In 2003, the Japanese government introduced a prospective payment methodology into acute inpatient care services by developing a new, national patient grouping, called Diagnosis Procedure Combination(DPC). It raised issues relating to; 1) settling charges for combinations of treatment modalities in a single admission, 2) large practice variations in chemotherapeutic regimens and its pharmaceutical costs, 3) effects of shorter length of stays and outpatient chemotherapy, 4) payment adjustment for hospitals providing care to terminally ill, relapse and metastatic cases. In order to overcome these issues; a) oncologists need to develop treatment guidelines and standardize chemotherapeutic regimens, b) refine DPC to incorporate chemotherapy protocols, c) develop adjustment measures for different densities of care and casemix.