Japan Civilian Medical Advocacy

18/09/2025

💡 What do you think? The aero medevac capabilities at Yokota allowed us to get more advanced medical care to patients in 30 minutes rather than several hours - potentially life saving.

✏️ Yet it was also quite limited; for example it wasn’t able to transport patients that were not medically stable. In several brainstorming meetings between USFJ, MTF staff, and JCMA volunteers, we determined it would not have helped in multiple heart attacks and other emergencies, even for patients who lived and needed care for several more hours.

⬇️ Even so, it’s disconcerting to see capabilities decline while the emergency care dilemma in Japan hasn’t been solved. There is still no trauma rated hospital on any U.S. base in Japan (and the far Pacific), and Japanese facilities can still deny care at any time.

Ground ambulances will replace medical evac flights previously handled by recently retired UH-1N Huey helicopters out of Yokota Air Base in western Tokyo.

31/08/2025

Navy and DODEA plan to launch a mental health counseling pilot for some students overseas

21/08/2025

The Defense Department extended its Japan healthcare pilot program for civilian employees but still excludes their families.

20/08/2025

🎉 well, moments after we decided to make a “still waiting” post, the memo confirming pilot program extension reached our inbox! This is great news.

Disappointingly, it still does not include dependents. If we hear of the reasoning behind that we‘ll let you know.

——

MEMORANDUM FOR SENIOR PENTAGON LEADERSHIP DEFENSE AGENCY AND DOD FIELD ACTIVITY DIRECTORS

SUBJECT: Extension of the Temporary Pilot Health Insurance Enhancement for Department of Defense Civilian Employees in Japan.

On August 9, 2024, the then-Official Performing the Duties of the Under Secretary of Defense for Personnel and Readiness directed the Assistant Secretary of Defense for Health Affairs (ASD(HA)) to establish a 1-year pilot program to include a "wrap around" contract improve access to health care for non-TRICARE beneficiary DoD civilian employees stationed in Japan. A recent evaluation determined that the pilot program addressed many of the concerns.

I therefore extend the pilot program for an additional 1-year with a period of performance from September 30, 2025 to September 29, 2026.

The evaluation identified two gaps in the pilot program: interpreter services and
coverage of DoD civilian employee dependents. The ASD(HA) will include interpreter services, subject to their availability, starting in the next year of the pilot program period of performance.

This pilot program will continue to test whether it is feasible and desirable to provide this type of support to DoD civilian employees in Japan who are not TRICARE beneficiaries. The ASD(HA) will continue evaluating the effectiveness of the pilot program.

The ASD(HA) will ensure that the Director, Defense Health Agency (DHA), establishes
appropriate agreements with each participating DoD Component or other organization with DoD civilian employees in Japan as needed. Participating DoD Components or other organizations with DoD employees in Japan will provide funding to DHA proportionally based on the number of their employees in Japan who are not TRICARE beneficiaries.

My point of contact for this action is Lieutenant Commander Sierra Nichols, Office of the
Assistant Secretary of Defense for Health Affairs, at (703) 697-2111 or sierra.r.nichols2.mil@mail.mil.

20/08/2025

⏳ Awaiting a Decision on the Pilot Insurance Program

Thank you to everyone who volunteered their time to attend the DHA Listening Sessions earlier this year! Your presence made sure that the concerns of our community were heard, including:

✅ positive feedback about appointment finding services,
✅ the need for dependents to be covered,
✅ issues with refill appointments,
✅ initial call center delays,
✅ the ongoing need for guaranteed emergency care that isn’t addressed by this program.

We also confirmed that feedback submitted in advance by email was reviewed and taken into account—a big win for making sure every voice counted.

Military Treatment Facilities in Japan have recommended that the program be renewed and expanded to include dependents—and we’ve echoed that call loudly and clearly. We’ve been told an update on the final decision is coming soon.

Your continued engagement makes a difference. Thank you.

Japan Civilian Medical Advocacy

04/07/2025

Thankfully the poor decision to restrict access to r**e kits did not appear to be enforced in Japan, and now it’s been reversed!

https://www.stripes.com/theaters/europe/2025-07-03/r**e-test-kits-for-civilians-18322525.html Military reverses policy that blocked r**e kit exams for civilian workers abroad | Stars and Stripes

Defense Department civilian workers and contractors stationed overseas can once again undergo r**e kit exams at U.S. military medical facilities, following a reversal of a short-lived policy that had restricted their access to such care.

04/07/2025

"The decision to eliminate the Adolescent Support and Counseling Services after the 2025-26 school year follows a federal watchdog agency report’s findings that Department of Defense Education Activity schools are overwhelmed by a surge in student mental health concerns, especially suicidal behavior. The decision was made to eliminate the $4.9 million program because “similar services exist”.

Not in Japan they don’t.

The decision to eliminate the Adolescent Support and Counseling Services after the 2025-26 school year follows a federal watchdog agency report’s findings that Department of Defense Education Activity schools are overwhelmed by a surge in student mental health concerns, especially suicidal behavio...

28/06/2025

🚨 Pregnant Patients at Risk Due to Broken HVAC at U.S. Naval Hospital in Japan 🚨

We’ve received reports that dozens of pregnant patients have been forced to accept a last-minute off-base birth or medical evacuation to Iwakuni or Okinawa—against their wishes—due to HVAC failure at the U.S. Naval Hospital.

Some were told that if they declined the assigned medevac plan because they preferred to return to the U.S., they would have to cover the costs themselves. Several patients were already near full term and unsure if flying was safe.

