U.S. military health care facilities in the Indo-Pacific region are scaling back treatment options this year for military-affiliated civilians experiencing chronic ailments.

While the military’s hospitals have historically prioritized active-duty military service members and their families, who receive their coverage under the military’s Tricare program, it has also provided “space-available” care to military-affiliated civilians who are referred to as “non-enrolled patients.” The military has long relied on civilian employees and contractors to conduct operations around the globe in support of its active-duty force.

Many Department of Defense employees working under U.S. Indo-Pacific Command, the military’s largest area of operations, have relied on military medical facilities.

Medical appointments for civilians without Tricare are now restricted to same-day appointments for episodic, nonrecurring and acute health issues — and military officials are increasingly urging them to look for care elsewhere altogether. The new restriction took effect Sunday.

A December memo signed by Defense Health Agency Region Indo-Pacific Director Maj. Gen. Joseph Heck, and first reported by Stars &Stripes, stated that “treatment on a space available basis does not allow for continuous management of chronic health problems” and that “chronic health problems such as diabetes, hypertension and other major ailments must be managed carefully by a primary care manager for continuity of care and patient safety.”

The memo stated that space-available appointments will still be offered for family medicine, pediatrics and gynecology, but only when “excess capacity exists” after meeting health care obligations for active- duty service members and their families.

The Honolulu Star- Advertiser reached out to Tripler Army Medical Center and other military medical facilities in Hawaii for comment and received no response.

According to the Pentagon’s Office of Local Defense Community Cooperation, in Hawaii the Department of Defense had a workforce of 20,200 civilian personnel as of the 2021 fiscal year. Hawaii is grappling with a major shortage in health care workers, especially nurses, with providers struggling to manage appointments and some island residents waiting for weeks or months to see a doctor.

In an emailed statement to the Star-Advertiser, DHA Region Indo-Pacific spokesperson Whitney Trimble said military-affiliated civilians with military installation access credentials can still call on military facilities in the event of a medical emergency and are eligible to have prescriptions filled at military pharmacies as long as the prescriptions are from a licensed U.S. provider and written in English.

Even before the new directive took effect, though, it was already apparent that some health care options were limited. In 2022, military hospitals at Yokosuka Naval Base and Yokota Air Base in Japan began telling military-affiliated civilians to seek treatment from Japanese providers. During a town hall meeting in December, the director of U.S. Naval Hospital Yokosuka told attendees that “folks who are not beneficiaries of Tricare should seek care in the community or through a U.S. provider.”

In the case of military- affiliated civilians in Hawaii not covered by Tricare, Trimble said, “Defense Health Agency Region-Indo-Pacific encourages non-enrolled patients to work with their respective health insurance companies or Human Resources representatives for more information on available health care coverage, options for care and other related questions.”

Trimble said the directive has no impact on the newly established Red Hill Clinic as it already only provides treatment to active-duty service members and civilian Tricare recipients. The clinic, which opened Tuesday, was established following 2021’s fuel contamination of the drinking water system serving Joint Base Pearl Harbor-Hickam and surrounding neighborhoods.