Overview
In Japan, the Universal Healthcare Insurance System offers a high standard of medical care for all citizens. Generally, companies provide the insurance for their employees and family members. Local governments provide insurance to people without it from their employers. With the insurance system, the majority of Japanese citizens are covered up to 70% of medical costs, which means you pay 30% out of your pockets.

People over 75 years old have 90% of their costs covered, but there are exceptions for those with high income. All medical fees are covered for people who live on welfare benefits and for those who have suffered from disasters (such as earthquakes, typhoons and those affected by the atomic bomb). Local governments provide special coverage for children, lone parent families and people with disabilities. Type 1 diabetes is classified as a childhood chronic disease. Therefore, special coverage is offered for those up to 20 years old. If your annual total out of pocket fee reaches a set limit (about US$1000), you can apply for a deduction with your tax return at the end of year.

What happens if you need to see a doctor?
Anyone can go to any hospital or clinic of their choice. Some doctors require an appointment. Large hospitals ask for a referral from your local clinic. If you do not have one, you need to pay an extra fee. This is to avoid the hospitals getting crowded with patients with minor conditions so they can focus on advanced medical care. People with type 1 diabetes tend to be seen at hospitals, but there are specialized doctors in some local pediatric or internist clinics.

Who decides what medicines a doctor can prescribe?
The Ministry of Health, Labor and Welfare approves a new drug, then it becomes available nationwide. Each hospital/clinic decides which product to introduce at their board meetings. For type 1 diabetes, most kinds of insulin are introduced soon after they become available in the world market. However, some continuous glucose monitoring devices cannot be made available because of the Radio Law. In Japan, mobile phone/internet systems are operated differently from many other countries.

Practically, what is it like to live with type 1 diabetes in Japan?
People with type 1 diabetes get check-ups every 1-3 month at a hospital or clinic. At that time, you have blood and urine tests. Then your doctor prescribes what you need until the next appointment. You can get your insulin and needles at any pharmacy with the prescription. Other devices, such as pens, pumps, CGM, glucometers, test strips, lancets are provided by the hospital or clinic. Retinopathy screening is offered by the hospital or local eye clinics every 12-18 months. Many hospitals have qualified dietitians or nutritionists who can guide you with healthy ways of eating. The carbohydrate counting method is also widely introduced for people with type 1.

Japan is a country with a high proportion of type 2 diabetes. Type 1 consists of about 3% of the total diabetic population, though we do not have an official figure. Differences between type 1 and type 2 diabetes are not recognized by the general public. People with type 1 often do not tell others about their diabetes. Some patients face difficulties in schools, jobs, relationships, marriages, family lives and other social/personal occasions. For psychosocial problems, there are peer support groups and workshops in major cities. Internet and Social Media provides information and support networks for the young adults. There are over 50 camps nationwide for those under 18 years old.

Financial burden is another issue for the patients and the government. Most patients pay over US$100/month from their pockets for managing type 1 diabetes. If you would like to use up-to-date devices (such as pump/CGM/SAP), it can cost even more.

What about getting admitted to the hospital?
Most type 1 patients stay in a hospital for 2-4 weeks at their diagnosis for the initial treatments, exams, and diabetes education. The medical costs are covered by the insurance, but not your bed and meals. You can apply for the deduction of the excess fees as mentioned above.

How does diabetes care vary throughout Japan?
The standard of health care is high in all of Japan. Even if you live in rural areas or a small island, you can receive good quality of care and the access to insulin is not a problem. In big cities, large hospitals may offer more freedom of choice for your diabetes device. In case of earthquakes and other natural disasters, emergency helplines will be available to ensure insulin access.

Special thanks to Hisako and Chihiro in Japan for providing this information.