village doctors'income decreased,leading to theri relatively low working enthusiasm. Conclusion The implementation of essential drug zero profit sales policy reduces medical costs of villagers and improves their enthusiasm to go to the village clinics. However,at the same time the policy also imposes a large impact on the village doctors' income, which is not conducive to the healthy development of the team of village doctors. Therefore,a perfect matched compensation mechanism is desiderated.%目的：探讨基本药物零差率销售政策对村卫生室村医收入、患者就医费用及村卫生室工作量的影响。方法选取服务人口数、人均收入相当的唐山市丰南区王兰庄镇、唐坊镇和南孙庄乡分别作为基本药物零差率销售试点乡镇、非试点乡镇。收集试点乡镇和非试点乡镇的村医收入、人均门诊费用、月均门诊人次，采用倍差法，计算村卫生室基本药物零差率销售政策实施后村医收入、人均门诊费用、月均门诊人次的净变化，进行假设检验。在试点乡镇和非试点乡镇，选取乡镇卫生院和村卫生室管理人员、村医、村民进行关键人物访谈，访谈内容为对村卫生室基本药物零差率销售政策效果的感受。结果试点乡镇村卫生室基本药物零差率销售政策实施前后，村医收入变化率为-45.84%，人均门诊费用变化率为-35.94%，月均门诊人次变化率为40.14%；非试点乡镇村卫生室基本药物零差率销售政策实施前后，村医收入变化率为-1.09%，人均门诊费用变化率为-3.85%，月均门诊人次变化率为-1.56%。倍差法结果显示：基本药物零差率销售政策的实施造成村卫生室村医收入下降了1.796万元，造成人均门诊费用下降了30.350元，造成月均门诊人次上升了135.067人次，有统计学意义（ P﹤0.05）。访谈结果显示：基本药物零差率销售后，村民医疗费用降低，但村卫生室药品种类较少；村医收入降低，导致其工作积极性较低。结论基本药物零差率销售政策的实施降低了村民的就医费用，提高了村民在村卫生室就医的积极性；但对村医收入影响较大，不利于村医队伍的健康发展，亟须完善配套的补偿机制。
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