so, you’re pcsing to japan

what to expect as a dod civilian or contractor in japan as of 2023

March 2023: Some bases allow non military patients to schedule as much as 3 days in advance, others continue to restrict access same-day only after 10. All services are only provided if space is available. The policy change responsible for this, dated 3 March 2023, can be viewed here.

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In January 2023, the Defense Health Agency restricted access to medical care for all patients without Tricare insurance on all military bases in Japan. Tricare is primarily for military patients and military retirees. These changes were made with intent for civilian employees, contractors, and their families to go off base for most medical care. However, Japan is in the midst of a long-term healthcare shortage and Japanese hospitals can legally deny care to any patient at any time, even in emergencies. Between February 2021- February 2023, at least 12 Americans serving their country in Japan died due to lack of access to medical care. Below are the top 6 medical considerations that employees wish they knew before PCSing and a list of exactly what care is accessible on military bases in Japan.

things to consider before you commit

No Guaranteed Access to Emergency Care

Japanese facilities can legally deny medical care to any patient at any time, even active duty military patients in life­threatening emergencies. No U.S. Military base in Japan has a trauma center; they rely on Japanese facilities to take patients in major emergencies. Between 2021-2022, at least 12 SOFA (Status of Forces Agreement) patients in Japan died due to lack of access to medical care.

High Upfront Costs

Those without Japanese health insurance must often pay upfront and in full for all services at 200%-300% of the standard cost. Japanese hospitals are not obligated to accept non-Japanese insurance, even if they have direct billing agreements or a letter of payment guarantee from US insurance companies.

Denials of Care

Civilian SOFA members are regularly denied medical care from both MTFs (military treatment facilities) and Japanese doctors, leaving no access to any medical care at all within Japan. In late January, the Japanese Ministry of Foreign Affairs stated they were unaware their healthcare system would need to assume care for more than 10k civilians beginning January 1st, 2023. This led to more barriers for Americans to obtain medical care, such as the Red Cross Hospital in Okinawa's decision to ban non-Japanese patients.

Lack of Access to Medication

Some medications common in the US are illegal in Japan (i.e. select ADHD medications); others are restricted for Japanese-use only and may not be provided to foreigners (i.e. Epi-pens). Some medications prevent patients from receiving care (e.g. one pregnant patient was turned away from 50 birth clinics due to taking mental health medications). Pain management medications for dental procedures, sutures, colonoscopies, and childbirth are often not available. Pain management medications for recovery are often lower strength.

Cultural Differences: Ambulances and Expectations

Japanese paramedics must receive doctor approval prior to treating emergency patients; this cannot happen until a hospital agrees to accept a patient. In 2011, 16,000 Japanese patients were turned away from 3 or more hospitals consecutively during emergencies. Hospital rejections have only increased during COVID. In 2021, a member of Yokota Air Base died of a heart attack because the Yokota MTF was unable to transfer him to a local trauma center - their transfer requests were rejected by 10 hospitals over a 5-hour period.

Lack of U.S. Standard Pregnancy and Pediatric Healthcare

Americans are often considered "high risk" and can be refused prenatal and delivery care. If accepted, it is difficult to obtain an epidural. Newborns are provided Vitamin K orally instead of by injection (proven to be less effective at preventing brain bleeds). Infants and children are often separated from parents and guardians during procedures. Well­child exams may not be obtainable and do not screen for the same criteria as those recommended in the U.S.

medical treatment facility priorities

As of January 2023, patients are prioritized in the following order at Military Treatment Facilities (MTFs):

PRIORITY ONE

Active duty military members

Family members of active duty military members

PRIORITY two

PRIORITY three

Retirees enrolled in TRICARE PLUS

Patients in priority levels 4-6 can only be seen for “Space Available” appointments. Space Available appointments are defined differently by each base. For example, Yokosuka will not allow these appointments to be used for routine or chronic needs, such as prescription refills, diabetes, asthma, hypertension, etc, even when space is available. Camp Zama allows these appointments to be used for child well-checks but other bases only offer 1-2 checks out of the 7 recommended in a child’s first year. Find more details about each base’s offerings below.

Retirees and others enrolled in TRICARE SELECT (if space is available)

PRIORITY four

Department of Defense Civilians (if space is available)

PRIORITY FIVE

Department of Defense Contractors (if space is available)

PRIORITY six

What can you access on base as a civilian employee or contractor without Tricare Insurance?

Click each drop down below for more information

  • LIMITED ACCESS | Appointments may be claimed for acute needs, defined as non-recurring sudden-onset medical needs such as a UTI or sprained ankle, at every MTF if space is available.

    Yokosuka, Atsugi, Iwakuni, and Sasebo only allow same-day appointments after 10am.

    Yokota allows scheduling up to three days in advance.

    Okinawa and Misawa have not specified how far in advance patients may claim Space-Available appointments.

  • LIMITED TO NO ACCESS | Depending on location.

    Yokosuka: does not allow civilians to make appointments for primary care, including for routine exams, medication refills, and chronic conditions such as diabetes, hypertension, asthma, thyroid disease, etc. Civilians must rely on off-base facilities for these needs and may encounter denials of care or denials of insurance, among other challenges noted above.

