The performance of Italian hospitals and their hierarchical structure of administrative employees

Object: considering the Italian health-care system, the present study analyzes what might affect the efficiency of hospitals. Methodology: in this work, authors propose the Directional Distance Function (DDF) to analyze hospitals' performance, considering efficient each medical center which is able to maximize the production of medical treatments (good output) while complying, at the same time, with budget constraints (i.e. minimizing the expected bad output: financial loss). Results: the empirical analysis suggests that an excessive allocation of employees at the highest level of the hierarchical pyramid can affect the hospitals' performance. Conclusions: a redistribution of employees among hierarchical levels is necessary to increase the hospital's efficiency