Abstract
Formal and informal computations of "need" used to determine distribution of public funding within emergency health services do little to alleviate contention over priorities. This article examines two sources of disagreement: the different conceptual perspectives on need, and the inabilities of clinical device designers, physicians, and health planners to confront the full range of issues underlying the debate about need. Prescriptions for improving need determination, including a revised definition of need and a more systemic approach to technology assessment, are presented.