Our sector expertise
Chartered Accountant for Private Clinics
Chartered accountant for private clinics and healthcare facilities: activity-based pricing, per-stay cost accounting, practitioner fees, holding and property SCI, corporate tax.
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A private clinic is not an enlarged medical practice. It is a commercial care facility, subject to corporate income tax, financed largely by the national health insurance scheme through activity-based pricing. It combines high capital intensity (operating theatres, imaging, technical platform), a mix of salaried and self-employed practitioners, and an almost systematic group structure. The most costly confusion we see in this sector is treating a clinic like a liberal profession taxed on non-commercial income: it is the wrong framework, fiscally, in accounting terms, and for management.
This page is for the directors and finance teams of for-profit private hospital facilities (acute care, follow-up care, psychiatry, dialysis, home hospitalisation) looking for a firm that can speak in terms of activity-based pricing, homogeneous stay groups and cost per stay, not just produce a set of accounts.
One essential clarification up front: a private clinic is a commercial care facility subject to corporate income tax, distinct from the self-employed physician (taxed on non-commercial income or through a professional company) who practises within it. This page covers the clinic's operating company, not the physician's personal tax return. For non-commercial outpatient care structures, see also our health centres page.
Quick answer: what sets a private clinic's accounting apart#
A commercial private clinic is an enterprise subject to corporate income tax and the general accounting plan, not to the non-commercial income of a self-employed physician. Its revenue comes mainly from health insurance through activity-based pricing (T2A and GHS), recorded via the PMSI. Management relies on per-stay cost accounting, third-party-payment monitoring and a group structure (holding, operations, property SCI) with intragroup flows justified at arm's length value.
Is a private clinic subject to corporate tax or to non-commercial income?#
The self-employed physician works under their own name or through a company, keeps cash-basis accounts as non-commercial income, and reports fees. The clinic is a commercial enterprise: it bills stays, employs care and administrative staff, capitalises a heavy technical platform, and falls under corporate income tax and the general accounting plan applied to healthcare facilities.
This difference is not academic. It governs the treatment of VAT, the depreciation of equipment, the structuring of capital, the taxation of directors and the way performance is read. Confusing the two logics distorts the director's salary versus dividend trade-off and leads to unsuitable structuring choices. Our chartered accounting work always begins by framing this scope.
How is a private clinic financed (T2A, GHS, PMSI)?#
The heart of an acute-care clinic's economic model is activity-based pricing. Each stay is classified into a homogeneous patient group from the medical data, then billed to the national health insurance scheme through a homogeneous stay group (GHS). This activity is recorded through the national medical information system (PMSI).
Why this changes the accounting#
The pace and quality of coding directly determine revenue. Incomplete coding, or a poorly valued stay, is lost income that cannot always be recovered. The link between the medical record, the activity record and billing must therefore be reliable end to end. On the cash side, the health insurance share follows its own settlement cycle, distinct from supplementary insurers and the patient co-payment: a separate tracking of flows is essential to manage working capital.
Our reading#
The main value leak we observe is not fiscal: it sits at the junction between medical coding (which is not the accountant's job) and billing. Our role is to secure the revenue chain, reconcile recorded activity with booked revenue, and flag discrepancies. The bookkeeping and review of a clinic without this activity-to-billing reconciliation remains incomplete.
Massive third-party payment and cash management#
In a clinic, most collection comes from third parties (health insurance, supplementary insurers) rather than from the patient. Third-party payment is massive. This generates multiple receivables, billing rejections to reprocess, and settlement times that vary by payer.
The underestimated risk: a rejection rate that drifts slowly without an alert. A few uncorrected rejection points quickly tie up significant cash. We recommend monthly tracking of receivables by payer, of the stock of rejected invoices, and of receivable ageing, integrated into management reporting.
Cost accounting: cost per stay, per theatre and per unit#
This is where the real added value of a firm that knows the sector lies. A clinic is not managed with an aggregate income statement. It requires fine cost accounting:
- by unit or department (medicine, surgery, obstetrics, etc.);
- by operating theatre, the most capital-intensive and most constrained resource;
- ideally by type of stay, to compare the actual cost with the GHS tariff collected.
Without this level of detail, it is impossible to know which activities genuinely contribute to the margin and which destroy it. Choosing between two specialties, opening an additional theatre session, investing in new equipment: each of these decisions requires a full cost per stay, not an average.
