34 Asia The EconomistNovember 21st 2020
21- Toyoda Goichiro of Medley, a telemedi-
cine firm, says his colleagues often have to
help new clients with digital basics, such as
choosing computers and setting up Wi-Fi
networks. But there is also an economic
disincentive. As a government official puts
it, “There are people in the jmawho are
afraid of competition from telemedicine.”
In 2015 the government allowed tele-
medicine to treat a few conditions, albeit
for less compensation and with more pa-
perwork. Predictably, it did not take off:
less than 1% of all medical institutions of-
fered online consultations in 2018. But
many restrictions on telemedicine were
suspended in April because of the pandem-
ic, sending patients and doctors flocking to
their screens. The situation “changed radi-
cally”, says Hara Seigo, the boss of micin,
another telemedicine firm, which saw
monthly registrations jump ten-fold. Gov-
ernment surveys show the share of institu-
tions using telemedicine has risen to near-
ly 15% this year. Mr Suga hopes to make the
changes permanent.
Mr Toyoda, who gave up a career in
brain surgery to work in digital health care,
hopes that wider adoption of telemedicine
will also promote the use of electronic
medical records. Japan’s medical system is
overwhelmingly paper-based, laments
Tsuchiya Ryosuke, a former head of the Na-
tional Cancer Centre Hospital. (Mr Tsu-
chiya uses a smartphone, but keeps “a fax
machine ready just in case”.) Only 42% of
clinics have digitised their data on pa-
tients. Big hospitals do better: 85% keep at
least some digital records. But information
tends to sit on proprietary systems that are
often incompatible with each other.
Linking and analysing those data could
help to reduce costs. Duplicate procedures
would be easier to avoid. The effectiveness
of treatments could be measured. Having a
clearer picture of patients’ history is also
essential if Japan is to shift from its fee-for-
service system, whereby doctors get paid
more for ordering more tests, to a system in
which their pay is based on outcomes, as
the health ministry wants. “To fix pro-
blems, you need to have records,” says Shi-
buya Kenji of King’s College London. “It’s
not about just abolishing stamps or faxes,
it’s about integrating data sources.”
For Koizumi Keigo, a doctor who serves
two remote islands in Mie prefecture, the
expansion of telemedicine has been a huge
boon. Previously, when he was visiting one
of the islands, patients on the other were
left without a supervising physician. This
year he began keeping tabs over video chat.
Nurses hold up an iPad at patients’ bed-
sides, while Bluetooth devices monitor
blood pressure. That is enough to give him
a sense of how his charges are doing. They
are pleased with the extra attention, too.
Now, he says, “even the grandmas” would
like to see more doctors go online. 7
E
lections amidthe craggy splendour of
Gilgit-Baltistan are usually of interest
only to its residents—if them. The region at
the northern tip of Pakistan is home to five
of the 14 mountains in the world that ex-
ceed 8,000 metres, but contains only 1% of
Pakistan’s population. The pragmatic lo-
cals tend to vote for the party that runs the
national government. Moreover, the local
assembly has limited powers, since the re-
gion is not a province, but merely a territo-
ry, being part of Kashmir, which India and
Pakistan both claim and which they divid-
ed by war in 1947.
It was odd, therefore, to see Pakistan’s
political elite campaigning furiously in
Gilgit-Baltistan ahead of elections to the
assembly on November 15th. A new opposi-
tion alliance was hoping that the vote
would prove its mettle. The prime minis-
ter, Imran Khan, was eager to show that his
Pakistan Tehreek-e-Insaf party (pti) re-
tained public support.
To curry favour with the locals, Mr Khan
announced at a campaign rally in the town
of Gilgit on November 1st that his govern-
ment would confer provincial status on the
region. Maryam Nawaz, daughter of Mr
Khan’s predecessor, Nawaz Sharif, spent a
week in the region trying to drum up sup-
port for his party, the Pakistan Muslim
League (Nawaz) (pml-n). While there, she
met her fellow dynast and leader of the
Pakistan Peoples Party (ppp), Bilawal
Bhutto-Zardari. So fierce was the scrum of
national grandees, in fact, that a local court
ordered many of them out of the region,saying they were breaking a rule against
electioneering by senior officials.
The pml-n and the pppare the main-
stays of the new opposition alliance, the
Pakistan Democratic Movement (pdm). Its
goals include curbing the army’s meddling
in politics and sending Mr Khan packing.
The two ambitions are related in the eyes of
the pdm, since it accuses the army of help-
ing to rig national elections in Mr Khan’s
favour in 2018.
Mr Sharif, who is in exile in London, has
been giving incendiary speeches, accusing
the army of operating as a “state above the
state”. Although this is true, Pakistani poli-
ticians tend not to say it, for fear that the
army will arrange their downfall. Within
Pakistan the pdmhas held a series of rallies
to demonstrate its support.
Widespread public anger at the rising
cost of such staples as flour, sugar and to-
matoes has given the pdmammunition. At
a rally in Gujranwala in the province of
Punjab last month, it was this that seemed
to exercise participants most, rather than
the army’s assertiveness. “We are here to
send Imran Khan home!” shouted one of
them, Muhammad Rafique, above the din
of the protest. “It’s the price rises. Everyone
is fed up.”
The vigour of these events appears to
have rattled Mr Khan and the army. After a
gathering in Karachi, Ms Nawaz’s husband
was arrested at the insistence of military
officials. The local police chief was alleged-
ly kidnapped by soldiers to force him to
sign the warrant. The brazen nature of theISLAMABAD
The opposition takes on not just the government, but the armyPolitics in PakistanA mountain to climb