Health care for Defense Ministry workers in Japan near 'lowest point in decades,' advocates say

YOKOSUKA NAVAL BASE, Japan — Japanese hospitals are refusing health care to civilians and Defense Ministry military personnel once every two days on average, according to a recent report from the group Japan Civilian Medical Advocacy.

More than 340 people were denied access to routine, specialized or emergency care between February 2022 and April 2024, and at least 13 died between 2021 and 2024 due to refusal or inability to receive timely medical care, says a research report released by the group on May 18.

“The state of health care for military and civilian personnel in Japan has reached one of its lowest points in decades,” Randi Wilson, a spokesperson for the group, told Stars and Stripes via Messenger on Tuesday.

The advocacy group, a grassroots organization that began as an online forum for DOD employees to share tips on accessing health care, cites 140 sources in its research. These include investigations, testimony and personal correspondence collected by the group, media coverage and reports from the DOD and the U.S. Government Accountability Office.

Japanese hospitals are not required by law to accept patients for care and routinely refuse patients at their discretion. The reasons for refusals can vary but are often linked to a preference for the Japanese national insurance system or the belief that it lack adequate resources to care for a patient.

“Currently, no one – whether active duty, retired, civilian employee or contractor – is guaranteed medical care for themselves or their loved ones in the event of an emergency,” Wilson said.

Department of Defense employees have struggled to receive care at U.S. military hospitals and clinics in Japan and local hospitals since the Defense Health Agency began implementing changes in February 2022.

The changes were intended to prioritize health care for active-duty patients on overseas military bases and reduce wait times.

This plan, which significantly reduced access to health care for DOD civilians, did “nothing to alleviate this crisis” and potentially made the situation worse, according to Wilson.

“Instead, these measures backfired, forcing civilian health care providers to resign and military personnel to terminate their contracts, further reducing access,” she said.

Wait times at Yokota Air Base in Tokyo, for example, have not “changed significantly” over the past three years, according to the report.

Services responsible for areas such as ship repair, education, health care and others have also reported a 20 to 80 percent drop in job applications due to concerns about access to medical care.

DHA spokesman Peter Graves acknowledged Stars and Stripes' request for comment on the report in an email Thursday, but was unable to immediately provide a response.

The DHA lifted some restrictions in 2023, and civilians can now seek treatment for acute or chronic illnesses subject to availability.

However, accessing this care can be difficult.

“The lack of codified policies and protections for DOD civilians allows DOD leaders to [military treatment facilities] to set rules independently, often without public transparency, resulting in considerable variation in available care across MTFs,” the advocacy group’s report said.

Some bases only offer same-day appointments, subject to space availability, while others offer limited appointments up to three days in advance. The range of services also varies, with some bases allowing civilian access to OB-GYN care and others prohibiting it, according to the report.

In early 2023, Gilbert Cisneros Jr., undersecretary of defense for personnel and readiness, and Seileen Mullen, then-acting assistant secretary of defense for health affairs, along with Maj. Gen. Army Joseph Heck, DHA director for the Indo-Pacific. at the time, held a series of public meetings on these topics at American bases in Japan.

In front of sometimes noisy crowds of civilian employees and their families, the three men promised to create working groups with the Department of Defense to respond to these complaints, but Wilson said there has been no follow-up or communication on the matter.

The advocacy group is proposing a variety of short- and long-term solutions, including temporarily waiving space restrictions, funding translation services, and reforming communications, billing, and administration.

“What we need now – what we have always needed in the Pacific – is rapid access to quality preventive and emergency care,” she said.