Connecting online visits, e-prescriptions and home delivery of medication
0. If you can only do one thing today
You don't have to do everything. Just start by telling the office in your city or ward that handles Jiritsu Shien Iryo (Japan's subsidy for ongoing outpatient mental health care) this one message:
"I'd like to renew my Jiritsu Shien certificate, or transfer it because I've moved. Can I start the process now with my current hospital and pharmacy? If you need to check with my previous municipality, can the two offices contact each other directly?"
That's all you need.
Jiritsu Shien Iryo is a system that lowers out-of-pocket costs for people who keep going to psychiatric or similar outpatient care. At designated providers, the covered care is generally billed at 10%, and depending on your income a monthly cap may apply. To use it, the hospital, clinic or pharmacy you'll use has to be registered in advance as a designated provider.
If you try to research the system, find a hospital, find a pharmacy and go to city hall all on the same day, it's easy to freeze up. The administrative step that has a deadline and the long-term choice of which hospital and pharmacy to use can sometimes be handled separately.
1. Why is this so exhausting?
It isn't just a lack of willpower.
In public administration research, the effort it takes to get access to a benefit is called "administrative burden," and it's usually split into three parts:
- Learning costs: finding out the system exists, whether you qualify, and what to submit
- Compliance costs: making phone calls, filling in paperwork, traveling, renewing, and getting certificates
- Psychological costs: putting up with anxiety, confusion, stress, embarrassment and plain hassle
With mental health support programs, the very people who need help most can end up facing all three at once.
Japanese research on access to mental health care has also found that reasons like "I don't know where to go," "it seems like it'll take a long time," "transport or my schedule makes it hard," and "I'm worried about the cost" were linked to delays in getting treatment. The survey is old, so those figures can't be used as-is for Japan today, but the pattern is easy to recognize.
So on a day when you can't move, there's no reason to decide you don't deserve the system. The system simply has too many steps.
2. The basics of the system: start here
Jiritsu Shien Iryo (the outpatient mental health version) lowers medical costs for people who need ongoing outpatient treatment for a mental health condition.
The basics are:
- Covered care has to be received at a registered designated Jiritsu Shien provider
- Your out-of-pocket share for covered care is generally 10%
- A monthly cap may be set depending on your income and other factors
- Not only the hospital but also the pharmacy has to be registered
- You manage your costs with the beneficiary certificate and the monthly cap record sheet
- The certificate is generally valid for 1 year
- At renewal, if your condition and treatment plan haven't changed, the doctor's certificate is in practice required only every 2 years
Submission methods and temporary arrangements differ by municipality, so in the end, check with the office where you live.
3. If you've moved: first ask whether renewal and changing hospitals can be separated
When you move, several things tend to hit at once:
- Moving in from another prefecture or city
- A renewal deadline
- Changing hospitals
- Changing pharmacies
- Changing health insurance
- Reissuing the certificate or having records confirmed
You don't necessarily have to put everything on hold until you've chosen a new hospital.
Ask the office:
"Can I do the move-in procedure and the renewal first, with the hospital and pharmacy I'm currently registered with? And once I've chosen a new hospital and pharmacy, can I change them afterward?"
If the answer is yes,
you can separate the lane for meeting the deadline from the lane for choosing a hospital and pharmacy.
What matters in this city hall RPG (a video-game-style way of describing the maze of official procedures) is telling apart "it'd be easier if you called your previous municipality yourself" from "we can't accept this unless you call yourself."
"Is this a required step that only I can do, or can the two municipalities check with each other?"
This single sentence can sometimes cut down a lot on being bounced from desk to desk.
4. Check My Number Portal first
When they ask "did you submit a doctor's certificate last time?", it's perfectly normal not to remember.
In that case, instead of trying to answer from memory, check whether My Number Portal (the government's online account service) or the beneficiary information you have on hand shows which year of the cycle you're in and whether a certificate is needed next time.
If it says you're in year 1 and no certificate is needed next time, you may be able to skip the doctor's certificate as long as you renew on time and your treatment plan hasn't changed.
The important point is this:
"A certificate can be written" and "a certificate is needed this time" are two different things
Before paying a few thousand yen for the document "just in case," ask the administrative office whether it's required this time.
