Mass evacuation and increases in long-term care benefits: Lessons from the Fukushima nuclear disaster

Autoři: Tomohiro Morita aff001;  Michihito Ando aff002;  Yui Ohtsu aff003
Působiště autorů: Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan aff001;  Department of Economics, Rikkyo University, Toshima-ku, Tokyo, Japan aff002;  Graduate School of Humanities and Social Sciences, Saitama University, Shimo-Okubo, Sakura-Ku, Saitama, Japan aff003
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0218835



Though mass evacuation may increase the need for long-term care (LTC) services, how the need for LTC services increases and how the public LTC system affects it is not well understood. We evaluated changes in public LTC benefits for the people living in the mandatory evacuation areas established after the 2011 Fukushima nuclear disaster and examined the roles of the universal LTC insurance system in Japan.


In order to evaluate the effect of the mandatory evacuation on LTC benefits, we examined the trends of LTC benefits in the Fukushima evacuation group and the nationwide non-evacuation group. We first decomposed per-elderly-individual benefits at the municipality level into the LTC certification rate and per-certified-individual benefits, and then implemented difference-in-differences analysis using these variables as outcomes.


Per-elderly-individual benefits significantly increased from 2012 onward in the evacuation group, and this was explained by an increase in the certification rate rather than in per-certified-individual benefits. Increases in per-elderly-individual benefits and the certification rate in the post-disaster period were observed in all but the highest care level, and the corresponding outcomes for the highest care level decreased immediately after the disaster. We also found that the increase in the certification rate had been mostly realized by an increase in the number of certified individuals.


The increase in LTC benefits can be associated with the impact of the increase in the number of people newly certified to receive LTC benefits after the mandatory evacuation. In order to cope with the increase in utilization of long-term care and associated costs after disasters in aging societies, both formal long-term care services and social support for informal care for evacuees should be considered important.

Klíčová slova:

Aging – Elderly – Finance – Geriatrics – Insurance – Japan – Long-term care – National governments


1. Council NR, Grid I. Global Report on Internal Displacement. Consultado en 2016.

2. Hasegawa J, Hidaka H, Kuriyama S, Obara T, Hashimoto K, Tateda Y, et al. Change in and long-term investigation of neuro-otologic disorders in disaster-stricken Fukushima prefecture: retrospective cohort study before and after the Great East Japan Earthquake. PloS one. 2015;10(4):e0122631. doi: 10.1371/journal.pone.0122631 25849607

3. Morita T, Nomura S, Tsubokura M, Leppold C, Gilmour S, Ochi S, et al. Excess mortality due to indirect health effects of the 2011 triple disaster in Fukushima, Japan: a retrospective observational study. Journal of epidemiology and community health. 2017;71(10):974–80. doi: 10.1136/jech-2016-208652 28830951.

4. Tomata Y, Kakizaki M, Suzuki Y, Hashimoto S, Kawado M, Tsuji I. Impact of the 2011 Great East Japan Earthquake and Tsunami on functional disability among older people: a longitudinal comparison of disability prevalence among Japanese municipalities. Journal of epidemiology and community health. 2014;68(6):530–3. doi: 10.1136/jech-2013-203541 24570399.

5. Tomata Y, Suzuki Y, Kawado M, Yamada H, Murakami Y, Mieno MN, et al. Long-term impact of the 2011 Great East Japan Earthquake and tsunami on functional disability among older people: A 3-year longitudinal comparison of disability prevalence among Japanese municipalities. Social science & medicine. 2015;147:296–9. doi: 10.1016/j.socscimed.2015.11.016 26613535.

6. Uchimura M, Kizuki M, Takano T, Morita A, Seino K. Impact of the 2011 Great East Japan Earthquake on community health: ecological time series on transient increase in indirect mortality and recovery of health and long-term-care system. Journal of epidemiology and community health. 2014;68(9):874–82. doi: 10.1136/jech-2014-204063 24847089.

7. Tsutsui T, Muramatsu N. Japan’s Universal Long‐Term Care System Reform of 2005: Containing Costs and Realizing a Vision. Journal of the American Geriatrics Society. 2007;55(9):1458–63. doi: 10.1111/j.1532-5415.2007.01281.x 17767690

8. OECD. Japan's Compensation System for Nuclear Damage2012.

9. Ministry of Internal Affairs and Communications. Portal Site of Official Statistics of Japan [cited 2017 September 23].

10. Cotton J. On the decomposition of wage differentials. The review of economics and statistics. 1988:236–43.

11. Finkelstein A. The aggregate effects of health insurance: Evidence from the introduction of Medicare. The quarterly journal of economics. 2007;122(1):1–37.

12. Dobkin C, Finkelstein A, Kluender R, Notowidigdo MJ. The Economic Consequences of Hospital Admissions. Am Econ Rev. 2018;108(2):308–52. 30091560.

13. Solon G, Haider SJ, Wooldridge JM. What are we weighting for? Journal of Human resources. 2015;50(2):301–16.

14. Morita T, Leppold C, Tsubokura M, Nemoto T, Kanazawa Y. The increase in long-term care public expenditure following the 2011 Fukushima nuclear disaster. Journal of epidemiology and community health. 2016;70(7):738. doi: 10.1136/jech-2015-206983 27288528.

15. Fernandez LS, Byard D, Lin C-C, Benson S, Barbera JA. Frail elderly as disaster victims: emergency management strategies. Prehospital and disaster medicine. 2002;17(2):67–74. 12500729

16. Matsuyama Y, Tsuboya T, Bessho SI, Aida J, Osaka K. Copayment Exemption Policy and Healthcare Utilization after the Great East Japan Earthquake. Tohoku J Exp Med. 2018;244(2):163–73. doi: 10.1620/tjem.244.163 29503394.

17. Yasumura S, Goto A, Yamazaki S, Reich M. Excess mortality among relocated institutionalized elderly after the Fukushima nuclear disaster. Public health. 2013;127(2):186–8. doi: 10.1016/j.puhe.2012.10.019 23158829

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