 If we define a “health need” as any decrement in health (either years to live or a less-than-optimal level of bodily functioning), health resource efficiency is a matter of using health resources to minimize ill-health in a manner that does not waste health care resources. In the case of a single individual, there is no issue: give the person the resources he or she actually requires and nothing more. But resource allocation is only an issue when there is more than one claimant to the same, scarce, resource. Resource allocation is a problem of fairness across populations. This leads us to the question of distributional fairness where, as we shall see below, there are various competing options besides CEA. At first glance, however, the general efficiency requirement that scarce health resources be used to maximize benefit or minimize need seems strongly intuitive. 