    Atsugi, Sasebo, and Iwakuni only have limited-capability clinics which follow the direction of the Yokosuka Naval Hospital above. They do not allow civilian access to primary care.

    Yokota: allows civilians to make appointments for routine needs up to three days in advance, if space is available.

    Okinawa: allows civilians to make appointments for routine needs if space is available, but does not specify whether they can schedule in advance or are restricted to same-day appointments. Some departments are regularly full with no access for civilians for months at a time.

    Camp Zama: allows civilian patients to schedule an unspecified amount of days in advance for routine needs and optometry, if space is available.

    Misawa: allows civilians to make appointments for routine needs if space is available, but does not specify whether they can schedule in advance or are restricted to same-day appointments.

  • LIMITED ACCESS | If a base has an Urgent Care or ER, it is open 24/7 for all patients, however none are equipped for major emergencies and some bases such as Sasebo have neither. If a patient needs more care than is available on base, they are reliant on a Japanese facility accepting the patient. Japanese facilities can legally deny care to any patient at any time. For example, there are no cardiology capabilities on any U.S. base in Japan. Patients have been denied care by Japanese facilities during cardiac arrest.

  • LIMITED ACCESS | Specialty care may be accessible if the patient can obtain a referral, which is not always possible due to lack of access to primary care.

  • NO ACCESS | Mental health services are unavailable on base, and there may be barriers and stigmas preventing access off base. Patients may go to the ER in a mental health crisis.

    Click here for a live spreadsheet of mental health resources we have compiled by location for your convenience.

  • LIMITED ACCESS | Appointments for dental services which are unavailable on the Japanese economy or same-day appointments for dental emergencies may be available at some bases such as Yokota, however this is subject to change in availability and policy and not guaranteed.

  • LIMITED ACCESS | Availability varies from base to base. In late 2022 and early 2023, civilians could not receive prenatal care or give birth on base in Okinawa. No MTF is equipped for major emergencies, therefore high risk pregnancies may be referred elsewhere.

    Patients should be aware that the labor and delivery experience at Japanese facilities is very different from U.S. standards and may place the patient and child at greater risk.

    Pregnancy Considerations Document

    Most MTFs do not offer the full recommended amount for child well-checks and these checks may not be available at Japanese facilities.

  • ACCESSIBLE | Pharmacy services are accessible, however the patient must have an existing prescription from a U.S. licensed physician.

    This means that it must be from an MTF physician for an acute, sudden onset condition, or it must be from a Stateside provider for chronic or long-term maintenance medications. It is recommended to maintain a relationship with a provider in the States and renew any necessary prescriptions before PCS for this reason. Note that some medications commonly prescribed in the U.S. are illegal or controlled in Japan and cannot be mailed to Japan, as this violates the Status of Forces Agreement (SOFA). 

    Patients cannot make an appointment for a refill on base unless it is for a medication which is unavailable off base.

accessing medical care off-base

Japanese facilities are under no obligation to admit any patient. This may result in delays or refusal of admittance, even in life-threatening emergencies. Language barriers are common and patients must arrange their own translation service. Payment is often required at the time of service, ranging from a few hundred dollars to $25,000+ depending on treatment. Facilities that are more willing to admit foreigners and have greater English speaking capabilities are mostly available in Tokyo, however their distance from all MTFs makes them non-viable options in emergencies.

Patients should be prepared for no visitation if hospitalized, lower strength medications, limited availability of anesthesia and epidurals, and obstacles in obtaining mental health medications. Some prescriptions that are common in the U.S. are considered illegal or controlled substances that cannot be prescribed by Japanese providers to non-Japanese citizens. Patients may have to rely on off-base providers or telehealth to meet their family's mental health needs. Telehealth providers may be unable to diagnose or prescribe to patients living in Japan. Many patients arrive with misconceptions about how advanced Japan is. You will experience language barriers, fax machines, and non-digital files. 

Emergencies Off-Base

Emergency services off base can be reached by calling 119. It is recommended that patients carry a wallet card for emergencies which lists name, address, emergency contact, and medical conditions on it for first responders. Make sure you can say your address in Japanese, as some first responders do not know English. Ambulances will not administer medical care without orders from a Japanese doctor; you may not receive any aid during transport. You may be charged up-front and in full. You may receive faster or more assured admittance from a hospital if you are already a current patient – consider registering in advance and obtaining a member ID card. Some patients schedule appointments a year in advance every year to maintain current patient status for this reason, however it does not guarantee admittance. 

The Japan Medical Practitioner’s Act (No. 201 of 1948, amended 2007) Chapter IV Article states that “no medical practitioner who provides medical treatment shall refuse any request for examination or treatment without just cause”. In practice however, Japanese facilities may deny patient admittance without explaining why. 

Insurance

The two most common plans are Blue Cross Blue Shield (FEP Blue) and Aetna (Foreign Service Benefit Plan). Both have some direct billing agreements in Japan, however not all hospitals will honor them at all times. Both insurances offer telehealth but they cannot diagnose or prescribe in Japan. They both offer some virtual translation services, but some hospitals will only accept in-person translators. They also offer useful services such as free virtual second opinions. If you have doubts about a diagnosis or treatment, take advantage of this.

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