Economics
Introduction
Do the benefits of telesurgery technology justify the costs? Some distinct areas in which costs are identified are as follows:
· purchasing of the robots and infrastructure
· maintenance/training costs
· academic/research costs
· insurance
· reimbursement costs
· cost for ethical guidelines and intellectual property rights
The first question that comes to mind is where all this money is going to come from. In Canada where the health care system is publicly funded by the government, will the government be paying for these robotic machines and in doing so will there be an increase in taxes? What about countries like the United States, where the health care system there is privately owned? The government might help with the cost but unfortunately, it is likely that only people with enough money will have access to those machines.
Capital costs of robots and infrastructure
Much of the cost associated with telesurgery are those related to the purchasing of robots and communications infrastructure. The robotic machines cost approximately $1 million (Ahmad & Zarraga, 2008, p. 51). Obvious infrastructure costs include renovations to hospitals, as the bulky robotic equipment and consoles take up a lot of space. However, there are other infrastructure costs to consider as well. Most notable is the communication infrastructure costs. Satellite links, fiber-optic networks, and the use of unmanned aerial vehices as communication nodes are all options here. The use of unmanned aerial drones is particularly attractive, as these drones would each become nodes in a temporary network (Doarn et al., 2007, p. 372). In the considering of medical response to a natural disaster, a mobile network is desirable because any permanent communication would likely have sustained damage.
“There is no such thing as a free lunch” - a fast, dedicated network will cost a lot of money. While it would be possible to use public communication infrastructure (like the internet) for telesurgery, the high latency and variable bandwidth would be dangerous to the patient. Instead, high-speed, low-latency networks with backups (redundancies) must be used. The consoles used for controlling the telesurgery robot must have redundancies as well – all of these are capital costs associated with telesurgery (Doarn et al., 2007, p. 371).
Maintenance and training costs
In order to guarantee that these tools and equipments/robots give the best results, proper maintenance has to be an essential component of this process. Maintaining the equipment to prevent problems will require money, an estimated $100,000 US annually (Ahmad & Zarraga, 2008, p. 51). Furthermore, hospital staff, doctors, and surgeons responsible for the maintenance and use of these machines will have to be properly trained. The training costs required to train a team to use one robot are estimated to be $250,000 US Ahmad & Zarraga, 2008, p. 51). There is also a time investment relating to the training of staff to use telesurgery robots.
Academic/research costs
Many of the issues with telesurgery can be resolved through research to improve existing technologies. The existing telesurgery systems were largely a product of corporate and university research. For example, the da Vinci machine (which we investigate closely) was developed by SRI International, and was funded by agencies including the National Institute of Health (NIH) and the Defence Advanced Research Projects Agency (DARPA). It follows that subsequent improvements to telesurgery technology will also come from the research sector, likely through government funding as well. In 2008, it was estimated that an additional $380 million dollars would be required to advance telesurgery into the realm of early acceptance (Moses et al., 2008, para. 6).
Research in other areas will also positively impact telesurgery, as well. For example, the codec (digital encoder/decoder) used to transmit video feeds from the slave unit to the master unit introduce an additional latency to the system. The current codec with the lowest latency is MPEG-2, which adds about 90ms to the transmission times (Doarn et al., 2007, p. 376). With the research and development of faster codecs (or indeed, faster communication networks), telesurgery will greatly benefit.
Insurance/Reimbursement Costs
Another drawback to telesurgery is the cost of insurance/reimbursement. Countries where the cost of health care is not covered by the government the people use health plans by different insurers. Since telesurgery is a brand new procedure many private insurers do no pat additional fees for this service. So, hospitals are likely to increase the cost for procedures or diagnoses for which robots are used. Medicare and private insurance company’s reimbursement rates are calculated based on the how much the hospital charge for the procedures. This means that increases in charges for robot-associated diagnoses and procedures may lead to higher payments for procedures that are not even related to telesurgery (Barbash & Glied, 2010, para. 7). What this basically means is that most Health insurance companies do not provide additional reimbursement for the use of robotic surgical devices and the patient getting the procedure done will have to pay for it themselves.
Conclusion
All these are the reasons why the cost for telesurgery is controversial. The money to build the robots, the cost for the maintenance, the amount of time and money required to train staff, and expanding the health care/communications infrastructure to store these robots require a great deal of money and even though there are great benefits to telesurgery are those benefits great enough to justify the cost.
It might appear that the cost of this equipment is covered by the government and the hospital staff but if we look at the bigger picture, where do the hospitals and the government gets the money? In Canada the government is responsible for providing those services in the healthcare system but they get that money from taxpayers. Will all the taxpayers have the same benefit from telesurgery? Even though everyone will pay taxes, it is unlikely that all of the taxpayers will get the same advantages from this technology. If the equipment if just available in large cities, what about the people that live in small towns - they will not have the access to same services but they pay taxes as well. Another drawback is that this process is only applicable to some surgical procedures. This further reduces the number of taxpayers that will benefit from telesurgery. So, how much money should be invested in this technology?