# Immigration to Japan & Type 1 Diabetes



## Otenba

Hello all,

I am currently trying to work out if it is possible for me to stay or live in Japan at all. I have been a Type 1 Diabetic for 21 years (diagnosed age 5) and I have been to Japan twice on holiday for two weeks each time so I am not an experienced traveller to the country... but I want to be. Staying for a year may even be enough for me at this time... but I'm not sure I can even do that.

I can appreciate the possibility that there are already many Type 1 Diabetics living there, but considering I've been on the NHS all my life (where I have not had to pay for my healthcare myself to my knowledge), I am very unsure about how it all works over there. 

I am aware that there is either the Employees' Health Insurance Plan or the National Protection Scheme... but which one that would be best for someone like me, I am not sure. Is one better than the other for things like staying only for a year or two as well?

I have the impression that it will be very expensive for me to live there based on medication alone...

The sort of things I need to restock are (off the top of my head):
2 boxes of 5 Levemir cartridges
2 boxes of 5 Humalog cartridges (3ml I think)
300 6mm pen needles
300 finger testing lancets
200 blood testing strips for my blood testing machine
20 ketone testing strips (I have a blood testing machine for this currently - because I'm not ill often, I don't have to stock them much)

At the moment, I think I would be looking at paying an very rough estimate of £500-£900 to cover the cost of most of my needed stuff per month; especially if I was ill and having to test and inject more. 

If that's what I'm possibly looking at for the UK, then I dread to think what's the case for Japan (especially considering the exchange rate too). I do plan to look more into it using sites like the Japanese medication site called dm-rg but it just takes time...

I am looking at getting in contact with my hospital healthcare team about this, as well as the Japanese Embassy (hopefully in December when I can go down to London).

Is there any Japan living diabetic expats on here that could help clear some of this cloud or just talk to me about your experience? I've been quite saddened by my findings so far because I feel like all the odds are against me pursuing this dream - I'm having so much trouble finding any Type 1s that have migrated to Japan (or have at least tried to), hopefully I'll have some more luck here. All this information has been very overwhelming for me to take on board.

I know my partner (who's not diabetic) would love to do it as well so I am not alone with this idea.

Thanks in advance for your replies (and sorry for waffling)!


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## Joppa

Otenba said:


> Hello all,
> 
> I am currently trying to work out if it is possible for me to stay or live in Japan at all. I have been a Type 1 Diabetic for 21 years (diagnosed age 5) and I have been to Japan twice on holiday for two weeks each time so I am not an experienced traveller to the country... but I want to be. Staying for a year may even be enough for me at this time... but I'm not sure I can even do that.
> 
> I can appreciate the possibility that there are already many Type 1 Diabetics living there, but considering I've been on the NHS all my life (where I have not had to pay for my healthcare myself to my knowledge), I am very unsure about how it all works over there.
> 
> I am aware that there is either the Employees' Health Insurance Plan or the National Protection Scheme... but which one that would be best for someone like me, I am not sure. Is one better than the other for things like staying only for a year or two as well?
> 
> I have the impression that it will be very expensive for me to live there based on medication alone...
> 
> The sort of things I need to restock are (off the top of my head):
> 2 boxes of 5 Levemir cartridges
> 2 boxes of 5 Humalog cartridges (3ml I think)
> 300 6mm pen needles
> 300 finger testing lancets
> 200 blood testing strips for my blood testing machine
> 20 ketone testing strips (I have a blood testing machine for this currently - because I'm not ill often, I don't have to stock them much)
> 
> At the moment, I think I would be looking at paying an very rough estimate of £500-£900 to cover the cost of most of my needed stuff per month; especially if I was ill and having to test and inject more.
> 
> If that's what I'm possibly looking at for the UK, then I dread to think what's the case for Japan (especially considering the exchange rate too). I do plan to look more into it using sites like the Japanese medication site called dm-rg but it just takes time...
> 
> I am looking at getting in contact with my hospital healthcare team about this, as well as the Japanese Embassy (hopefully in December when I can go down to London).
> 
> Is there any Japan living diabetic expats on here that could help clear some of this cloud or just talk to me about your experience? I've been quite saddened by my findings so far because I feel like all the odds are against me pursuing this dream - I'm having so much trouble finding any Type 1s that have migrated to Japan (or have at least tried to), hopefully I'll have some more luck here. All this information has been very overwhelming for me to take on board.
> 
> I know my partner (who's not diabetic) would love to do it as well so I am not alone with this idea.
> 
> Thanks in advance for your replies (and sorry for waffling)!


