Given the pressures to promote the efficient utilization of medical resources, hospitals have developed cost accounting systems in several countries. This study discusses the recent development and problems of hospital cost accounting practices in three countries: UK, US, and Japan. first, we discuss a cost accounting structure and detailed pictures of costing practices. Second, problems of current systems arc reviewed and then possible remedies are discussed. Third, we provide implications for implementing the systems(especially ABC). finally, we assert that infrastructure(hospital information systems, database, etc.) must be established and the target level of costing has to be considered before organization-wide application.