Japan Civilian Medical Advocacy’s Mission
To regain improved access to quality healthcare for all members of the DOD serving abroad, to uphold the standards of practices set forth by the Joint Commission, and to protect the personnel that support the mission of the U.S. Armed Forces and national defense strategy of the United States of America.
The problem
Civilian employees, active duty military members, and other DoD workers stationed in Japan are dependent on a foreign nation for access to medical care.
The recent deterioration of access to care for civilians in particular means that patients are exposed to greater risk of denials of medical care even in life threatening emergencies, maternal and fetal mortality risks, improper pain management protocol, diminished access to prescribed medications, price gouging, exposure or espionage of personal medical information, and more.
This situation has already contributed to ten civilian deaths and culminated into four areas of concern:
Access to routine medical care
Access to emergency medical care
Access to prescription medication
Poor quality of care at Military Treatment Facilities (MTFs)
THE JOURNEY
Military Treatment Facilities (MTFs) on U.S. bases in Japan have stripped access to routine medical care for civilians in accordance with the 2018 National Defense Authorization Act and DHA initiatives which were supported by Congress and implemented in Japan in FY22, including DHA PI 6025.11.42-47, 50-56, 61, 63, 73.
This understaffed MTFs by provisioning them only for the amount of Active Duty military and beneficiaries, leaving over 10,000 DOD civilians and their family members without access to healthcare at the U.S. bases where they live and work.
Though DOD civilians have been intermittently restricted to obtaining medical care on a Space-Available basis at MTFs in the past, DHA protocols implemented in 2022 aim to “cease providing healthcare to Space-Available beneficiaries,” and “offer minimal or no space-available primary care,”
Because offering Space-Available appointments indicates to them that MTFs are over-manned, incurring resource cuts.
Simultaneously, the Status of Armed Forces Agreement (SOFA) does not guarantee American citizens the right to medical care in Japan.
Japanese medical facilities can legally refuse care to anyone, to include both Japanese and American citizens, without recourse.
OUR Requests
No single solution addresses all four issues mentioned above, implementing multiple changes is necessary to secure quality medical care equivalent to American standards for the affected population.
Whatever solutions are enacted, they must not detract from the services available to active duty military members, nor should they place strain on the hard-working medical professionals supporting the base population. Rather, sufficient resources must be provided for all parties.
A comprehensive GAO study of the impacts of potential implementation by DHA for all overseas regions, including an assessment of local healthcare capabilities.
Temporarily rescind new space A changes until there is a reliable, quality healthcare solution and transition plan where responsibility for civilians is clearly defined and enumerated.
A unified way (not dependent on command) for impacted civilians (including teachers, whose agreements are particularly strict) to get medevac or leave Japan early if needed, without penalty or cost to themselves. Not impose a hiring ban on qualified offerees who rejected jobs due to the new lack of healthcare access.
Immediate stopgap remedies for those attempting to get care and stay at their post, such as but not limited to: a system to fill digitally shared prescriptions without a wet-signature, licensed US medical providers can practice with any state license for overseas via telehealth, telehealth providers can request lab work, requirements for referrals to be waived for civilians, fully-funded medical translation and interpretation, and other systems to provide necessary care.
Clear feedback and quality assurance mechanisms that are directly reported to all impacted agencies, not just regional leadership or DHA. All committees and working groups must involve impacted civilians stationed in those regions.
Knowing that all American patients serving their nation in Japan can be denied healthcare in an emergency, including a rice duty military, we recommend establishment of a facility for the region that is capable of handling standard-to-higher levels of emergency care, similar to LRMC in Germany.
Hire civilian healthcare providers to serve the civilian workforce in Japan. This addresses three of the four main concerns: access to routine care, prescriptions, and quality of care.
Designate Japan as a post provisioned with annual return travel due to lack of adequate medical care via the State Department’s Office of Allowances. Some civilian commands currently provide return travel from Japan on a two- or three-year cycle, which is not sufficient to address routine care needs now that access on base has been stripped.
Provide TRICARE benefits to civilians at overseas posts with poor access to medical care, allowing them the same on-base access and off-base network that active duty and their dependents receive. This addresses access to routine care, prescriptions, and possibly quality as more TRICARE enrollees would afford more resources to the MTFs.
We are a grassroots group that has mobilized individuals all over Japan who are reeling from the effects of the DHA transition and have been left in a healthcare desert.
Read the Advocacy Package for more info.