5. Don't think of online visits as "just the hospital"
If you're serious about going online, the hospital isn't the only thing to look at.
The ideal flow looks like this:
Online visit
→ fully electronic prescription
→ online medication counseling
→ public subsidy applied at payment
→ delivery to your home
The Ministry of Health, Labour and Welfare also explains that using electronic prescriptions makes it easier to handle everything from the online visit to the online medication counseling online.
That said, online visits aren't available to everyone or for every medicine. A doctor may decide you need to be seen in person. Some medicines have restrictions on being prescribed at a first visit, so prepare your treatment history, a referral letter and your medication notebook before you ask.
6. Questions to ask when looking for an online hospital
"Do you do online visits?" isn't enough.
Ask all of the following together:
- Can I have my first visit as a new patient online, even though I'm transferring?
- Can I discuss continuing my current treatment and medication?
- Are you a designated Jiritsu Shien provider?
- Can patients who hold a certificate from my municipality use you?
- Can you issue a fully electronic prescription?
- Do you have weekday evening or Saturday slots?
- Is a referral letter required, or just recommended?
- Can you write the renewal doctor's certificate if I need one?
- How do you handle the application receipt before the certificate arrives?
- If I pay 30% before the subsidy is applied, can I get a refund later?
Just "supports electronic prescriptions" can sometimes fall short.
Check whether it is a fully electronic prescription, with no paper copy issued, where the pharmacy can pull up the original data from the system. That makes it easier to get rid of the mailing step.
7. The real final boss is the pharmacy
Even if the hospital is online, if the pharmacy requires you to show up in person, you still lose half a Saturday.
Ask the pharmacy:
- Are you a designated Jiritsu Shien (outpatient mental health) pharmacy?
- If I register you with my municipality in advance, can the subsidy be applied at payment?
- Do you support fully electronic prescriptions?
- Do you offer online medication counseling?
- Do you deliver within Japan?
- How much are shipping and system fees?
- Can you check my certificate from an uploaded image?
- Can you handle the monthly cap record sheet as an image?
- If the amount I paid at the hospital isn't written on the sheet, will you confirm it with the hospital for me?
- Can you accept the municipality's application receipt while my application is pending?
- Do I need to mail a paper original or come in every time?
- Can you stock or order the medicine I take?
- Do you have evening or Saturday counseling slots?
- Can you deliver into my mailbox?
The key point here: "we deliver" does not mean "Jiritsu Shien is fully online."
Some pharmacies offer online counseling and delivery but still ask for an in-person visit because of the monthly cap record sheet for the public subsidy.
On the other hand, there are pharmacies that let you upload images of the certificate and the cap sheet, check the amount with the hospital themselves, and skip mailing a paper original if the prescription is fully electronic.
That difference is huge.
8. The application receipt and paying 30% while you wait
How things are handled until your certificate arrives depends on each hospital and pharmacy, so ask each one.
Some will apply the subsidy provisionally on the strength of the application receipt alone. Others have you pay 30% first and settle up after the official certificate arrives.
Be careful here.
The extra you paid won't necessarily come back on its own.
If you paid 30%, keep:
- Receipts
- Itemized medical statements
- Itemized dispensing statements
Once the certificate arrives, ask the hospital or pharmacy yourself:
"I paid 30% during my Jiritsu Shien application. Can that be refunded later?"
If you assume it'll be refunded automatically and leave it, it may simply never happen.
If you don't need to be seen urgently, waiting until the official certificate arrives before your visit can sometimes mean fewer provisional arrangements to deal with.
9. If your health insurance is about to change
Even if your health insurance is about to change soon because of a new job or a job change, and you don't yet know the new insurance number, you don't necessarily have to stop everything else.
Ask the office:
"Can I go ahead with the renewal or move-in using my current insurance details, and then change only the insurance details after the switch?"
And go one step further:
"Can the insurance change alone be done by mail or online?"
Asking that much may save you one extra trip to city hall later.
10. For when it's really hard: three levels
Level 1: You can't make even one call today
On your phone, search "[your municipality] Jiritsu Shien Iryo seishin tsuin" (the outpatient mental health program) and just screenshot the name of the counter and the phone number. That's it.
