Cost analysis of youth clinic network in Estonia.
BACKGROUND
Youth-friendly sexual and reproductive health (YFSRH) services for young people have high priority in many countries. Yet, little is known about the actual cost of delivering YFSRH services. This article analyses costs of a fully scaled up national youth clinic network (YCN) in Estonia. It reports; 1) total budget of the YCN during the period 2002-2012, and 2) annual clinic level costs of three youth clinics (YCs) in 2012.


METHODS
The retrospective cost analysis is based on financial and medical records of Estonian Health Insurance Fund (EHIF), Estonian Sexual Health Association (ESHA), National Institute for Health Development and the YCs. The programme level costs are analysed per year, financing source and a portion spent on coordination in 2002-2012. Costs of three YCs are analysed per clinic, expense category, patient and healthcare service in 2012.


RESULTS
The total budget of the YCN was €8.38 million and it served 304,000 young patients in 2002-2012. 95% of the total budget was financed by the EHIF. 3.6% was spent on coordination. The YCs in Tallinn, Tartu and Ida-Virumaa had annual budgets of €247,000, €267,000 and €42,000 respectively. In 2012 the three YCs provided YFSRH services to 19,700 patients, excluding sexuality education lessons and internet counselling. The YFSRH services cost €543,000. Consequently, the average cost per patient was €27.76. The largest expense categories were personnel salaries 35% and medical supplies 33%. Cost of the YFSRH services were; STI consultation €54.80, SRH counselling €13.13, contraception consultation €9.32, internet counselling €8.21 and sexuality education lesson €1.52.


CONCLUSIONS
The Estonian YCN is a positive example for other countries considering or already implementing similar programmes. The cost analyses highlighted the following: Sustainable funding is particularly important, without it the YFSRH services would not have been scaled up and sustained on the national level in Estonia. Investment in professional coordination of the YFSRH services is recommended, and it does not necessarily have to be expensive. Only 3.6% of the total budget of YCN was used for ESHA coordination, which is a small portion especially when taking into account ESHA's substantial contributions to development, training, quality improvements and representation of the YCN.
Qalys Health Economics, Middenweg 239 I, 1098AP, Amsterdam, the Netherlands. jari.kempers@Qalys.eu.
Jari
J
Kempers
D000328:Adult; D003362:Cost-Benefit Analysis; D004957:Estonia; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D008297:Male; D011787:Quality of Health Care; D034121:Reproductive Health Services / Q000191:economics* / Q000592:standards; D012189:Retrospective Studies