Local governments have turned down some 20 percent of applications for the triennial renewal of atomic bomb disease certification for receiving medical allowances, data from the Ministry of Health, Labor and Welfare show.
The rejection rate, which was reported to be only around several percent in the past, shot up to the current level after 2014, when the central government instructed local governments to "properly manage" the program.
Groups of atomic bomb survivors, or "hibakusha," say that some applications are turned down almost automatically, and that such handling runs counter to the spirit of the medical allowance coverage.
Certifications for atomic bomb diseases, which includes symptoms believed to have been caused by the atomic bombing of Hiroshima and Nagasaki in 1945, are approved on the basis of two criteria: whether the health conditions were induced by radiation and if the applicants are in need of medical treatment. Certified patients have to apply for renewal every three years, and prefectural governments or the municipal governments of Hiroshima and Nagasaki review their applications in terms of the latter criterion.
As for the certification criterion on radiation, courts sided with the hibakusha plaintiffs in many class action lawsuits seeking certification, and in 2008 the central government changed its stance and eased conditions for approval. Applications were then accepted if they met certain standards, including how far the individual was from the hypocenter of the atomic blast, and the approval rate shot up from 48 percent during the 2007 fiscal year to 70 percent in fiscal 2017.
Regarding the other criterion concerning the necessity for medical treatment, the health ministry instructed the local governments concerned in 2014 to "objectively confirm" renewal applications, after participants in a ministry panel reviewing the procedure reportedly pointed out that the process was carried out "loosely." The ministry also introduced new conditions for this criterion as well, telling the prefectural and municipal governments to reject applications if a hibakusha's cancer did not relapse roughly five years after undergoing an operation.
Consequently, the number of rejected renewal applications surged. According to the health ministry, the ratio was around several percent before fiscal 2014, but increased to 17 percent in fiscal 2014, with 607 out of 3,618 applications turned down. In fiscal 2016, the rejection rate reached 21 percent, as 443 of 2,095 applications were scrapped.
In the city of Hiroshima, where about 1,000 renewal applications are submitted annually, the refusal rate rose from 2 percent in fiscal 2013 to 20 percent the next fiscal year, and the figure was 13 percent in fiscal 2017. In Nagasaki, no rejections were made in fiscal 2013, but as many as 25 percent of applications were rejected in fiscal 2017.
A 73-year-old hibakusha said, "I think certification should be made even in questionable cases." He was exposed to radiation at less than a year old, when he and his mother went into the area damaged by the atomic bomb in Hiroshima. The man developed colon cancer and had a heart attack, and was recognized as having atomic bomb disease in 2009. Following an operation to remove the cancer and with no subsequent relapse, his application for certification renewal in 2015 was turned down. The amount of monthly medical allowance he received was cut from about 140,000 yen to 50,000 yen.
The man said he depends on his pension to live, and he still sees doctor regularly to check for cancer recurrence, which he worries about constantly. "I became sick because of the atomic bomb, but I was cut off (from the medical allowance program) so easily," he lamented.
Michiko Murata, a counselor at Toyukai, a group of atomic bombing survivors in Tokyo, pointed out, "Applications for atomic bomb disease certification should be approved widely because of the program's status as state compensation for the victims."
A health ministry official acknowledged that the increase in rejections is a result of the ministry's instructions, but stated that the change was necessary because "the application review is now managed the way it should be."
(Japanese original by Itsuo Tokubo, Hiroshima Bureau)