Medical Expense Subsidies for Designated Intractable Diseases in Japan

Japan’s medical system includes a specific support framework for people diagnosed with one of approximately 340 conditions classified as “designated intractable diseases” — shitei nanbyo. These are conditions that are severe, chronic, have no established cure, and affect a relatively small number of people. The designation triggers access to a subsidised treatment cost programme, reducing what patients pay to substantially below the standard 30-percent copay.

For foreign residents in Japan who carry one of these diagnoses, understanding how the system works — and that they are eligible to apply — can have a significant financial impact on the cost of ongoing treatment.

What conditions are covered

The list of designated intractable diseases has expanded considerably since the system was established. As of recent years, it covers around 340 conditions. These include:

• Neurodegenerative diseases such as Parkinson’s disease, multiple system atrophy, and amyotrophic lateral sclerosis (ALS)
• Inflammatory bowel diseases including Crohn’s disease and ulcerative colitis
• Autoimmune conditions such as systemic lupus erythematosus and Sjögren’s syndrome
• Haematological conditions including aplastic anaemia and certain haemophilia variants
• Rare connective tissue and pulmonary conditions

The full list is maintained by the Ministry of Health, Labour and Welfare (MHLW) and updated periodically. If a patient has received a diagnosis outside Japan for a condition that may correspond to a nanbyo designation, it is worth having a specialist in Japan review whether the diagnosis qualifies.

How the subsidy works

Once a patient is certified as having a designated intractable disease, a monthly out-of-pocket ceiling is applied to their treatment costs — similar to but more generous than the general high-cost medical expense benefit. The ceiling amount depends on household income.

For the lowest income brackets, the monthly ceiling can be very low — in some cases zero. Middle-income patients typically pay a fixed monthly ceiling regardless of how much treatment they actually receive in that month. This means that hospitalisation, expensive biological medications, or regular outpatient treatment at specialist clinics all become more predictable in cost.

The subsidy applies only at certified medical institutions. Patients should confirm with their treating facility that the institution is registered to process nanbyo-designated treatment.

Applying for certification

The application process runs through prefectural governments, not through the patient’s municipality. Applications are submitted to the prefecture’s health office (hokenjo or kenkoufukushikyoku, depending on the prefecture), typically with the following documentation:

• A completed application form (available from the prefectural office or downloadable from the prefecture’s website)
• A diagnostic certificate completed by a specialist physician, confirming that the diagnosis meets the criteria for the specific designated condition
• Proof of health insurance enrolment (NHI card or employer insurance card)
• Proof of income or tax assessment for all household members
• A photograph and personal identification

The diagnostic certificate — called an individual sheet (kojin hyo) or clinical form specific to the condition — requires completion by a physician at a facility that is designated for that condition. This is an important detail: not all hospitals are designated for all conditions, and the physician completing the form must be at a qualifying institution.

Processing typically takes several weeks. Once approved, the certification card (jushinkasha shobenhyo) is issued and must be presented at each relevant medical visit.

Foreign residents and eligibility

Foreign residents enrolled in National Health Insurance or a workplace health insurance scheme are eligible to apply for nanbyo certification on the same basis as Japanese nationals. Residence status and valid health insurance enrolment are the key eligibility conditions; nationality is not a criterion.

Language access at prefectural health offices varies. Some prefectures publish multilingual guidance for the nanbyo application process; many do not. Regional international exchange associations or patient advocacy organisations (a number of condition-specific groups operate in Japan with multilingual materials) can assist with the application process.

If the original diagnosis was made in another country, a Japanese physician must review the case and issue a fresh diagnostic certificate using the Japanese format. Medical records from abroad, including biopsy results, imaging, and specialist letters, can support this process but the Japanese physician makes the formal determination for certification purposes.

Medication coverage under nanbyo designation

Some designated intractable diseases involve treatment with specific biological agents or orphan drugs that are expensive. Once nanbyo certification is in place, these medications fall within the subsidised ceiling alongside other treatment costs, provided they are prescribed at a designated institution.

Patients should be aware that treatment must continue at a certified facility to maintain coverage. Changing hospitals mid-treatment may require confirming that the new facility is designated for the relevant condition and that the certification covers treatment there.

For anyone managing a serious chronic condition in Japan, understanding the nanbyo system is one of the most financially consequential pieces of information available. The system exists to make long-term treatment affordable for those with the most medically demanding diagnoses — and foreign residents with qualifying conditions are fully entitled to access it.

Last reviewed: September 2026