Persistently uneven deep brain stimulation management in Japan: a nationwide claims analysis, 2014-2024

The study analyzed deep brain stimulation (DBS) management data in Japan over ten years (2014-2024) using the national health insurance database. National DBS management billings increased from 18,659 to 27,233 cases. However, significant unevenness persisted between prefectures throughout the period, with only modest improvement - the Gini coefficient ranged between 0.54 and 0.40. In 2024, the prefecture with the highest DBS management activity billed at 9.1 times the rate of the prefecture with the lowest. Of 23 prefectures with low baseline activity, nine actually showed a subsequent decline. The research demonstrates that universal health coverage and national-level growth alone do not ensure equitable access to long-term specialized care.