[Answered] Robotics is expanding healthcare, offering faster recoveries despite high costs. Analyze the technological and economic challenges in making robotic surgeries affordable and accessible for equitable healthcare delivery in India.

Introduction

Robotic surgery represents a transformative leap in modern medicine, enabling precision and faster recovery. However, high costs and limited access pose significant challenges for equitable healthcare delivery in India.

Robotic Surgeries: A Medical Revolution

Robotic-assisted surgeries, unlike autonomous procedures, are entirely operated by surgeons via advanced consoles controlling precision instruments inserted through small incisions. Technologies like the da Vinci Surgical System are widely used in complex surgeries involving the colon, prostate, and uterus. Advantages include:

1. Minimal invasiveness, leading to reduced pain and smaller scars.
2. Lower risk of infection and post-operative complications.
3. Faster discharge and recovery, aiding workforce productivity.
4. Enhanced surgical precision, critical in difficult anatomical areas like the pelvis or deep abdomen.

Technological Challenges in India

1. High Capital Investment: A single robotic surgical system like da Vinci costs ₹14–18 crore (~$1.7–2.2 million). Annual maintenance can cost ₹1–2 crore, making it unviable for smaller hospitals.
2. Lack of Trained Personnel: Robotic surgery requires rigorous training and credentialing. India has few structured training programs and robotic surgery fellowships, limiting surgeon availability especially in Tier-II and Tier-III cities.
3. Inadequate Infrastructure: Advanced hospitals with integrated robotic operating theatres are limited mostly to metropolitan centres such as AIIMS Delhi, Apollo Hospitals, and Tata Memorial Centre. Rural and semi-urban India lacks even basic surgical facilities, making high-end robotic systems distant aspirations.
4. Technology Import Dependency: Most robotic systems are imported, making them cost-sensitive to foreign exchange fluctuations. India lacks indigenous large-scale robotic surgical technology production.

Economic and Accessibility Concerns

1. High Procedure Costs: Robotic surgery can cost 20–30% more than conventional laparoscopic surgeries. For example, a robotic prostatectomy can cost ₹2.5–3 lakh compared to ₹1.5 lakh for laparoscopic versions.
2. Exclusion from Public Health Schemes: Ayushman Bharat – PMJAY, covering 50 crore beneficiaries, does not currently cover robotic procedures due to high costs. Consequently, robotic surgery remains largely limited to private hospitals and out-of-pocket expenditure.
3. Urban-Rural Divide:70% of India’s population lives in rural areas, but most robotic surgeries are conducted in urban centres, further deepening healthcare inequities.

Policy Recommendations

1. Public-Private Partnerships (PPP): Facilitate shared robotic infrastructure in regional government hospitals under PPP models, making advanced surgeries more accessible.
2. Make in India for MedTech: Promote indigenous development of robotic systems through schemes like PLI (Production Linked Incentive) for medical devices, reducing capital costs.
3. Training and Capacity Building: Create AIIMS-led national training centres with fellowships in robotic surgery, expanding the talent pool.
4. Insurance and Inclusion in PMJAY: Rationalize robotic surgery cost structures and integrate essential procedures into PMJAY with outcome-based funding models.
5. Technology Assessment Board: Set up an independent board to evaluate cost-benefit ratios of robotic procedures and recommend standardized pricing and inclusion into public healthcare.

Conclusion

Robotic surgery offers immense promise, but for it to become a pillar of equitable healthcare, India must invest in technology indigenization, policy support, and training to bridge the affordability-access gap.