My reply is based on what I know about health insurance in Japan and online research.
If you join most health schemes in Japan, either company-sponsored or state plan, you normally pay 30% of the treatment and drug costs. According to an estimate, Type 1 diabetic will make around 11,160 yen per month in contributory payment, which works around £90. The figure assumes using proprietary drugs - use of generic drugs where available may reduce your contributory payment. If you have other symptoms like hypertension, your contribution will increase.


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## Otenba

Thanks for your response Joppa.

That is very interesting and in a way a relief to hear because perhaps in the big scheme of things, £90 is not as bad as I was expecting. I will need to look more into the costs in Japan in order for me to try and stay on my current items.

Just to check - When you say use of generic drugs, does that mean a change of insulin? 

People's bodies respond in different ways to different insulins so it would be a lot of grief for me to have to change my insulin for this (especially during a high-stress time such as moving country). I would have to work out all over again what my doses are and this can take months or years... 

Thankfully, I am a Type 1 with no complications and have the UK's DAFNE course's information under my belt. I do appreciate the heads up about things like hypertension... who knows what the future will bring.


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## Joppa

Otenba said:


> Thanks for your response Joppa.
> 
> That is very interesting and in a way a relief to hear because perhaps in the big scheme of things, £90 is not as bad as I was expecting. I will need to look more into the costs in Japan in order for me to try and stay on my current items.
> 
> Just to check - When you say use of generic drugs, does that mean a change of insulin?
> 
> People's bodies respond in different ways to different insulins so it would be a lot of grief for me to have to change my insulin for this (especially during a high-stress time such as moving country). I would have to work out all over again what my doses are and this can take months or years...
> 
> Thankfully, I am a Type 1 with no complications and have the UK's DAFNE course's information under my belt. I do appreciate the heads up about things like hypertension... who knows what the future will bring.


Yes, the insulin and any other medication you may have to take. It's always a moot point whether you get exactly the same formula you currently get in another country, even if it's from the same drug company. You will have to be reassessed under a Japanese physician. The estimate I found of course gave a typical cost, and your exact cost may vary, but it did include the cost of self-checking kits for blood sugar level (60x a month), insulin kits etc. Two of my relatives had Type 1 so I know what it involves.


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## Otenba

Joppa said:


> Yes, the insulin and any other medication you may have to take. It's always a moot point whether you get exactly the same formula you currently get in another country, even if it's from the same drug company. You will have to be reassessed under a Japanese physician. The estimate I found of course gave a typical cost, and your exact cost may vary, but it did include the cost of self-checking kits for blood sugar level (60x a month), insulin kits etc. Two of my relatives had Type 1 so I know what it involves.


So I'm potentially looking at a complete overhaul of my medication due to the reassessment? Thanks for telling me this, I had no idea could possibly happened like that. Most I've managed to get knowledge of is getting a note from the doctor and taking a copy of my prescription with me during the immigration process. 

It is true that you're best to "shop around" when it comes to doctors in Japan, yes? Is this possible through both types of healthcare options or do you get assigned doctor(s) through, say, the employment option?

Thanks again for your response.


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## Joppa

Otenba said:


> So I'm potentially looking at a complete overhaul of my medication due to the reassessment? Thanks for telling me this, I had no idea could possibly happened like that. Most I've managed to get knowledge of is getting a note from the doctor and taking a copy of my prescription with me during the immigration process.
> 
> It is true that you're best to "shop around" when it comes to doctors in Japan, yes? Is this possible through both types of healthcare options or do you get assigned doctor(s) through, say, the employment option?


You should take your initial supply of insulin and other medication to tide you over (with your prescriptions), but for further supplies you will have to be reassessed in Japan. As I've said, it's unlikely that the exactly the same formulations will be available in Japan, so reassessment is necessary. 

Under Japanese health insurance, you have a free choice of doctors, but you will want an English-speaking doctor so you need to get a list of them from the embassy and perhaps local recommendations from colleagues and other expats. Make sure any doctor you consult works under health insurance (most do). Unlike in UK, you don't need a referral from a GP to see a specialist so you just go direct to a diabetic clinic at a hospital or practice, though a referral letter will make things easier (e.g. from your current GP - English is fine). St Luke's Hospital (Seiroka Byo-in) in Tokyo has English-speaking doctors (or translator) and diabetic clinic Home | St. Luke's International Hospital


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## Otenba

Thank you so much for your helpful replies with this Joppa. ♥

It is helping me get a lot of my ideas into a more realistic perspective on what I could actually do. Becoming a life long expat there is looking unrealistic right now but perhaps I could at least do something more short term based on how things are looking right now...

