Dear Community,

We’re in your inbox today to update you on the medical situation for Americans stationed in Japan. Your unwavering support has been instrumental. Below are the realities we face, the strides made through your assistance in 2023, and the path forward for 2024.

Current Situation: A Continuing Crisis

• JCMA documented 340+ denials of care between Feb 2022 - Feb 2024, averaging one patient denial of care every two days in Japan. 
  Click here to read them all or click here to report a medical hardship or denial of care.
• U.S. Forces Japan (USFJ) began tracking cases of denied emergency care for the first time because of your voices. They reported 24 such cases between 2022 and 2023, averaging 1 per month.
• At least 13 Americans stationed in Japan died between 2021 and 2024, including:
  • A military spouse who was denied care for a severe head injury.
  • A Defense Department employee who was denied care by more than 10 hospitals during a heart attack.
  • A 7-year-old child of a U.S. marine who was denied care after a multi-story fall.A parked Japanese ambulance provided incorrect care for while calling hospitals for help. The child died after 30 minutes of oxygen deprivation. U.S. Naval Hospital Okinawa was located only 9 minutes away, but does not have a trauma-certified ER. There is no U.S. base with a trauma certified ER in Japan; The closest guaranteed emergency care for Americans is 3,000 miles away in Hawaii. Click here to read more about this issue.
• A U.S. Marine investigation into the 7-year-old's death concluded “USFJ cannot depend on Japanese trauma hospitals as the primary source of trauma care. Japan EMS is not up to the US 'Standard of Care' and relying on these hospitals exposes SOFA personnel to an unnecessary level of risk. The Japanese EMS system makes SOFA members dependent on a system that is completely at the mercy of the Japanese hospital workload and individual doctor’s comfort level with handling specific traumas and will lead to unacceptable delays in trauma care due to ambulance redirects.” Read the full investigation here.
• Japanese facilities, including the Red Cross Hospital in Okinawa and the University of Tokyo’s International Medical Center discontinued all patient services to foreigners. A separate Japanese facility terminated care for a patient at their 20th week of pregnancy, stating it is their policy to not accept patients who take "mental health medications." St. Luke’s International Medical Center in Tokyo, a facility long referred to U.S. personnel, began refusing all non-Japanese insurance. One patient was required to pay approximately $90,000 up front for a triple bypass surgery in 2023. 

How did it get this bad? 

The root causes of this crisis are multifaceted, stemming from changes in administration, staffing shortages, and systemic issues within the Defense Health Agency (DHA). In 2022, the DHA took over Military Treatment Facilities (MTFs) in Japan and discovered that they were violating minimum standards for military members, their priority patients. They severely restricted access for all non-military members, including veterans and many healthcare providers working at those facilities, causing extreme retention issues. This situation pushed 10,000+ American patients on to the Japanese healthcare system without warning the Japanese government. Japan is in a well-documented healthcare shortage; Japanese hospitals across the country immediately placed signs in their lobbies declaring that they would not accept foreign patients (including military members). As of today, DHA’s efforts to improve access for military patients in Japan have failed. In three years, military patients’ wait times for appointments have not improved and the MTFs lost money and staff due to lack of civilian access. 

Progress: YOUR efforts achieved these significant milestones:

• CONGRESS TAKES A CLOSER LOOK: The DHA painted a false picture of medical care in Japan to Congress in 2022 and 2023, insisting the problem was fixed even as several Americans died, thousands signed our petition and wrote letters to congress, and we provided hundreds of medical hardship testimonials from patients on the ground. Congress passed legislation ordering an immediate, official study of what access to medical care is really like in Japan (Section 726 of the 2024 National Defense Authorization Act). The Government Accountability Office (GAO) will present their study findings to Congress this summer.
• REVEALING INSPECTIONS: A 2023 report by the Department of Defense Inspector General (DOD IG) exposed significant obstacles to accessing medical care in Japan, including language barriers, high upfront payments, different cultural approaches to medical care, lack of availability of medications, and more. Click here to read it. 
• PRESSURE: Lawmakers, spurred by our community's efforts, increased pressure for change. Read media coverage here and here.
• RESEARCH: We wrote a comprehensive paper detailing the problems, impact to operations, and solutions: https://tinyurl.com/JapanResearchPackage We sent it to Congress and other stakeholders in May 2024. Help us by sharing it with your state representatives, your employers, HR, and your military chain.
• LEGISLATION ON THE HORIZON: JCMA is pleased to see Senator Tammy Duckworth's engagement with the "Access to Care for Overseas Military Act". Now included in the House draft version of the NDAA 2025, this establishes a program dedicated to improving medical readiness and healthcare for civilian and military personnel in the Indo-Pacific. JCMA is working to understand the potential impact on key questions including: 
  • Will MTFs still rely on Japanese hospitals for emergency and specialty care?  
  • Will Japanese facilities be adopting US standards for those cases?
  • Will American insurance be accepted?
  • Would this bill prevent denials of care? If not, how will this bill address care denials?  

As we await study findings and legislation details, we ask that your voices to remain strong. We rely on your experiences and insights. Here’s how you can help:

• Take our survey: https://tinyurl.com/JapanMedicalSurvey
• Share the petition: https://www.change.org/p/dod-civilian-families-in-a-healthcare-crisis 
• Write to your state representative (again)! Contact us if one of our volunteers can be of assistance. 
• Forward this email and spread the word, especially to any military and federal civilian families you know! 
• Contact us if you’ve struggled to receive adequate medical care - we can get your story to the right place (anonymously if needed).

Your volunteers will not stop until our mission is accomplished. Together, we can make a difference.

In Service,

Japan Civilian Medical Advocacy 
info@jcmadvocacy.org