Flat-Rate vs Per-User Clinic Software: Cost Analysis

Flat Pricing vs Per-User Clinic Software: True Cost Analysis (2026)

Clinic software pricing models fall into two main categories: flat-rate (one price regardless of staff count) and per-user (price scales with the number of staff accounts). The difference is easy to understand in principle but frequently misanalysed in practice — leading clinics to choose a model that costs significantly more than necessary over a two-to-three year period.

This guide explains both models, shows how to calculate true total cost across growth scenarios, and identifies which model fits which type of clinic.

The Two Models Explained

Flat-rate pricing

One monthly price covers the full team — all practitioners, all support staff, all admin accounts. Adding a new hire, a locum, or a second practitioner does not increase the software cost.

Example: Tregovia at EUR 47/month base plan (includes up to 2 staff accounts). A clinic with 2 staff pays EUR 47/month. A clinic with 8 staff adds extra-user packs: 6 additional users = 2 packs × EUR 10/month = EUR 67/month total. Module add-ons (clinical notes, online booking, etc.) are also flat-rate — not per-user.

Revenue implication: As the clinic grows and generates more revenue, the software cost as a percentage of revenue decreases. At year one with EUR 10,000/month revenue, EUR 47/month is 0.5%. At year three with EUR 40,000/month revenue and a modest user-pack addition, costs remain a small fraction of revenue.

Per-user pricing

Price is multiplied by the number of active user accounts. Adding practitioners or staff increases the monthly cost.

Example: A platform at EUR 40/user/month. 1 practitioner = EUR 40. 4 practitioners = EUR 160. 8 practitioners (including support staff) = EUR 320.

Revenue implication: As the clinic grows, software cost grows proportionally. The cost as a percentage of revenue stays roughly constant or increases if software cost grows faster than revenue.

True Cost Calculation: 3-Year Scenarios

Most clinics underestimate per-user cost by calculating only current headcount, not growth trajectory. Run the 3-year model:

Scenario: Small physiotherapy practice, 1 → 3 practitioners over 3 years

Flat rate (EUR 70/month including clinical modules):

• Year 1 (1 practitioner): EUR 840/year
• Year 2 (2 practitioners): EUR 840/year
• Year 3 (3 practitioners): EUR 840/year
• 3-year total: EUR 2,520

Per-user (EUR 45/practitioner/month including clinical modules):

• Year 1 (1 practitioner): EUR 540/year
• Year 2 (2 practitioners): EUR 1,080/year
• Year 3 (3 practitioners): EUR 1,620/year
• 3-year total: EUR 3,240

The per-user model is cheaper in year one (EUR 540 vs EUR 840). It becomes more expensive in year two and significantly more expensive in year three. Over three years, flat rate saves EUR 720 — and the gap widens further with growth.

Break-even calculation

For any flat-rate vs per-user comparison:

• Break-even user count = Flat rate ÷ Per-user rate
• Example: EUR 70/month flat ÷ EUR 45/user/month = 1.6 users

At break-even (1.6 users, effectively 2 users), both models cost the same. Below that, per-user is cheaper. Above that, flat rate is cheaper.

For any clinic expecting to have more than 2 practitioners or staff accounts, flat-rate pricing is typically the better long-term choice.

What's Included in "Per User"

Not all per-user models count the same users. Verify:

Does the per-user count include:

• Support staff / receptionists?
• Part-time or casual practitioners?
• Locum or substitute practitioners?
• Admin-only accounts (manager, owner)?

A platform that charges per-practitioner (not per-staff) is cheaper than one that charges per-staff-account. A clinic with 3 practitioners and 4 support staff pays 3× on a per-practitioner model but 7× on a per-staff-account model.

Always calculate cost using total expected headcount across all account types, not just current practitioners.

Hidden Costs in Per-User Models

Per-user pricing often has hidden cost components that don't appear in the headline rate:

Add-on modules priced per user: Some platforms charge a flat module price; others charge per-user for add-on modules. A EUR 10/user/month clinical notes add-on at 5 users is EUR 50/month, not EUR 10/month.

Inactive user policies: Some platforms count inactive accounts (staff on leave, departed employees not yet removed) toward the user limit. Failing to promptly remove departed staff adds unnecessary cost.

Account type tiers: Some platforms offer "limited" accounts at a lower per-user rate for support staff vs full accounts for practitioners. This can reduce per-user cost but requires managing two account types.

Minimum user requirements: Some platforms have minimum user counts at certain tiers. A platform pricing at EUR 30/user/month with a 5-user minimum is effectively EUR 150/month minimum, not EUR 30/month.

When Per-User Pricing Makes Sense

Per-user pricing is the better choice when:

• The clinic is very small and unlikely to grow. A solo practitioner on a EUR 30/user/month platform saves money vs a EUR 70/month flat rate for several years.
• Access should be strictly limited. In a practice where software access should be tightly controlled (e.g., only 2 practitioners and no support staff need access), per-user pricing aligned with actual access is appropriate.
• The per-user model includes features the flat-rate alternative charges as add-ons. If a per-user platform includes SOAP notes, online booking, and intake forms in the per-user price while the flat-rate alternative charges these as add-ons, calculate total cost including add-ons — not just the base prices.

Tregovia's Flat-Rate Model

Tregovia uses flat-rate pricing:

• Base plan: EUR 47/month — up to 2 staff accounts, up to 100 clients (extra users EUR 10/month per 5 seats)
• Module add-ons: EUR 5–15/month per module — not per user
• Published staff limits, client limits, seat-pack pricing, and module pricing

At what team size does Tregovia become cost-competitive?

Compared to a EUR 40/practitioner/month alternative (clinical modules included in their base):

• Break-even: EUR 47/month ÷ EUR 40/month = 1.2 practitioners
• At 2 practitioners, Tregovia (EUR 47) is already cheaper than the per-practitioner alternative (EUR 80)
• At 5 practitioners, Tregovia (EUR 47) vs EUR 200 per-practitioner — EUR 153/month saving

FAQ

How should I calculate whether flat or per-user is better for my clinic?

Step 1: List all staff who will need system access (practitioners, support staff, admin). Step 2: Get the per-user rate including all relevant add-ons. Step 3: Multiply by current headcount and projected headcount at 12 and 24 months. Step 4: Compare to the flat-rate total for the same period. The model with the lower 24-month total is usually the better economic choice.

Does flat-rate pricing mean every feature is included?

No. Flat-rate pricing does not mean every feature is included. Tregovia's EUR 47/month base plan includes core scheduling, billing, and CRM features, while clinical modules, online booking, and intake forms can be separate add-on costs. The important distinction is that add-on modules are priced by module, not one charge per clinician.

Do support staff need the same access level as practitioners?

Usually not. Most clinic software allows role-based permissions — receptionists can access scheduling and billing but not clinical notes; practitioners have full clinical record access; owners see reports and financial data. Both per-user and flat-rate platforms typically support role-based access. The cost difference comes from whether the platform charges for each role, or charges one flat rate regardless of how many roles are used.

What happens to per-user cost when hiring a temporary locum?

On a per-user model, adding a locum for a 2-week cover period typically requires creating a user account — which may trigger a full month's per-user charge even for a short-term engagement. On a flat-rate model, adding a locum account has zero additional cost. For clinics that regularly use locum practitioners, flat-rate pricing is significantly more economical.

Is per-user pricing negotiable?

Yes, often. Most per-user platforms will negotiate annual contracts with discounts, particularly for multi-year commitments or higher user counts. However, negotiate based on a realistic user count projection — committing to a higher user block for a discount that you then grow into is fine; paying for a block you never reach is not.

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