Growth of catheter ablation in Japan: a nationwide observational study of hospital activity, fiscal years 2014–2024
- 1NHO Kyoto Medical Center, Kyoto, Kyoto Prefecture, Japan
- 2Healthcare Management, International University of Health and Welfare, Tokyo, Japan
Abstract
Objectives Catheter ablation volume has grown rapidly in Japan, but whether this growth was driven by existing facilities or by new entrants, and whether it was accompanied by concentration into high-volume centres, remains unknown.Design Retrospective observational study using an 11-year facility-level panel constructed from Diagnosis Procedure Combination (DPC) open data. Facilities were linked across years by record linkage based on continuity of registry numbers, locations and case volumes.Setting All Japanese DPC hospitals disclosed in the DPC open data (≥10 catheter ablation cases/year), fiscal years 2014–2024.Participants 867 unique facilities contributing 6886 facility-years.Primary and secondary outcome measures Growth accounting decomposing the net volume increase into the intensive margin (volume increase at existing facilities), entry and exit; concentration indices (Gini coefficient and five-facility concentration ratio (CR5)); and the association between baseline volume and subsequent growth.Results Total volume increased 2.58-fold, from 51 619 to 133 229 cases and the number of facilities increased from 469 to 764. Of the cumulative net increase of 81 610 cases, 84.7% arose from volume increases at existing facilities, whereas net entry and exit contributed 15.3%. Both concentration indices declined (Gini coefficient, 0.524 to 0.485; CR5, 7.5 to 4.3%), indicating no concentration into high-volume facilities. Among continuing facilities, those with smaller baseline volumes grew at higher rates (median growth ratio, 4.37 for <50 baseline cases vs 1.34 for ≥300). Volume increased 2.3-fold to 2.8-fold across all nine regions.Conclusions The expansion of catheter ablation in Japan was driven predominantly by existing facilities rather than new entrants and was not accompanied by concentration into high-volume centres or into specific regions; smaller facilities showed larger relative increases. Ablation has thus expanded as a dispersed hospital network, and planning and quality assurance should take this structure as their starting point.
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BibTeX
@article{yoshizawa2026growth,
title = {{Growth of catheter ablation in Japan: a nationwide observational study of hospital activity, fiscal years 2014–2024}},
author = {Takashi Yoshizawa and Kiyohide Fushimi and Yoshio Sumida},
journal = {BMJ Open},
year = {2026},
month = nov,
doi = {10.1136/bmjopen-2026-127395},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-127395},
note = {CC BY},
}
RIS
TY - JOUR
TI - Growth of catheter ablation in Japan: a nationwide observational study of hospital activity, fiscal years 2014–2024
AU - Takashi Yoshizawa
AU - Kiyohide Fushimi
AU - Yoshio Sumida
PY - 2026
DA - 2026/11/06
JO - BMJ Open
DO - 10.1136/bmjopen-2026-127395
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-127395
AB - Objectives Catheter ablation volume has grown rapidly in Japan, but whether this growth was driven by existing facilities or by new entrants, and whether it was accompanied by concentration into high-volume centres, remains unknown.Design Retrospective observational study using an 11-year facility-level panel constructed from Diagnosis Procedure Combination (DPC) open data. Facilities were linked across years by record linkage based on continuity of registry numbers, locations and case volumes.Setting All Japanese DPC hospitals disclosed in the DPC open data (≥10 catheter ablation cases/year), fiscal years 2014–2024.Participants 867 unique facilities contributing 6886 facility-years.Primary and secondary outcome measures Growth accounting decomposing the net volume increase into the intensive margin (volume increase at existing facilities), entry and exit; concentration indices (Gini coefficient and five-facility concentration ratio (CR5)); and the association between baseline volume and subsequent growth.Results Total volume increased 2.58-fold, from 51 619 to 133 229 cases and the number of facilities increased from 469 to 764. Of the cumulative net increase of 81 610 cases, 84.7% arose from volume increases at existing facilities, whereas net entry and exit contributed 15.3%. Both concentration indices declined (Gini coefficient, 0.524 to 0.485; CR5, 7.5 to 4.3%), indicating no concentration into high-volume facilities. Among continuing facilities, those with smaller baseline volumes grew at higher rates (median growth ratio, 4.37 for <50 baseline cases vs 1.34 for ≥300). Volume increased 2.3-fold to 2.8-fold across all nine regions.Conclusions The expansion of catheter ablation in Japan was driven predominantly by existing facilities rather than new entrants and was not accompanied by concentration into high-volume centres or into specific regions; smaller facilities showed larger relative increases. Ablation has thus expanded as a dispersed hospital network, and planning and quality assurance should take this structure as their starting point.
SN - 2044-6055
SN - 2044-6055
ER -