US Naval Hospital YokosukaHost Nation Relations

TRICARE Pacific Conference

22-24 October 2008 Seoul, Korea

US Naval Hospital Yokosuka, Japan

USNH-Host Nation InteractionsSnapshot 2008

• Clinical Care– 1291 Outpatient Referrals, 40 Inpatient

Referrals– Daily liaison managed by bilingual staff of

Referral Management Office and Japanese Interns

• Billing outreach by TRICARE office including educational presentations

USNH-Host Nation InteractionsSnapshot 2008

• Professional Exchange– >10 small-group medical lectures at local

sites– 4 large-scale case conferences at local

sites and USNH– Kanagawa Perinatal Conference at USNH– USNH representation at ceremonies at

local nursing school and National Defense Medical College

– Kameda Medical Center JC assist

USNH-Host Nation InteractionsSnapshot 2008

• Contingency Preparedness• Annual disaster drill with Japanese Self

Defense Force: mass casualty at refueling island in Yokosuka Harbor

•Contaminated Person Demonstration at USNH, in preparation for CVN 73

•CNFJ/Kanagawa Prefecture/Yokosuka City earthquake evacuation exercise in Yokosuka City

• Annual JSDF/USNH Softball games

Objectives of the Host Nation Relationship

• Optimize prompt high quality local care for US forces and other US beneficiaries with urgent/emergent needs beyond MTF capabilities

• Facilitate medical cooperation with JSDF in military contingencies

• Establish joint preparedness for host nation civil contingencies/natural disasters

• Enhance professional and personal development of MTF staff in the overseas environment

USNH Host Nation Partners

• JSDF Yokosuka Hospital• Yokosuka Kyosai Hospital• Uwamachi Hospital• Kanagawa Children’s Hospital• Yokohama City University Medical Center

(two sites)• Kameda Medical Center• JSDF Central Hospital

Host Nation Relationship:SWOT Analysis

• Referral Management staff and Japanese Interns are bilingual, dedicated, and culturally sensitive.

• Members of the medical staff naturally develop productive professional relationships with host nation counterparts.

• USNH can contribute significant capability and expertise to civil disaster relief planning and JSDF interoperability.

Host Nation Relationship:SWOT Analysis

• Frequent turnover among MTF medical and dental staff weakens long-term personal relationships with host nation counterparts.

• Some of our referrals are particularly challenging:– perinatal cases, because of the severe shortage of

perinatal care in Kanagawa– patients without full TRICARE benefit who may not

promptly pay their bills– Patients with cases demanding high level English-

language proficiency, such as end-of-life and mental health care

Host Nation Relationship:SWOT Analysis

• Japanese Self Defense Force Medical personnel are committed to maintaining a mutually productive relationship.– Shared military culture facilitates development of

personal relationships– Shared responsibility for contingency medical

readiness encourages more interaction than would be required by clinical referrals alone

• Interest in and respect for American medical practice among many Japanese physicians.

Host Nation Relationship:SWOT Analysis

• Care delivered in Japanese system may not meet expectations of US patients or providers, even when directed by bilingual Japanese physicians with US training, due to cultural differences

• Political climate is complex and may influence the ability of key host nation partners to support us – for example, Dr Heli network and Kanagawa Neonatal Network

Strategic Recommendations

1. To be ready to provide prompt, high quality urgent/emergent care for our beneficiaries, we need to maintain strong, specific relationships with certain host nation providers, hospitals, and networks.

2. Strong medical relationships require investment in expert translation and Japanese liaison manpower.

3. We should leverage our potential contributions to disaster relief and military operations in order to solidify and enhance the responsiveness and quality of peacetime medical support that is available to us.