Indicators to monitor monthly#
| Indicator | What it measures | Why track it |
|---|---|---|
| Bed occupancy rate | Use of authorised capacity | Under-occupancy means poorly absorbed fixed costs |
| Average length of stay | Efficiency of the patient pathway | An overly long stay weighs on cost without extra revenue |
| Full cost per stay | Actual cost against tariff | Reveals loss-making activities |
| Margin rate per unit | Contribution of each activity | Guides theatre allocation trade-offs |
| Practitioner fees / revenue | Weight of self-employed practitioners | Secures a recurring product and its treatment |
| Billing rejection rate | Quality of the revenue chain | A drift ties up cash |
How should the fee from self-employed practitioners be booked?#
Two models coexist in most facilities. Some practitioners are salaried by the clinic: their pay is a personnel cost, with the associated social contributions, managed like any payroll. Others work on a self-employed basis within the facility and pay a fee for the provision of resources (premises, theatres, staff, technical platform).
This practitioner fee is a product for the clinic, not a neutral re-invoicing. Its amount, its basis and its treatment must be documented contractually and in the accounts. It is a recurring item that deserves dedicated monitoring: it secures part of the revenue and attracts particular attention during an audit. Never confuse it with an employee's pay.
Heavy investment and depreciation#
A clinic is a capital-intensive activity: operating theatres, imaging, intensive care equipment, information systems. These investments weigh on the balance sheet and generate significant depreciation that durably shapes the income statement.
The points we address: the term and method of depreciation by equipment category, the treatment of technical-platform upgrade spending (expense or asset), the choice between purchase, finance lease and rental for heavy equipment, and the impact of these choices on self-financing capacity and the ratios watched by lenders.
Why set up a holding company and an SCI for a clinic?#
Clinics are rarely held in a single company. The most common structure combines a holding company, an operating company (often a simplified joint-stock company, or a professional one where the purpose requires it) and a property company (SCI) that holds the walls, that is the operating real estate.
This scheme serves real objectives: ring-fencing real estate from operations, organising the upstreaming of cash, preparing for a transfer or the entry of investors, structuring the director's taxation. In return, it calls for flawless rigour on intragroup flows: SCI rents, fees, cash agreements, service agreements. Each flow must be justified at arm's length value, on pain of recharacterisation.
Our support in holding taxation covers overall consistency: the parent-subsidiary regime, tax consolidation where relevant, the setting of SCI rents, and the securing of regulated agreements. For a facility of this size, a statutory auditor is also often required. The firm acts as a statutory auditor registered with the CNCC, and keeps incompatible engagements separate: the same structure cannot be both the bookkeeper and the statutory auditor of the same entity.
Representative case (illustrative)#
A common case in the sector: a mid-sized acute-care clinic with a sound overall result but permanently strained cash. On analysis, two causes combined. First, a billing rejection rate that had drifted without monitoring, tying up health insurance and supplementary receivables for several months. Second, the absence of cost accounting: a structurally loss-making unit was being maintained without management's knowledge, masked by the other activities.
We set up monthly tracking of receivables by payer and of the stock of rejected invoices, and rebuilt unit-level cost accounting with a cost per stay. On this basis, management was able to renegotiate the allocation of theatre sessions and make informed trade-offs. We do not disclose a profit figure: the lesson is methodological, analytical management made visible decisions that were being taken blind.
Quick decision: which project to prioritise#
| Situation | Recommended priority |
|---|---|
| Strained cash despite a sound result | Track billing rejections and receivables by payer |
| Doubt about the real profitability of an activity | Cost accounting by unit and cost per stay |
| Preparing a transfer or a fundraising | Review the group structure and intragroup agreements |
| Renewing the technical platform | Purchase versus finance lease trade-off and depreciation plan |
Key takeaways#
Managing a private clinic means holding three requirements together: securing the activity-pricing revenue chain through to billing, having genuine cost accounting per stay, and mastering a group structure with flawless intragroup flows. It is specialist work, not standard corporate accounting. If you run or oversee a private healthcare facility, let us discuss your situation and your priorities.
Healthcare facilities are subject to regional health authority authorisation and a dense regulatory framework. This page is informative; a decision specific to your facility requires examination of your accounts, your agreements and the law in force.
Updated 19 June 2026. Informative content reviewed by a chartered accountant and statutory auditor registered with the Île-de-France Chartered Accountants Board and the CNCC. A decision specific to your facility requires a review of your accounts and the regulations in force.
Sector Ecosystem
For-profit private hospitalisation covers commercial care facilities subject to corporate tax and to regional health authority authorisation, financed largely by the national health insurance scheme through activity-based pricing. Their model combines high capital intensity, a mix of salaried and self-employed practitioners, massive third-party payment and group structures (holding, operations, property SCI). Management relies on per-stay cost accounting and close monitoring of the billing chain.
