Hospital resource management is an activity directed toward work that produces efficiency. Efficiency means that the resources put in produce the maximum output. Hospital technical efficiency can be affected by internal and external factors. For external factors, market structure factors, ownership, and regulations may cause technical inefficiency. For internal factors, indeed, the process that occurs in using resources to produce output may cause inefficiency. Economic efficiency can be achieved if disutility phenomena are avoided. Scale efficiency relates to the whole system in producing output using the lowest cost. Scale efficiency can be achieved in the short and long term. Scale efficiency in the health service industry is strongly affected by market and institutional obstacles. Competition among hospitals as well as hospital institutions can hamper hospitals in working at the optimum scale. A hospital manager may face more than one inefficiency problem. The aim to increase efficiency sometimes leads to sacrificing efficiency.