Value for money audit

1.Its sometimes hard to measure outputs for organisations for example a hospital is number of patients attended to or those healed or those admitted?
2.Organisations will have many conflicting objectives hence hard to measure effectiveness e.g a hospital wants to treat people and still cut operating costs. Hard to achieve both.
3. Economy and efficiency are sometimes achieved by sacrificing quality.
4. Over emphasis on economy may lead to going for short term goals at the expense of long term ones.