It’s no secret that Department of Defense civilians working in Japan are having a difficult time navigating healthcare options in Japan. This is due to restrictions placed on the usage of military-operated hospitals and clinics whose administration and management has recently fallen to the Defense Health Agency (DHA). The agency received a mandate from Congress in 2017 instructing them to prioritize treatment for active-duty service members, their families, and others covered by the military health plan TRICARE Prime, a service only available to Servicemembers on active duty, their immediate family, or as a benefit for someone who is retired from the military.
The slow rollout of new universal DHA rules and regulations supplanting the healthcare norm in Japan ruffled more than a few feathers in the overseas civilian workforce. Where once they had regular access to U.S. military doctors through the various on-base hospitals and clinics, they now have much more restricted “space available” clinic visits as their only option. That options’ availability fluctuates from day-to-day. This, in addition to on-post facilities refusal to treat reoccurring, or chronic, issues such as high blood pressure or psychological/behavioral disorders and perceived hurdles to filling prescriptions has made the American civilian population of on-base workers in Japan very vocal.
And the Defense Heath Agency has listened.
They’ve sent a group of high-level decision-makers including the Under Secretary of Defense for Personnel and Readiness, Hon. Gilbert R. Cisneros, Acting Assistant Secretary of DHA, Ms. Eileen Mullen, and U.S. Army Maj. Gen. Joseph Heck, the director of Department for Health Affairs Region Indo-Pacific to Japan to meet face-to-face with DoD civilians who have been impacted by the 2017 mandate. Touring America’s Eastern ally, they are holding a series of Town Halls at major instillations across the country.
“This is a big deal,” pointed out Maj. Gen. JB Vowell, U.S. Army Japan Commanding General, who hosted the group’s Camp Zama Town Hall, January 31.
“[These are] the persons responsible for executing law, enacting policy, and helping to provide the access to care and other personnel issues… They know we have challenges forward in this environment… that we are unique and have unique requirements for all our population compared to other places,” USARJ’s Commanding General said, opening the event.
“We came a long way to listen to you – we want to hear what you have to say,” Sec. Cisneros told a crowd of approximately 200 who had gathered to engage with the group. “We have people working on your issues. We have people at [Indo-Pacific Command] and the surrounding [Zama] community involved to see if we can improve the quality of life for the total force.”
Still, even with the promise of a working group designed to engage, address, and eventually offer long-term solutions to the current health concerns DoD civilians are having in Japan, people were quick to share personal experiences that underline the immediate seriousness of the issue.
“I broke my leg and immediately sought assistance at the on-post medical clinic,” one Japan Engineer District team member shared. “I was turned away without even being seen by a physician or [being] provided a diagnosis.”
The team member also said that as a dual-hatted DoD civilian/U.S. Army reservist with the U.S. Army Pacific Support Unit, they have experienced issues with scheduling appointments. Being that his status changes from active to inactive only once a month, if he contracts an illness or suffers a physical injury, he can only be seen on base the one duty day he is considered “active Army.”
Another JED Engineer working in Okinawa described the extreme difficulties he and his pregnant wife experienced due to the DHA-enacted space-available policy, and how JED’s command was preparing to transition both he and his family back to the U.S. to safely give birth in an American hospital. After almost exhausting all options, they were finally admitted into a Japanese one.
“We had to give birth via cesarean section, and even though the C-section went smoothly we were living in fear that if she had a postpartum hemorrhage similar to our first birth that she would die,” he explained. “Off-post hospitals have been denying patients who do not have Japanese health insurance and there was a very high chance that she would have been left to bleed out in the ambulance instead of being taken into local hospital care.”
“It's important to note that the Japanese healthcare system and the American healthcare system are not analogous,” JED’s Public Affairs Officer Charlie Maib points out.
Having lived in Japan since 2008 first as a Soldier, then as an ex-pat, and finally as a DoD civilian, he’s experienced all the facets of both healthcare systems from multiple points of view.
“In America we’re used to the idea that if someone needs medical attention, they’ll get it. That you can’t be turned away from a hospital,” he said. “That’s not how it works in Japan. Hospitals and clinics can turn anyone away for any reason. Additionally, most health insurance issued in the United States is only good in the United States, so it’s not accepted at most medical facilities in Japan. That means you’ll have to pay cash up front for any service, get receipts, translate them into English, and then submit them on your own to your insurer if you want to see any kind of reimbursement.”
Maib also said that the language barrier can present a problem as well, as most doctors, hospitals, and clinics in Japan operate in Japanese. He pointed out that there were English language options in the Tokyo area, but that you would have to seek them out.
“Google is your friend,” Maib expressed. “Also, U.S. Army Japan has a list of doctors that speak English and can work with payments or foreign insurance posted on their webpage.”
Still, some JED members have found success when looking for healthcare outside the gate.
“Language is likely the biggest hurdle for seeking medical care in Japan,” observed another member of JED who has navigated both systems. “Knowing that there may be some challenges with getting medical support, my family and I identified and [have] used off-post medical care since July. From second-hand accounts, I understand that receiving care you’re unfamiliar with in a language you can’t understand can be unsettling.”
Yet another JED team member shared that, “Because of the inconvenience and inconsistency with making appointments and being seen on-post, I find things are much faster just going to a Japanese doctor,” he noted. “The level of care, ease of access, and ability to be seen almost immediately makes going off-post my preferred option.”
Lingual familiarity is his key to success.
“My wife usually goes with me to appointments,” he said, explaining that his wife is a citizen of Japan and speaks Japanese fluently. “We’ll be seen together, and she’ll act as a translator for what the physician says, after which we’re able to get medicine or whichever support we need quickly and efficiently even at a premium.”
Hearing the concerns of people from not only across the District, but from DoD Civilians at other agencies as well, the representatives from Washington underscored that the concerns of the civilians in Japan are their concerns as well, reiterating the fact that a solution was on its way.
“Representing DHA… I appreciate being here and being able to explore the difficulties we have with access to care and looking for a comprehensive and holistic solution to taking care of our total force,” Maj. Gen. Heck told the crowd.
“We all have skin in the game over here,” said Maj. Gen. Vowell as the Camp Zama Town Hall came to an end. “We have a lot of people here who are caring for family members and caring for Soldiers to accomplish that mission.”
“This is a learning opportunity for us. This is a chance for us to get our feet down here, to learn what your experiences are and take this back and come up with some solutions that are going to help benefit everyone here,” Cisneros concluded.
The team of Hon. Cisneros, Acting Assistant Secretary Mullen, and U.S. Army Maj. Gen. Heck will continue their Town Hall tour across Japan, visiting Okinawa and other limited instillations before returning with their findings to Washington D.C.