Critical needs

1. Developing donation

The current donation development, including recruiting new donors and raising the awareness of the population, is left as the task of blood centres, i.e. hospitals in Estonia. This does not ensure an even development by districts and there is no systematic national promotion for raising awareness and forming attitudes in Estonia. Unfortunately the healthcare budget does not have resources for developing donation, the finances from the state budgets of the last two years were too small for real impact and this financing is not necessarily ensured for the following years. 16 750 Euros have been allocated for donation development in 2013, which will be used to cover the distribution costs of the video clip produced in 2012, and the expenses of donor tents.

There should be separate financial means for developing donation and these should be distributed to the centres either as direct financing or centrally from the budget of the Ministry of Social Affairs. The financing could be divided into two: 1) raising awareness among the population and shaping attitudes with the aim to find new donors; 2) motivating current donors and involving the passive donors.

Several activities could help to shape the attitudes, e.g. cooperation with schools and organizations, campaigns and articles in media (e.g. producing and distributing a commercial), finding new cooperation partners (informational days with local municipalities’ leaders, an approximate sum per event 200 Euros). Motivating current donors could be done by events directed to donors (donor family day, approximate sum per event 3500 Euros) and contacting passive donors (approximate sum per donors 1 Euro, approximately 100 000 inactive donors in Estonia). The sums are based on the calculations brought out in the State program of developing blood donation and blood product self-sufficiency.

2. Blood service information system

The current blood service information system (EVI) has been used in blood centres for organizing their own work and it does not enable information exchange between blood centres. Not all hospital blood banks have joined the blood service information system and it does not work as an operative tool for haemovigilance. The development of blood service information system has been left to the hospitals and therefore depends on the budget priorities of every hospital. That is why there is still no clear overview of donors, blood products supplies and recipients on a national level and there is no way to observe the blood from donor to recipient. In addition, the implementation of the information system is on different levels of development in different blood centres and hospital blood banks.

Blood information system needs to be joined into a centralized system, which shows all donations of every donor, their test results, prepared blood products and possible aberrances; all hospital blood banks need to be added into the system. Financial measures for this development have to be allocated and divided to the centres as direct financing or from the budget of the Ministry of Social Affairs.

With a centralized information system it would be possible to consider its development into an automatic ordering system, which monitors the blood supplies of hospitals and performs automatic orders. A similar system is, for example, used in the Finnish blood service (FRCBS Annual Report 2010). The described ordering system could be combined with planning logistics – i.e. combining the transportation for everyday orders (like Rakvere – Kohtla-Järve – Narva), which would help to cut back on transportation costs.

Preparations for a centralized information system have been started in 2012, with the first stage being mapping the situation and analyzing the needs; developments are planned for the upcoming two years. The plan states the creation of a central information system, where all important data regarding blood handling would be submitted. Thereby, the donor eligibility control would be improved, finding the suitable donor for the patient would be faster, blood traceability is ensured, an overview of product supplies is given, opportunities for electronic ordering and submitting statistic reports are enabled. According to initial evaluation, the central system and creating opportunities for integrating local systems will cost 500 000 Euros, plus management expenses. The developments are financed by the Ministry of Social Affairs. Alongside the central information system, local information systems (e.g. EVI) will remain, the maintenance and development of which will be done by the hospitals. Local systems (at least EVI) need to be renewed within a 5-10 year perspective, estimated cost of the new software is 3-5 million Euros (Analysis of the national information system of blood, tissue and cells 2012).

3. Financing blood service

Currently the financing is based on the issued blood products – the more products are sold, the bigger the income. Financing by product prices has ensured an efficient use of donor blood and a high level of productivity in blood centres, but developing activities – e.g. promoting donation, developing information system – have received less attention and incentives for competition have occurred. Implementing only product-based financing focuses attention on sales of blood products and does not support developments in areas which do not directly result in revenue, e.g. training the staff and quality management. Product- based financing also does not support cooperation, where the biggest problem is creating a unified national information system, but finding necessary resources for that from the sales revenue of blood products is not possible for blood centres as the price calculation does not take into consideration expenses for developing EVI.

A combined financing system should be implemented in financing Estonian blood service, which would consist of elements of product-based financing and base-financing. Activities related to the development of the blood service (promoting donation, developing the information system, training, quality management) would be financed by base-financing, processing by product prices. In this case, activities covered by base-financing should be excluded from product price calculation. In current prices it is mainly quality management, donation development and EVI are not calculated into product prices today and these costs should be covered by base-financing.

4. Selling blood plasma for fractionation

The issue of blood plasma price needs special attention. The current price calculation of Estonian Health Insurance Fund assumes that the product prices cover all costs from donation to transfusion and blood centres do not have other sources of income from the collected blood. In a time where this pricing model was created, blood centres did not have additional revenues and the leftover plasma was thrown away. Today, blood centres can dispose of the leftover plasma by selling it to fractionation. Considering the current product prices and the difference between the prepared and issued plasma the collection and processing of fractionated plasma has been compensated through blood prices with 400 000-500 000 Euros per year in the last few years (i.e. ca. 10% of total compensation of blood products).

Selling plasma leftovers is legal in Estonia and a very reasonable activity from the view point of a specific blood centre (or hospital). Leftover plasma is common in blood processing, but it needs discussion

whether the use of the income from selling blood plasma should purely belong to the blood centre producing the plasma or should general interests be taken into account. This is a supplementary reason for reviewing the product price calculations.