Priorities to Care within the Military Health System: A Mixed Methods Study on Military Spouse Access to Care during COVID-19 on Okinawa

Military spouses in Okinawa experienced denial of care at military treatment facilities and off base Japanese healthcare facilities during the COVID-19 pandemic. Over two years of travel restrictions further contributed to difficulties accessing healthcare while stationed on the island with their active-duty spouse. This study examined the implications of a priority-based access system through the TRICARE program implemented due to limited resources during COVID-19 and its impact on military spouses in a scarce medical resource environment. This concurrent mixed-methods research used a survey tool developed by Community First Hawaii to quantify access to healthcare and in-depth interviews to further explore access barriers and facilitators. Logistic regression was conducted to determine demographic characteristics that were more likely to experience access to care challenges. Findings indicate that less than 50% of the survey population received access to care within TRICARE regulatory standards for urgent care (19%), routine care (17%), specialty care (25%), or preventive care (47%). Spouses who were 30 years old or younger, assigned to 18th Medical Group at Kadena, or married to an enlisted servicemember were more likely to experience barriers to access. Using Leveque’s Access Framework, Availability and Accommodation, as well as Ability to Perceive, which included sub-themes for Trust in the Government and Trust in the Military Health System, received the highest frequencies of negative sentiment among research participants. These findings resulted in five specific recommendations for the United States Government to improve access to healthcare for military spouses stationed in Okinawa, which may be applicable in other geographic locations: (1) prevent discrimination based on dependent status; (2) establish crisis standards of care that align with the National Academy of Medicine; (3) reevaluate Okinawa as an accompanied tour; (4) provide clear and transparent communication about access and risk; and (5) decouple adult and pediatric dependent data for access to care metrics reported by the Department of Defense.