Cost-benefit performance simulation of robot-assisted thoracic surgery as required for financial viability under the 2016 revised reimbursement paradigm of the japanese national health insurance system

Naohiro Kajiwara, Yasufumi Kato, Masaru Hagiwara, Masatoshi Kakihana, Tatsuo Ohira, Norihiko Kawate, Norihiko Ikeda

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    2 Citations (Scopus)

    Abstract

    Purpose: To discuss the cost–benefit performance (CBP) and establish a medical fee system for robotic-assisted thoracic surgery (RATS) under the Japanese National Health Insurance System (JNHIS), which is a system not yet firmly established. Methods: All management steps for RATS are identical, such as preoperative and postoperative management. This study examines the CBP based on medical fees of RATS under the JNHIS introduced in 2016. Results: Robotic-assisted laparoscopic prostatectomy (RALP) and robotic-assisted partial nephrectomy (RAPN) now receive insurance reimbursement under the category of use of support devices for endoscopic surgery ($5420 and $3485, respectively). If the same standard amount were to be applied to RATS, institutions would need to perform at least 150 or 300 procedures thoracic operation per year to show a positive CBP ($317 per procedure as same of RALP and $130 per procedure as same of RAPN, respectively). Conclusion: Robotic surgery in some areas receives insurance reimbursement for its “supportive” use for endoscopic surgery as for RALP and RAPN. However, at present, it is necessary to perform da Vinci Surgical System Si (dVSi) surgery at least 150–300 times in a year in a given institution to prevent a deficit in income.

    Original languageEnglish
    Pages (from-to)73-80
    Number of pages8
    JournalAnnals of Thoracic and Cardiovascular Surgery
    Volume24
    Issue number2
    DOIs
    Publication statusPublished - 2018 Jan 1

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    Keywords

    • Cost-Benefit performance
    • Da Vinci Surgical System
    • Japanese National Health Insurance System
    • Robot-assisted thoracic surgery

    ASJC Scopus subject areas

    • Surgery
    • Pulmonary and Respiratory Medicine
    • Cardiology and Cardiovascular Medicine
    • Gastroenterology

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