Only less than 30% hospitals do not carry out any cost accounting. But in most hospitals specialty costing is implemented, and more detail-level cost accounting such as clinical protocol costing is carried out in only a few hospitals. Relatively more cost accounting is done in hospitals with long-time experience of DPC, large-scale hospitals, hospitals engaged in target costing, and hospitals with administrative staff actively involved in clinical protocol development. Long-time experience of DPC is important but not enough to facilitate carrying out detail-level cost accounting. It is important to acquire structure as a medical corporation with adequate human resource and information system enough to implement cost accounting. In addition, it is important to facilitate active involvement in target costing and arrange active involvement in clinical protocol development by administrative staff.