I realise now that I do really need to speak to the Japanese Embassy in London more than anything...! I'm still preparing my notes so when I call them up to make an appointment I can help them prepare for our enquiry! ^0^

Just did a quick search on the NHS site too... Can my GP prescribe extra medication to cover my holiday?

Looks like 3 months might be the magic number for at least a decent experience of being in Japan without too much trouble health wise...! 
How exciting! I just hope the visa stuff works out okay (considering I do not have a degree, etc. I may have to look at a non-working option... shall see).

Edit: Just so I can reference it properly (I mention it in my first post but was restricted to post the link): http://dm-rg.net/ - Diabetes Resource Japan Guide Site. Any idea on how reliable this site is?


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## Joppa

Otenba said:


> Thank you so much for your helpful replies with this Joppa. ♥
> 
> It is helping me get a lot of my ideas into a more realistic perspective on what I could actually do. Becoming a life long expat there is looking unrealistic right now but perhaps I could at least do something more short term based on how things are looking right now...
> 
> I realise now that I do really need to speak to the Japanese Embassy in London more than anything...! I'm still preparing my notes so when I call them up to make an appointment I can help them prepare for our enquiry! ^0^
> 
> Just did a quick search on the NHS site too... Can my GP prescribe extra medication to cover my holiday?
> 
> Looks like 3 months might be the magic number for at least a decent experience of being in Japan without too much trouble health wise...!
> How exciting! I just hope the visa stuff works out okay (considering I do not have a degree, etc. I may have to look at a non-working option... shall see).
> 
> Edit: Just so I can reference it properly (I mention it in my first post but was restricted to post the link): ?????????? - Diabetes Resource Japan Guide Site. Any idea on how reliable this site is?


If you are under 30, you will qualify for a youth exchange visa, allowing you to live and work for a year.
I have looked at the DMRG site and seems well researched and up to date. Pity it's all in Japanese, though Google translate can give you a gist, sometimes with comical effect!


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## Otenba

That is good - I will use that site as a good reference point for trying to work out my medical costs. 

After a serious discussion with my partner, we have decided to work towards moving there for the long term - though when we will go is undecided yet because we have much work to do to get the ball rolling!

Talking about working out the job stuff... that will have to be for another thread!
Thanks again.


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## Joppa

Otenba said:


> That is good - I will use that site as a good reference point for trying to work out my medical costs.
> 
> After a serious discussion with my partner, we have decided to work towards moving there for the long term - though when we will go is undecided yet because we have much work to do to get the ball rolling!
> 
> Talking about working out the job stuff... that will have to be for another thread!
> Thanks again.


Easiest visa to get is an instructor's visa for teaching English. Not having a uni degree will be a problem, as it's required for the visa (to get your certificate of eligibility), unless you can show something like 5 years of professional activity. Perhaps your partner can apply and you go as dependant? Remember you need to be married in order to do this. If you are unmarried, you and your partner must qualify for a visa in your own right.


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## Otenba

You know, the fact that it said that we would need to get separate work visas as individuals got me thinking that we couldn't do a dependant situation... the possibilities through marriage didn't even enter our heads.



> 4. Dependent
> 
> Activities authorized to engage in: Daily activities on the part of the spouse or unmarried minor child of those who stay in Japan with the status of residence mention in EMPLOYMENT OR WORKING AND GENERAL (excluding the Temporary Visitor) or of those who stay with the status of residence of College, Pre-college or Trainee.
> Period of stay: 3 years, 2 years, 1 year, 6 months or 3 months.
> Applicants must either obtain a Certificate of Eligibility or read the next section (Dependent Visa) for an alternative procedure.
> 
> Dependent Visa
> 
> Visa for a legal spouse and/or minor child(ren) to accompany a member of the family employed in Japan.
> 
> REQUIREMENTS
> 
> If the employed member of the family is still in the UK
> 
> 1.Valid passport
> 2.One visa application form completed and signed
> 3.One photograph (taken within 6 months)
> 4.Passport of the employed member of the family containing a valid working visa for Japan
> 5.Letter of guarantee from the employer, giving full details of the accompanying family members
> 6.Marriage/Full Birth Certificate, whichever is relevant


Embassy of Japan in the UK

Yes, I see what you mean even more now! Golly, more to discuss!



> Dependents are not allowed to engage in any paid activities, unless they get permission from the immigration office. Even then, dependents may work only a set maximum number of hours per week.


Immigration to Japan

Is this information still reasonably correct? I will ask the Embassy too, of course.