We’ve seen how HVAC failures at U.S. facilities in Japan can take years to fund and repair. Yet the Defense Health Agency (DHA) claims the issue has been resolved. According to DHA, all patients with due dates through July were contacted individually, and that each patient had three options:

-Off-base delivery in Japan
-Delivery at another base in Japan
-Return to the United States

👉 If you are a patient and this does not reflect your experience, we encourage you to reach out. Your voice matters—and we are listening.

🤰 What You Need to Know About Off-Base Delivery in Japan

Giving birth off base can be an entirely different experience from what families expect under the U.S. system. We want to equip our community with the tools to make informed choices. If you're exploring off-base options, here’s a resource list with:

✅ Key comparisons between U.S. and Japanese maternity care
✅ Essential questions to ask hospitals and providers
✅ What to prepare for culturally, medically, and logistically

https://docs.google.com/document/d/11P_ctsF4eoOgIpCbNpIrqeIjOAvuMnfvB-0WoTBxGYw/edit?usp=drivesdk

🏥 Why This Matters

Volunteers with Japan Civilian Medical Advocacy have seen firsthand how lack of preparation, broken communication, and limited emergency care access in Japan has led to preventable deaths, injuries, and misdiagnoses among American civilians and service members.

A safe, well-resourced, and fully operational hospital is not optional—it’s critical. Every member of our on-base community deserves access to dependable, timely, and dignified care—especially during something as life-changing as childbirth.

Considerations for SOFA Patients in Japan: Seeking U.S. Standards of Prenatal Care and Labor & Delivery Services A common list of requirements when searching for a facility to provide equivalent care to U.S. standards: Location within 30 minute radius of residence NICU facility available Epidu...

17/04/2025

What an unacceptable step backwards. A 2020 review found that r**e kits were available in *less than one-third* of Japan's forty-seven prefectures, according to Cambridge University research. Once again, nobody researched what was available off base overseas.

The Military Health System said the recently issued guidance is meant to clear up confusion around who can receive the forensic evidence collection tests under existing policy.

11/04/2025

New efforts to improve health care access for civilian employees in Japan and Guam are underway, but it’s too soon to tell if they’re working, a federal watchdog said.

08/04/2025

📣 If you aren’t able to make the DHA listening sessions about the pilot civilian health insurance program, you can share your feedback in advance!

📣 Email dha.ncr.Exec-Svcs.mbx.pilot-listening-sessions@health.mil

07/04/2025

🗞️ JCMA Applauds GAO and DOD’s Attention to Healthcare Challenges in Japan

Tokyo, Japan — Japan Civilian Medical Advocacy (JCMA) is encouraged by Department of Defense (DOD) and Government Accountability Office (GAO) action to address the longstanding healthcare challenges faced by U.S. personnel in Japan. Following three years of dedicated advocacy by JCMA, the GAO has released a comprehensive report validating concerns raised by our community. The report confirms significant barriers to accessing healthcare through the Japanese system, including language barriers, billing and payment issues, differences in care approaches, and challenges with mental health and emergency medical services.

A GAO audit evaluated Defense Health Agency (DHA) space-available visits. It showed a significant drop in the use of space-available medical appointments during the 2020 pandemic, a brief resurgence in 2021, and declines until 2024. Status of Forces Agreement (SOFA) personnel experienced a significant shortage of appointments in Yokosuka and Yokota during the last quarter of 2022 – an issue exacerbated by the 2023 memo directing Military Treatment Facilities (MTFs) in Japan to refuse routine care to civilians. It was not until March 2023 that activism by SOFA personnel convinced the DoD to issue a corrective memo.

Notably, space-available appointment usage declined slightly in 2022 and, in 2023, reached levels lower than those seen during the pandemic. The decline in appointment usage has still not recovered to pre-pandemic levels, resulting in the loss of thousands of appointments annually across the MTF system for the past four years. Specific facilities, including Naval Hospital Yokosuka and 374th Medical Group Yokota, showed the most notable declines, an issue that community members highlighted during 2023 town halls. While GAO characterized this as “stable” availability, civilians shared their stories of the impact of receiving 12,000 fewer healthcare appointments than were available in 2019 and 4,000 fewer appointments than 2020 pandemic levels – and the damage inflicted by those policies.

In April 2024, DoD responded to JCMA’s recommendations regarding inconsistent information provided to new hires by mandating a statement of understanding about barriers to healthcare for civilian personnel. The GAO report highlights other initiatives, including the Pilot Health Care Program for DOD Civilian Employees in Japan, the Zama Civilian Navigator Program, the planned expansion of behavioral health clinics in Okinawa and Yokota, increased emergency and trauma care coordination with Japanese providers, and an unsuccessful attempt to establish a new hospital in Guam with pediatric intensive care capabilities. GAO also cited a DHA Action Plan with 17 tasks, ten of which have been completed, that seeks to address the critical lack of emergency care services in Asia without a trauma-certified MTF.

While JCMA is heartened by GAO’s acknowledgment of these longstanding issues, we agree it still too early to determine whether the DOD’s current initiatives will adequately overcome the healthcare barriers for the SOFA community. Among the most pressing concerns is the gap in emergency care for over 100,000 Americans and their families who serve the U.S. government in Japan. This gap has already led to the loss of lives and continues to pose a serious threat.

JCMA remains steadfast in ensuring that all U.S. personnel and their families receive appropriate medical care. We continue to call on the DOD and Congressional leadership to monitor and evaluate the effectiveness of these initiatives to ensure long-term solutions for our community’s healthcare needs.

About JCMA:
JCMA is a grassroots group of volunteers whose mission is to improve access to quality healthcare for all members of the DOD serving abroad.

For more information, contact:
Info@JCMAdvocacy.org