Cost of providing sexually transmitted disease services in Bangkok.

OBJECTIVE

The main purpose of this study was to assess the economic costs of sexually transmitted disease (STD) treatment and to identify opportunities for sustaining Bangkok's STD clinics.

DESIGN

A cost analysis was used to assess the resources required to provide (i) STD services, (ii) additional services at STD clinics during the evening, and (iii) outreach activities with commercial sex workers. The cost analysis included a review of opportunities to increase sustainability through cost recovery and institutional restructuring.

RESULTS

The study revealed that the cost of providing services does differ significantly across the five clinics analysed, with recurrent costs of day-clinic STD care varying from US$13-37 per patient reached. An analysis of expanded evening hours at STD clinics suggested that an investment of US$62 000 per year allowed an additional 2000 patients to receive STD treatment and that evening hours appear to offer greater convenience to patients. It was also found that outreach activities initiated by the STD clinics and carried out in brothels have been used inexpensively (US$0.20 per woman reached) to reach commercial sex workers with critical information on STDs, including HIV. An analysis of opportunities for cost recovery at public STD clinics indicated that although some resources can be recovered, government support will continue to be required. The cost recovery option believed to be most feasible for promoting sustainability was a proposed charge of US$2-4 for STD clinic attenders. This charge was projected to allow each clinic to recover between 11% and 22% of their recurrent costs.

CONCLUSION

This study concluded that there are numerous opportunities for promoting the financial sustainability of STD services at public clinics. It was also concluded that the existing outreach program is extremely inexpensive and is reaching people who are in need of the services that are being offered. However, this study was not able to determine if it would be worthwhile to reopen public STD clinics during evening hours.