 The intuitive plausibility of the efficiency requirement is the motivation for the rationing strategy based on cost-effectiveness analysis (CEA). The health resource is a cost, the health improvement a benefit, and intuitively we should try to get as much benefit from the cost as possible. Alternatively put, CEA mandates that the lower the cost per unit of health improvement the more effective the use of the associated health resource. Although this strategy can in principle be applied to health resource usage at the individual level, CEA, reflecting its intellectual heritage as a form of utilitarianism, is standardly viewed as a societal strategy in which costs and benefits are aggregated over the population.