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Cost measurement and cost management in the health sector are in the news. From a passive reality where costs were seen as inevitable, we turned into a society that questions the use of tax pay money and demands transparency in public money management. Hospitals must be rentable, but they should not downgrade the quality of their service. In line with this new reality, cost accounting appears as a way to evaluate and control management results and compare them with similar entities. Nowadays, all people that have to take decisions in health care organizations,are aware of the value of understanding and knowing all they can about costs. The main objective of this research is to understand how Setúbal s Hospital Center (CHS) applies hospitals Cost Accounting Plan (PCAH) and functions with it. This study will also focus on the use of cost accounting outputs on the decision making processes. The analyses should help to get a true vision of what happens in terms of cost accounting in Setubal s Hospital Center and should be especially useful to accounting professionals as well as health professionals that are interested in cost control