Kempers Jari
Qalys Health Economics, Middenweg 239 I, 1098AP, Amsterdam, the Netherlands.
Reprod Health. 2015 May 1;12:37. doi: 10.1186/s12978-015-0025-8.
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.
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.
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.
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.
为年轻人提供的青年友好型性与生殖健康（YFSRH）服务在许多国家都具有高度优先性。然而，对于提供YFSRH服务的实际成本却知之甚少。本文分析了爱沙尼亚一个全面扩展的全国青年诊所网络（YCN）的成本。它报告了：1）2002 - 2012年期间YCN的总预算，以及2）2012年三家青年诊所（YC）的年度诊所层面成本。
回顾性成本分析基于爱沙尼亚健康保险基金（EHIF）、爱沙尼亚性健康协会（ESHA）、国家健康发展研究所和各青年诊所的财务及医疗记录。分析了2002 - 2012年每年的项目层面成本、资金来源以及用于协调的部分。2012年分析了三家青年诊所的成本，按诊所、费用类别、患者和医疗服务进行分析。
YCN的总预算为838万欧元，在2002 - 2012年期间为304,000名年轻患者提供服务。总预算的95%由EHIF提供资金。3.6%用于协调。塔林、塔尔图和伊达 - 维鲁马的青年诊所年度预算分别为24.7万欧元、26.7万欧元和4.2万欧元。2012年，这三家青年诊所为19,700名患者提供了YFSRH服务，不包括性教育课程和网络咨询。YFSRH服务成本为54.3万欧元。因此，每位患者的平均成本为27.76欧元。最大的费用类别是人员工资35%和医疗用品33%。YFSRH服务的成本为：性传播感染咨询54.80欧元、生殖健康咨询13.13欧元、避孕咨询9.32欧元、网络咨询8.21欧元和性教育课程1.52欧元。
爱沙尼亚的YCN对于其他正在考虑或已经实施类似项目的国家来说是一个积极的范例。成本分析突出了以下几点：可持续资金尤为重要，没有它，YFSRH服务在爱沙尼亚就无法在国家层面上得到扩展和维持。建议对YFSRH服务的专业协调进行投资，而且不一定需要高昂费用。YCN总预算中只有3.6%用于ESHA的协调，这是一个小比例，尤其是考虑到ESHA对YCN的发展、培训、质量改进和代表性所做出的重大贡献时。