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## Joppa

Otenba said:


> You know, the fact that it said that we would need to get separate work visas as individuals got me thinking that we couldn't do a dependant situation... the possibilities through marriage didn't even enter our heads.
> 
> 
> Embassy of Japan in the UK
> 
> Yes, I see what you mean even more now! Golly, more to discuss!
> 
> 
> Immigration to Japan
> 
> Is this information still reasonably correct? I will ask the Embassy too, of course.


AFAIK, they are. Japan doesn't recognise unmarried partnership or same-sex union for immigration purposes.


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## Otenba

Some more questions...!

I'm just looking at the Public medical insurance section of the CLAIR site ( Multilingual Living Information ) and it says that health check-ups and comprehensive medical check-ups do not fall under insurance coverage...

With this, what does this mean for things like the diabetes check-ups that I'm used to having in the UK? 
Will I get asked to do those at all? How much will they cost? What about the blood tests checking my progress?

Will everything now be by my request?

Thanks in advance...!

Edit: A few of other questions...
As a diabetic, would I be looking at going to a hospital mainly rather than a local clinic because it is a condition?

Does anyone have a clear idea on what contraception options are available? Is the pill or the coil now available more easily? 
Are these covered by insurance or is it worth changing to condoms only (which seems to be the main form used according to my book dated 2008)?

Book I have: 




Thanks!


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## Joppa

Otenba said:


> Some more questions...!
> 
> I'm just looking at the Public medical insurance section of the CLAIR site ( Multilingual Living Information ) and it says that health check-ups and comprehensive medical check-ups do not fall under insurance coverage...
> 
> With this, what does this mean for things like the diabetes check-ups that I'm used to having in the UK?
> Will I get asked to do those at all? How much will they cost? What about the blood tests checking my progress?
> 
> Will everything now be by my request?


Basically, if you are diagnosed with a specific condition, such as diabetes, all your treatments, check-ups, self-tests etc will be covered by insurance, for which you normally pay 30% of the (regulated) cost. 
Comprehensive medical checks aren't even covered by NHS in UK. You have to go private with a well man clinic etc. Many Japanese employers pay for their staff to have an annual check up.



> Edit: A few of other questions...
> As a diabetic, would I be looking at going to a hospital mainly rather than a local clinic because it is a condition?


Hospitals, both large university teaching type and smaller local one, will have a dedicated diabetic clinic, but you can often get it done at a local practice, esp those that specialise in diabetes.



> Does anyone have a clear idea on what contraception options are available? Is the pill or the coil now available more easily?
> Are these covered by insurance or is it worth changing to condoms only (which seems to be the main form used according to my book dated 2008)?


Pills are now legal in Japan (since 1998) but their popularity is very low because of health concerns and the fact it isn't covered by insurance (1%). Morning-after pill is unapproved, though alternatives are available. About 50% of couples use barrier method, mainly condoms, and IUD like coil (10%), followed by withdrawals (20%) and natural birth control. As you can imagine, there is a rather high incidence of unwanted pregnancy and termination is routinely available. While there is little social stigma attached to abortions, it's not an ideal situation.


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## Otenba

Joppa said:


> Hospitals, both large university teaching type and smaller local one, will have a dedicated diabetic clinic, but you can often get it done at a local practice, esp those that specialise in diabetes.


That is reassuring to know. I will have to have a good look around if or when we get over there. 



> Pills are now legal in Japan (since 1998) but their popularity is very low because of health concerns and the fact it isn't covered by insurance (1%). Morning-after pill is unapproved, though alternatives are available. About 50% of couples use barrier method, mainly condoms, and IUD like coil (10%), followed by withdrawals (20%) and natural birth control. As you can imagine, there is a rather high incidence of unwanted pregnancy and termination is routinely available. While there is little social stigma attached to abortions, it's not an ideal situation.


Don't blame them for the iffy-ness about pills...! ^_^;

When it comes to the coil, is that covered by national insurance? If not, do you have any idea on the cost? The last one I had covered me for 5 years so if it was a one off payment each time, at the moment, I can't see it being a problem. 

It's reassuring to know they have them available at least.  Excellent.

Thanks Joppa.


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## Joppa

Otenba said:


> When it comes to the coil, is that covered by national insurance? If not, do you have any idea on the cost? The last one I had covered me for 5 years so if it was a one off payment each time, at the moment, I can't see it being a problem.


No contraceptive is covered by insurance. The cost will vary between gynae clinics, but around 20,000 to 50,000 yen (£160 to £400). I suggest you get new one fitted in UK.


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