Reimbursement Design and Procedure‐Level Gross Profit of Robot‐Assisted Gastrectomy in a Publicly Financed Health System: Evidence From Japan

Publicly financed healthcare systems must balance technological innovation with fiscal constraints. Reimbursement mechanisms influence institutional decisions regarding the adoption of high-cost surgical technologies. This study evaluated whether current reimbursement designs adequately reflect procedure-level gross surgical profit of robot-assisted gastrectomy within the Japanese National Health Insurance system. A retrospective cost analysis was conducted for curative gastric cancer surgery performed at a tertiary institution in 2024. Gross surgical profit was defined as total reimbursement minus procedure-related costs, including consumables, robot maintenance, and labour costs. Postoperative complication-related costs and total episode-of-care costs were not incorporated into the analysis. Fifty-two gastrectomies were analysed. Open and laparoscopic distal gastrectomy generated positive gross profits, whereas robotic distal gastrectomy resulted in a negative gross margin (-¥87,075 per case). Although robotic total gastrectomy showed a positive gross profit in absolute terms, it remained substantially less profitable than open total gastrectomy. Increased procedure-related costs associated with robotic surgery were only partially offset by higher reimbursement. Sensitivity analyses indicated that gross profit was more responsive to changes in surgical fees and material costs than to maintenance or labour costs. These findings suggest that current reimbursement increments may not fully reflect procedure-related costs associated with robotic gastrectomy and highlight the importance of procedure-specific reimbursement evaluation when introducing high-cost surgical technologies into publicly financed healthcare systems.