Impact of Robotic Surgery for National Health Insurance System of Japan

• In Event: Technology, Surveillance, and Artificial Intelligence in Global Health

Abstract

Given the high cost of robotic surgery systems, its’ maintenance and training expenses that are always compounded by risks of mechanical failure and malfunction, the introduction of robotic surgery for cancer treatment has been vehemently discussed in recent years. Japan, being the pioneer in this regard, approved robotic surgery of gastrointestinal cancer for national health insurance since April 2018. More than 9000 cases were treated at the facilities of approximately 400 robotic systems of different manufacturers throughout the country. Present paper highlights advantages and disadvantages of robotic surgery in comparison with open and laparoscopic surgery for the period of 2018-2022. Acknowledging highly contentious nature of the subject for both practicing surgeons and patients, the authors focus on the analysis of national health insurance expenditures data for robotic surgery and seek to estimate its appropriateness by introducing HE-SHI (health expenses - state health insurance) Index. HE-SHI Index implies the relation between patient’s short- and long-term health expenses (like complications after and during the surgery, time in anaesthesia, blood loss, local metastasis recurrence) and national health insurance expenditures. Generally, the process of assessment of new medical technologies lacks transparency and public discussion that is fraught with the risk of prevalence of two other parties: medical institutions as providers of medical services and manufacturers. The HE-SHI Index aims to contribute to evidence-based decision-making on the one hand and to bring the issue of robotic surgery into the plane of expert discussion of the political science community on the other.

Authors

• Hiroyuki Shiobara, Tokyo Medical and Dental University

• Olesya Sheblo, Gakushuin University