Communal Sharing and the Provision of Low-Volume High-Cost Health Services: Results of a Survey.

INTRODUCTION: This paper suggests and tests a reason why the public might support the funding of services for rare diseases (SRDs) when the services are effective but not cost effective, i.e. when more health could be produced by allocating funds to other services. It is postulated that the fairness of funding a service is influenced by a comparison of the average patient benefit with the average cost to those who share the cost.

METHODS: Survey respondents were asked to allocate a budget between cost-effective services that had a small effect upon a large number of relatively well patients and SRDs that benefited a small number of severely ill patients but were not cost effective because of their high cost.

RESULTS: Part of the budget was always allocated to the SRDs. The budget share rose with the number sharing the cost.

DISCUSSION: Sharing per se appears to characterise preferences. This has been obscured in studies that focus upon cost per patient rather than cost per person sharing the cost.