Can medical robots reduce health care costs?

Citation

Wells, P.N.T. (2003), "Can medical robots reduce health care costs?", Industrial Robot, Vol. 30 No. 1. https://doi.org/10.1108/ir.2003.04930aaa.002

Can medical robots reduce health care costs?

Can medical robots reduce health care costs?

P.N.T. Wells, DSc FREng, is Emeritus Professor of Physics and Engineering in Medicine, University of Bristol, Bristol General Hospital, Bristol BS1 6SY.

Keywords: Robots, Medical, Health care

This issue of Industrial Robot contains articles concerned with several different kinds of medical robots. Medical robots have been developed in response to a variety of different incentives. For example, some aspects of medical research would simply not be possible without the use of robots. The success of the human genome project has been fundamentally dependent on robotics. One of the primary drivers of the development of assistive technologies to support independent living of disabled and elderly people is to reduce health care costs through automation: often, this means through robotic systems. There will not be practicable alternatives to robotics for telehealthcare provision in inaccessible or dangerous environments, as in the sustainable exploration and exploitation of space, and in the battlefield. In such situations, people will certainly die if care cannot be provided by robots. Consequently, the cost of saving lives can be quite easily calculated. In the operating theatre, robots are in everyday use as mechanical assistants to hold and manipulate instruments, and are beginning to demonstrate their ability to enhance the dexterity of the surgeon, to perform minimal access and image-guided procedures and to reduce the incidence of infection. For these latter kinds of applications, however, the advantages and disadvantages are more problematic. On the one hand, efficacy and outcome are generally hard to define, let alone to measure; and, on the other, cost and benefit calculations are inclined to be contentious. Researchers, clinicians, healthcare managers, patients, politicians, manufacturers, the community, the media, economists, healthcare planners, and even insurance companies – in fact, all the players on the stage – have their own individual agendas. These agendas are all too often incompatible with each other.

A fundamental aim of any healthcare system, whether “publicly” or privately funded, for profit or not for profit, is to maximise the health and welfare of the participating community. This requires prioritisation, since the available resources have to be finite. There are several approaches to the economic evaluation of any health care technology. Although it has had a somewhat chequered history, cost-benefit analysis seems to be a sensible method for evaluating medical robots, by placing a monetary value on the benefit likely to be gained through their use. Thus, for example, it should be possible to calculate the additional cost of extending the lifetime of an artificial hip joint by, say, 3 years as the result of using a robot to increase the surgical precision. Then, the question is whether that initial financial outlay justifies the use of robotic surgery as a higher priority in comparison with, for instance, a comparable expenditure on increasing the cleanliness of the wards. That is where the difficulty arises with this approach: the individual patient benefiting from the improved surgery would be likely to be in favour of it, but would the expectant mothers putting up with filthy floors?

It is a lesson of history that those responsible for managing the provision of health care are averse to new technologies if they are seeking to contain costs in a resource-limited scenario, but actively promote their introduction if they are seeking to maximise their profits in a competitive environment. In the former case, experience has taught managers that technologies that purport to be cost-reducing generally are not; they somewhat cynically observe that they cannot afford such economies. Managers driven by profit, however, can see that more expensive treatments with apparently better outcomes increase both their margins and their competitiveness.

Whatever the constraints that may be imposed to limit the diffusion of robots in health care, however, we can be sure that patients and the public, in their special interest groups, will demand them. In retrospect, it may even be possible to identify the impact of the technology on health care costs; some classes of robots will increase costs, some will reduce them. Those that come into routine use will almost certainly prove to be beneficial. This is not a recipe for the orderly management of the diffusion of these technologies or for a smooth path to prosperity for industry, but at least it should be a comfort to all of us who stand to benefit from progress.