The notion of controlling performance in modern healthcare constitutes a key justification for implementing large IT systems. By examining the relationship between healthcare performance and IS cost we significantly improve our understanding of healthcare delivery profile. In the absence of an appropriate fit between the goals of IS projects and smooth healthcare delivery, this research satisfies information needs for healthcare decision-makers. Drawing upon contingency research the authors develop a framework to analyze fit between healthcare delivery strategies and IS focus. They review empirical evidence from the English National Health Service implementation of a nationwide healthcare system with functional and interpretive paradigms. The results not only suggest a monumental gap between the two and but also explains how attempts to control healthcare performance can easily lead to even higher costs. It also elaborates on current pragmatic thoughts about costing IS projects before outlining the research approach.