Corporate income tax (commercial company)
Tax regime
Health insurance via activity-based pricing
Main financing
National medical information system
Activity record
Salaried and self-employed (fee)
Practitioner models
Holding, operations, property SCI
Typical structure
Regional health authority authorisation
Oversight
Acute-care clinic (medicine, surgery, obstetrics)Follow-up and rehabilitation care clinicPsychiatric clinicDialysis centreHome hospitalisation
Practical framework
Making a clinic's financial management reliable
01
1. Secure the activity-pricing revenue chain through to billing
Reconcile activity recorded in the medical information system with booked revenue, track the stock of rejected invoices and trace every stay group billed. This is the first source of lost income and the basis for everything else.
02
2. Set up cost accounting per stay
Build cost accounting by unit, by operating theatre and, ideally, by type of stay, to compare full cost with the tariff collected and identify activities that destroy margin.
03
3. Manage cash by payer
Monitor monthly the receivables by payer (health insurance, supplementary insurers, co-payment), receivable ageing and the rejection rate, to anticipate the working capital tied to third-party payment.
04
4. Document practitioner fees and intragroup flows
Formalise the fees of self-employed practitioners and secure the SCI rents, cash agreements and service agreements between the holding and the operating company, at arm's length value.
05
5. Frame investments and their depreciation
Establish a depreciation plan by equipment category, decide between purchase and finance lease for the technical platform, and measure the impact on the self-financing capacity watched by lenders.
Your guarantees
National coverage, Parisian expertise
Wherever you are in France, we deploy a 100% digital interface to deliver fast, highly-structured accounting and financial steering.
Regulated firm
Samuel Hayot is a French chartered accountant and statutory auditor registered with the Paris professional bodies.
National reach
The firm is based in Paris 8 and operates with a delivery model designed for businesses located across France.
Modern stack
Pennylane, Dext, Silae and an automation-first setup built for visibility and speed.
Direct contact
Visible phone number, simple contact path, fast engagement letter and tighter qualification of the mandate.
Need a quick read on your situation?
30 complimentary minutes with Samuel Hayot to challenge your reporting and surface your priority levers.
FAQ
Frequently Asked Questions
Is a private clinic subject to corporate tax or to non-commercial income tax like a physician?
A commercial private clinic is an enterprise subject to corporate income tax, not to non-commercial income. The non-commercial regime applies to the self-employed physician working under their own name. The clinic bills stays, employs staff and capitalises a technical platform: its accounting and tax framework is that of a commercial company, which changes everything regarding VAT, depreciation and director taxation.
How does the accountant reconcile recorded activity with revenue?
Activity is coded through the national medical information system and billed to health insurance via stay groups. Our role is not to code, but to secure the chain between coding and billing: reconciling reported activity with booked revenue, tracking rejected invoices and flagging discrepancies. This is often where the first value leak sits, before any tax question.
How should the fee paid by self-employed practitioners be treated?
The self-employed practitioner working in the facility pays a fee for the provision of resources (premises, theatres, staff). This fee is a product for the clinic, to be documented contractually and booked as such. It must never be confused with the pay of a salaried practitioner, which is a personnel cost handled through payroll.
Why set up a holding company and an SCI for a clinic?
The holding, operating company and property SCI structure ring-fences real estate from operations, organises the upstreaming of cash and prepares a transfer or the entry of investors. In return, it requires strict rigour on intragroup flows (rents, fees, agreements), justified at arm's length value, on pain of recharacterisation.
Which indicators should be monitored monthly in a clinic?
Beyond the income statement, we track bed occupancy, average length of stay, full cost per stay, margin rate per unit, practitioner fees and the billing rejection rate. These indicators, built into analytical reporting, reveal loss-making activities and prevent cash drifts.
Does a private clinic need to appoint a statutory auditor?
It depends on the applicable thresholds and the group structure. For a facility of this size and given the holding structures often in place, appointing a statutory auditor is frequent. We assess the obligation in light of your actual situation and coordinate the statutory audit with the accounting work, keeping incompatible engagements separate.
Why is the billing rejection rate a risk for a clinic?
In a clinic, most collection comes from third parties (health insurance, supplementary insurers). A rejection rate that drifts slowly, without an alert, quickly ties up significant cash. Monthly tracking of receivables by payer and of the stock of rejected invoices is essential to manage working capital.
Article written by Samuel Hayot
Chartered Accountant, registered with the Institute of Chartered Accountants.
Regulated French firmUpdated 19 June 20262 sources cited
Regulated French accounting and audit firm based in Paris 8, built to support companies across France with a digital and decision-oriented approach.
Sources
Official and operational sources cited for this page.