By Dr HP Bhalodiya
Robotic-assisted surgeries are transforming joint replacement and other complex procedures by offering patients smaller incisions, reduced blood loss, quicker recoveries, and fewer complications. These benefits are not just theoretical; they are increasingly backed by global data and growing adoption across India.
As India’s healthcare system embraces these modern technologies, it becomes important that health insurance frameworks evolve in tandem to ensure equitable access for all patients. The Insurance Regulatory and Development Authority of India (IRDAI) took a key step in 2019 by directing insurers to include modern treatments in their offerings. Yet, coverage for robotic-assisted procedures continues to vary across plans, which may influence how patients evaluate their treatment options and affordability.
Robotic surgery is now being increasingly applied in orthopedic procedures, particularly in joint replacements, where it enhances precision and consistency in surgical outcomes. As this technology is still scaling in adoption, many patients look to their health insurance to help make such advanced care more accessible. While some public-sector insurers offer comprehensive coverage, others place caps on reimbursements. In such cases, the coverage amount often falls significantly short of the actual procedure cost, leaving patients to bear a large out-of-pocket expense. These limitations underscore the need for insurers to revisit sub-limits in light of evolving treatment standards and costs. Additionally, lower-tier plans may not yet reflect the advancements in surgical care available today.
In some cases, insurers face administrative challenges when evaluating claims related to robotic surgery. Differences in interpretation, such as what constitutes a “technology fee” or whether equipment charges are included, can result in partial reimbursements or delays. These nuances highlight an opportunity for clearer communication and alignment among stakeholders to reduce uncertainty for both patients and providers.
Healthcare experts and surgical associations have emphasised the importance of updating insurance plans to reflect these advancements. Their appeal is not to criticize but to collaborate: to work with insurers in creating policies that recognize robotic-assisted surgery as part of the evolving standard of care, not a niche or luxury offering.
Beyond immediate clinical benefits, robotic surgery is helping build a more skilled med-tech workforce and stimulate innovation in India’s healthcare sector. As the country advances its vision of universal, digitally enabled healthcare through national initiatives like Ayushman Bharat and the Ayushman Bharat Digital Mission, integrating modern technologies like robotic surgery into mainstream insurance coverage aligns well with these broader goals. It represents a timely opportunity to ensure that cutting-edge treatments are not just developed, but also equitablydelivered.
For insurers, this is more than just keeping pace with medical progress, it’s a chance to lead the transition to value-based care models. Robotic-assisted procedures often result in fewercomplications, shorter hospital stays, and faster return to daily activities. By recognizing these long- term advantages, insurers can help lower overall healthcare expenditure, enhance patient satisfaction, and reduce re-hospitalization risks. With the right checks and protocols in place, covering robotic surgery can be both sustainable and impactful.
Collaboration is key. A stronger partnership between insurers, healthcare providers, and policymakers can help design smarter, more flexible coverage models. These models should focus on long-term outcomes like fewer complications, shorter hospital stays, and faster return to work, which can ultimately reduce overall healthcare spending and improve patient satisfaction.
The way forward lies in shared responsibility. As medicine evolves, insurance must evolve with it. Together, we can ensure that robotic-assisted surgery is not reserved for a privileged few, but accessible to every patient who may benefit from it. With forward-thinking reforms and open dialogue, India has the potential to lead the way in integrating cutting-edge care with inclusive health financing.
(Dr HP Bhalodiya is chairman and managing director (CMD) of Saviour Hospital, Ahmedabad. Views expressed in the article are those of the author; Zee News does not confirm or endorse the same.)