title: Hospital efficiency: how to spend less maintaining quality?
abstract: BACKGROUND
  The recent global economic crisis is pushing governments worldwide to obtain a more explicit and urgent rationing of resources. The purpose of this study is to provide, through Data Envelopment Analysis (DEA), a methodological framework useful for investigating technical efficiency of hospital care.
  
  
  METHODS
  To validate such framework, we compared 50 Italian public hospital trusts (AOs) to identify relative efficient using inputs and outputs from national databases. We also evaluated if, and how, efficiency is affected by various exogenous factors.
  
  
  RESULTS
  On average, Italian AOs had an efficiency score of 77% (SD 0.12). Tobit regression model identified a positive association between efficiency and a lower case-mix index, being in the north of Italy, in a region with fiscal autonomy, with a higher public and a lower private expenditure on health as percentage of GDP.
  
  
  CONCLUSIONS
  DEA may provide useful and especially objective information regarding the technical efficiency of hospital care and support hospital management and policy makers' decisions.
authors.affiliation: Dipartimento di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Campanella
authors.affiliation: Dipartimento di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Azzolini
authors.affiliation: Dipartimento di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Izzi
authors.affiliation: Dipartimento di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Pelone
authors.affiliation: Dipartimento di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: De Meo
authors.affiliation: Dipartimento di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: La Milia
authors.affiliation: Dipartimento di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Specchia
authors.affiliation: President, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Ricciardi
mesh_terms: D017598:Efficiency, Organizational / Q000191:economics*; D005102:Health Expenditures; D006739:Hospital Administration / Q000191:economics*; D006761:Hospitals / Q000592:standards*; D007558:Italy; D058996:Quality Improvement