1. US Naval Hospital Yokosuka Host Nation Relations TRICARE Pacific Conference 22-24 October 2008 Seoul, Korea US Naval Hospital Yokosuka, Japan

2. USNH-Host Nation Interactions Snapshot 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

3. USNH-Host Nation Interactions Snapshot 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

4. USNH-Host Nation Interactions Snapshot 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

5. 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

6. 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

9. 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.

10. 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

11. 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.

12. 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

13. 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.