Express Healthcare

Insurance cover of all robotic-assisted surgical procedures to determine the future of a healthier India

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Dr Vivek Bindal, Regent, Clinical Robotic Surgery Association (CRSA)- India and HOD- MIS, Bariatric and Robotic Surgery, Max Super Speciality Hospital highlights that with multiple focused familiarising and upskilling initiatives taking shape all over India, the number of surgeons and patients benefiting from advanced surgical tool in alleviating their medical problems is consistently increasing every year

The early 90’ brought a revolution in the field of surgery with the advent of ‘Surgical Robotics’. The placement of a surgical robot between the physician and the patient increased the efficiency of the surgeon and better outcome for the patient in therapy areas like oncology, urology, gynecology, etc. Being present in more than 67 countries and with over 24,000 research papers evaluating the technology globally through the 85 lakh surgeries, surgical robots have come to the forefront of minimally invasive surgery.

Surgical robots such as the da Vinci by Intuitive came to India in 2002 at Delhi, and ever since, the uptake of Robotic-Assisted Surgery (RAS) has been on an all-time high. With more than 500+ surgeons who specialise in RAS, the numbers are constantly growing year on year. With multiple focused familiarising and upskilling initiatives taking shape all over India, the number of surgeons and patients benefiting from this advanced surgical tool in alleviating their medical problems is consistently increasing every year.

With such progress in surgical technology and optimistic surgeon and patient benefits being seen over the years, the insurance sector has not been able to scale up in terms of patient coverage of RAS procedures as expected despite the Insurance Regulatory and Development Authority of India (IRDAI) taking note of the benefits that RAS procedures could provide to the patients. Though many private insurance companies provide RAS coverage, depending on the procedures and payment type, the coverage cover for these procedures is less than rupees 2 lakhs. RAS procedures provide patients with the much-needed patient benefits like a decrease in postoperative complications, smaller incisions, lesser blood loss in comparison to open surgeries and lesser post-operative pain, minimal sutures and scarring, lesser chances for hospital-acquired infections. RAS also assists patients to return to regular diet and life in a week in specific cases, allowing for a shorter hospital stay. From a patient perspective, the lesser number of days that the patient spends in the hospital would result in lesser room rent and allied expenditure as well.

Data from the India Brand equity foundation shows that in July 2021, private health issuers registered a premium growth of Rs 1,753 crore (US$ 235.11 million), an increase of 27.5 per cent YoY. Records also show that six private-sector health insurance companies registered a jump of 66.6% in their gross premium at Rs 1,406.64 crore (US$ 191.84 million) in May 2021, as against Rs. 844.13 crore (US$ 115.12 million) earlier. Therefore, with the healthcare insurance companies growing at such a rapid pace every year, they have the financial capability to provide the best available care to their patrons if they choose to.

With COVID bringing more awareness among the people of the country for personal care and the importance of maintaining a healthy lifestyle and regular health checkups, the chances for early identification of non-communicable diseases like cancer, gynecological issues, respiratory illnesses, gastrointestinal diseases, to mention a few, are higher. Today, the adoption of RAS has been consistently rising across the globe because of the well-documented proven benefits. Globally, It has demonstrated cost-effectiveness, long-term cost savings for payors (Insurers), health outcomes for patients, and efficiency for providers.

There is rising acceptance by the provider community in India and abroad. Payors in other markets already cover RAS and now, IRDAI is also supporting robotics, making it a clear business case for payors to adopt RAS and increase coverage limits for Robotic-assisted surgery in light of long-term outcome benefits and cost-effectiveness.

Payors (Insurers) in India should engage with providers to understand cost differences for better negotiation of rates and standardizing the pre-authorisation justification and documentation requirements. Similarly, engagement with RAS technology vendors will keep them informed & updated on technological advancements on RAS and evidence of local experience of effectiveness.

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