Level 2: You can make one call
Just read this:
"I'd like to use or renew Jiritsu Shien Iryo. Could you tell me just one thing I should do next?"
You don't need to memorize the whole list of documents.
Level 3: You want to go all the way to online
Contact the hospital and the pharmacy at the same time.
To the hospital: "Jiritsu Shien, online first visit after transferring, fully electronic prescription."
To the pharmacy: "Jiritsu Shien, subsidy applied at payment, image support for the cap sheet, online medication counseling, delivery."
Look for the overlap of all of these.
11. Ready-to-use inquiry messages
For hospitals
I use Jiritsu Shien Iryo (the outpatient mental health program) and am considering changing hospitals because I'm moving. I'm currently in ongoing treatment. Is an online first visit possible for a transfer patient? Please also tell me about online visits under Jiritsu Shien, fully electronic prescriptions, consultation about continuing my current treatment, whether a referral letter is needed, and how you handle the application receipt before the certificate is issued.
For pharmacies
I use Jiritsu Shien Iryo (the outpatient mental health program) and would like online medication counseling and home delivery with an electronic prescription. If I register your pharmacy as a designated provider with my municipality in advance, can the public subsidy be applied at payment? Can I submit my certificate and monthly cap record sheet as images? With a fully electronic prescription, can I use your service without mailing a paper original? Please also tell me about shipping and system fees, evening and Saturday availability, and whether you can accept the application receipt.
12. "Even the city hall staff didn't know" is common
Staff at a municipal office are experts in administrative procedures, but they don't necessarily keep up in real time with online clinics across the country, which pharmacies support electronic prescriptions and delivery, or how provisional handling of public subsidies works.
So even if they say:
"I don't think there's anywhere that works online."
change the question to whether it's allowed under the system:
"Is there an out-of-prefecture provider that can be registered as a designated provider for this municipality?"
"Can I register a designated provider that I found myself?"
"Do you know any recommendations?" and "Is it allowed under the system?" are different questions.
13. AI is useful for "connecting," not just "searching"
A problem like this isn't a lack of information. It's that the information is scattered in different places.
- Municipality: the application system
- Prefecture: designated providers
- Hospital: online first visits and prescriptions
- Ministry of Health, Labour and Welfare: online visits and electronic prescriptions
- Pharmacy: online medication counseling and delivery
- My Number Portal: eligibility and medication records
- You: your current treatment history
Look at each one by itself and it says "we can do that."
But what you need is the overlap of all of these:
Jiritsu Shien × online first visit × fully electronic prescription × online medication counseling × subsidy at payment × monthly cap management × delivery
AI is good at finding candidates, organizing conditions, drafting inquiry messages, comparing replies and spotting the next bottleneck.
There's no need for a human to keep relaying calls between the municipality, hospitals and pharmacies.
Am I the API Gateway here? (a program that just passes requests between systems)
14. What this guide is ultimately aiming for
It shouldn't assume only people who can push themselves to go to the hospital.
The ideal is:
an online visit from home
→ a fully electronic prescription
→ online medication counseling from home
→ Jiritsu Shien applied on the spot
→ medicine delivered to your door
When an in-person visit is medically necessary, switch to in-person. For everything else, cut down on travel, waiting, paper mailing and trips to city hall as much as you can.
A support system shouldn't be a game that only people who can beat it get to use.
15. References and cautions
- Ministry of Health, Labour and Welfare, "Jiritsu Shien Iryo" (Support for Independence Medical Care)
- Ministry of Health, Labour and Welfare, "Overview of the Jiritsu Shien Iryo System"
- Ministry of Health, Labour and Welfare, "Electronic Prescriptions (for the public)"
- Ministry of Health, Labour and Welfare, "About Online Medical Care"
- Ministry of Health, Labour and Welfare, "Information on Online Medication Counseling"
- Halling & Baekgaard, Administrative Burden in Citizen–State Interactions: A Systematic Literature Review, JPART, 2024
- Research on barriers to mental health care access in Japan, based on the World Mental Health Japan Survey
Systems, designated providers, required documents and provisional settlement differ by municipality, medical institution and pharmacy. This article does not replace individual medical judgment or an official administrative decision. Depending on your symptoms and medication, online visits may not be appropriate.
