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Issues in relevance of accounting information systems are the heart of current theoretical debate. Hospitals strongly illustrate what is involved, given their process complexity (wide variety of clinical cases) and environmental uncertainly (extreme difficulty in prediction of care demand levels). These general issues have lead industrial enterprises to call into question traditional approaches to cost calculation for control purposes. What is the relevance then of the same approaches when implanted in such an unsuitable context? If at first sight the same sources of cost irrelevance are encountered as in the field of industry, a more detailed analysis shows that in the hospital context they take on particularly acute forms leading to complete disintegration of the control system. Hence, the hospital context invites our attention to the conceptual model underlying accounting arrangements.