Socioeconomic evaluation of Advanced Robotic-Assisted Rehabilitation in Taiwan: a Social Return on Investment (SROI) analysis and policy justification for universal health insurance inclusion

Background This study provides a rigorous socioeconomic evaluation of an advanced robotic-assisted rehabilitation (ARAR) program within Taiwan’s single-payer healthcare context, establishing an empirical macroeconomic justification to inform universal health insurance reimbursement policy. Methods Utilizing the Social Return on Investment (SROI) methodology aligned with Social Value International standards, this retrospective evaluative study mapped the systemic “Theory of Change” over a 31-month mature operational cycle (January 1, 2022, to July 31, 2024). The multi-stakeholder ecosystem encompassed adult neurological patients ( n = 133 ), pediatric early-intervention patients ( n = 59 ), frontline therapists ( n = 8 ), and the sponsoring medical center. Localized financial proxies derived from national occupational wage statistics and healthcare benchmarks monetized non-market psychosocial outcomes. Econometric deflators—including deadweight (0%–30%), attribution (0%–30%), and annual drop-off (0%–30%)—were empirically assigned to insulate the model from over-claiming, validated through adversarial sensitivity analyses. Results The ARAR program generated an aggregate SROI ratio of 6.86:1. From a total investment input of NT$18,932,518 (USD 587,966), the total present value (PV) of net social outcomes reached NT$129,868,110 (USD 4,033,171), yielding a net present value (NPV) of NT$110,935,592 (USD 3,445,205). Adult patients captured NT$ 46,247,300 (35.61%), pediatric patients and their family caregivers co-created NT$ 33,975,610 (26.16%), the sponsoring medical center realized NT$ 40,167,840 (30.93%), and frontline therapists accounted for NT$ 9,477,360 (7.30%). Adult functional independence reduced informal caregiving costs by NT$26,400,000, while pediatric therapy mitigated substantial parental care burden (NT$ 22,554,000). Adversarial stress tests demonstrated that the ratio remained 4.99:1 under combined worst-case conditions. Conclusions ARAR acts as a high-yield socioeconomic catalyst rather than an institutional financial drain. Incorporating robotic rehabilitation into tiered universal health insurance coverage offers a scalable policy blueprint to mitigate long-term care financial liabilities while advancing value-based clinical resource allocation.