The verdict in three sentences
For a Berlin medical practice, the choice is between a SaaS at 30-100 EUR/clinician/month and a custom build at 25,000-70,000 EUR, delivered in 3 to 5 months. SaaS wins below 6-7 clinicians or when needs are standard; custom takes the lead above that, with tuned SMS reminders and occupancy +18 %. Both require GDPR and certified health-data hosting, with a shared goal of -30 % no-shows.
Buy vs build: the real math
A shared SaaS costs little upfront but is paid every month, per clinician. Custom software needs starting capital but fixes the recurring cost (maintenance + hosting). The tipping point depends on clinician count and how long you use it.
| Criterion | Shared SaaS | Custom |
|---|---|---|
| Upfront cost | 0 - 3,000 EUR | 25,000 - 70,000 EUR |
| Recurring cost | 30 - 100 EUR/clin./mo | Maintenance 400 - 900 EUR/mo |
| Setup time | 2 - 6 weeks | 3 - 5 months |
| Customization | Low to medium | Full |
| SMS reminders | Included, capped | Unlimited, scripted |
| Data ownership | Vendor | Practice |
3-year cost and profitability levers
Over 3 years, an 8-clinician practice on SaaS at 60 EUR/month spends 17,280 EUR and owns nothing. The same practice built custom at 48,000 EUR + maintenance 600 EUR/month reaches 69,600 EUR but capitalizes an asset and tunes every reminder scenario.
| Scenario (8 clinicians, 3 years) | Total cost | Asset owned |
|---|---|---|
| SaaS 40 EUR/clin./mo | 11,520 EUR | No |
| SaaS 60 EUR/clin./mo | 17,280 EUR | No |
| SaaS 90 EUR/clin./mo | 25,920 EUR | No |
| Custom 35,000 EUR + maint. 500 | 53,000 EUR | Yes |
| Custom 48,000 EUR + maint. 600 | 69,600 EUR | Yes |
| Custom 60,000 EUR + maint. 800 | 88,800 EUR | Yes |
Mini case study
Dr. Bauer, manager of a 9-clinician practice in Berlin, sees 16 % no-shows on 1,900 appointments/month, or 304 lost slots at 28 EUR: 8,512 EUR/month lost. She weighs a SaaS at 70 EUR/clinician (630 EUR/month) against a custom build at 46,000 EUR + maintenance 650 EUR/month. SaaS cuts no-shows by 22 %, custom by 30 % thanks to reminders at D-3, D-1 and H-2. Difference: 8 % x 304 x 28 = 681 EUR/month in favor of custom, plus +18 % occupancy from recovered cancellations. The build premium pays back in about 30 months, after which the practice owns its tool.
FAQ
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At how many clinicians does custom become worthwhile?
Generally above 6-7 clinicians or 1,500 appointments/month. Below that, SaaS at 30-100 EUR/clinician stays faster and less risky.
Does SaaS handle certified health-data hosting?
Good health vendors do, via a certified host. Always check compliance certification and data location before signing.
How long for custom appointment software?
3 to 5 months: scoping, calendar and reminder development, testing, migration of existing data.
How many no-shows can you really avoid?
A well-configured SaaS targets -20 to -25 %; custom with multiple reminder scenarios reaches -30 %. On 300 lost slots, every point counts.
Can you migrate from SaaS to custom later?
Yes, by exporting patient history. Budget 3,000 to 8,000 EUR for data migration depending on format and volume.
Let's scope your project. Tell us your clinician count, appointment volume and budget: we cost the most profitable buy-vs-build scenario. Detailed quote within 48 h. WhatsApp +221 77 596 93 33.
Mohamed Bah
Fondateur, Kolonell
Passionate about digital and entrepreneurship in Africa, Mohamed has been helping Sénégalese businesses with their digital transformation since 2020. Founder of Kolonell, he believes every SME deserves a professional and accessible online présence.