Worsening Health Status among Evacuees: Analysis of Medical Expenditures after the 2011 Great East Japan Earthquake and Nuclear Disaster in Fukushima

Worsening Health Status among Evacuees: Analysis of Medical Expenditures after the 2011 Great East Japan Earthquake and Nuclear Disaster in Fukushima

MAKOTO HASEGAWA,¹ MICHIO MURAKAMI,¹ SHUHEI NOMURA,^2,3 YOSHITAKE TAKEBAYASHI¹ and MASAHARU TSUBOKURA^4,5,6

¹Department of Health Risk Communication, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
²Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
³Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
⁴Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
⁵Department of Radiation Protection, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
⁶Department of Radiation Protection, Soma Central Hospital, Soma, Fukushima, Japan

After Fukushima disaster in 2011, the health status of the region's residents deteriorated. We analyzed the health status, care needs, and access to health services among evacuees and non-evacuees using healthcare expenditure (for self-employed and unemployed individuals aged < 75 years) and long-term care expenditure (mainly for individuals aged ≥ 65 years). Fukushima Prefecture was divided into four areas according to their evacuation status: non-EOAs (municipalities that did not include evacuation order areas (EOAs)); EOAs/non-EOAs (municipalities that included both EOAs and non-EOAs); short-term EOAs (municipalities where the EOA designation was lifted in most areas by fiscal year (FY) 2011); and long-term EOAs (municipalities where most EOA designations remained in place until the end of FY 2015). Increases in expenditure on healthcare and long-term care per capita in short-term and long-term EOAs were greater in FY 2015 than the average values in FYs 2008-2010. The increases in expenditure were higher in short-term and long-term EOAs than those in non-EOAs and EOAs/non-EOAs. The increases in dental health expenditure were attributed to enhanced accessibility to dental health facilities. Furthermore, the evacuations contributed to increases in healthcare and long-term care expenditure, independent of aging and improved accessibly to health facilities. Possible explanations for these increases include the poor health status of the evacuees following the evacuations, reduced availability of informal care provided by family members and neighbors, and reduced patient copayments. The findings highlight the necessity of health promotion among evacuees.

keywords —— copayment; Fukushima Daiichi Nuclear Power Station accident; lifestyle-related disease; long-term care insurance; national health insurance

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Tohoku J. Exp. Med., 2019, 248, 115-123

Correspondence: Michio Murakami, Department of Health Risk Communication, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan.

e-mail: michio@fmu.ac.jp