1. Overseas Maternity Care: Delivering in Host Nation Facilities Clinical Operations, TAO-Pacific 23 October 2008

2. TRICARE Pacific 2 Deliveries in Pacific AOR 2007 Births at MTF 121/BAACH 406 NH Yokosuka 594 NH Guam 425 NH Okinawa 1134 35 th Misawa 215 374 th Kadena 258 Births in HN Facilities 40 8 2 30 9 4

3. TRICARE Pacific 3 Important Considerations with Host Nation Facilities Choosing a Hospital Payment Communication Issues Doctors Orders Cultural Differences in Pre/Postnatal Care

4. TRICARE Pacific 4 Choosing a Hospital Seek out a facility/physician early in your pregnancy Recommend seek hospital with international department or experience with Westerners Ensure facility can meet your birth plan needs Discuss expectations with physician

5. TRICARE Pacific 5 Payment May be required to pay up-front and seek reimbursement later MTF may have an arrangement with HN facility for payment Tricare Prime patients Referred – covered Not-referred – POS Tricare Standard pay co-pays and costs shares Local Nationals may receive payment from HN

6. TRICARE Pacific 6 Communication Issues Many facilities employ English speaking physicians MTFs may have dedicated interpreter to assist you May consider bringing a friend that speaks the language to assist Staff may understand more English than they are comfortable speaking Be patient Contact MTF Tricare rep if communication becomes a barrier to good care

7. TRICARE Pacific 7 Doctors Orders Some Asian physicians are viewed as paternalistic in their practice Doctors Orders model of practice not to be questioned May become offended or irritated if you ask questions or project your ideas of what your care should be Usually physicians are experienced with Western patients and understand cultural differences

8. TRICARE Pacific 8 Cultural differences in Pre/Postnatal Care Prenatal appointments Walk in? Limited information exchange Diet Japanese encourage limited weight gain Pain Control Japanese can be very conservative – read: no epidural Korean, more open to choice

9. TRICARE Pacific 9 Cultural differences in Pre/Postnatal Care Dad in delivery room Japan, traditionally not permitted Korea, family is okay C-section, no visitors Important to discuss your expectations After the delivery Focus on new mothers resting Babies to the nursery Length of stay typically longer in Japan

10. TRICARE Pacific 10 Cultural differences in Pre/Postnatal Care Patient rooms Usually shared bay type rooms (up to 5 people) Tricare covers semi private rooms if available Visiting hours are usually very limited Develop realistic expectations Communicate them Discuss your options

11. TRICARE Pacific 11 Resources http://www.tricare.mil/mybenefit/home/LifeE vents/NewbornAdoption/MaternityCare http://www.tricare.mil/mybenefit/home/LifeE vents/NewbornAdoption/MaternityCare http://www.webmd.com/baby/default.htm http://www.tcp- ip.or.jp/~lorna/mothers.pdf/booklet_e.pdf http://www.tcp- ip.or.jp/~lorna/mothers.pdf/booklet_e.pdf

12. TRICARE Pacific 12 QUESTIONS?