Robotic surgery free for poor patients faces funding crisis as Maharashtra delays scheme inclusion
More than two years after Mumbai's Sir J. J. Group of Hospitals proposed including robotic and bariatric surgeries under the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY), the Maharashtra government has not taken a decision. This delay raises concerns about the long-term sustainability of offering robotic procedures free of cost to poor patients.
Doctors at the state-run hospital said the robotic system itself has already been procured by the government and surgeries are currently being performed without charge. However, the specialised instruments and disposable consumables required for every procedure are expensive and will soon need replacement.
“We proposed nearly two years ago that robotic and bariatric surgeries be included under MJPJAY, but no decision has been taken so far,” said Dr Ajay Suman Haribhau Bhandarwar, Dean of Grant Government Medical College and Sir J. J. Group of Hospitals.
JJ Hospital, the only state-run hospital in Mumbai offering robotic surgeries, formally launched the service on April 9, 2025. Since then, it has completed over 260 robotic procedures across specialties including gastrointestinal surgery, colorectal surgery, urology, hernia repair and gynaecology.
“We want robotic surgery to be brought under MJPJAY so that poor patients can continue to benefit from this technology,” said Dr Girish Bakshi, Professor and Head of the Department of Surgery.
Unlike conventional surgical instruments, robotic procedures rely on specialised scissors, graspers, needle drivers, energy devices and other accessories that have a fixed number of uses. The robotic system electronically tracks each instrument and disables it once the prescribed usage limit is exhausted.
“The issue is not the robot. It is the consumables attached to it. Some can be used only once while others have a limited number of uses. Once that limit is reached, the system automatically rejects the instrument and it has to be replaced,” Dr Bakshi said.
Hospital officials said the initial package supplied with the robotic platform includes consumables sufficient for around 500 procedures. Having already completed more than 260 surgeries, the hospital has crossed the halfway mark.
“The recurring cost of consumables alone is around Rs 1 lakh to Rs 1.5 lakh per surgery. Once the initial stock is exhausted, we will have to procure fresh instruments and disposables,” Dr Bhandarwar said.
To continue offering the procedures free of cost, the hospital is currently trying to recover part of the expenditure by claiming reimbursement under existing laparoscopic surgery packages wherever applicable.
“We are showing eligible procedures under laparoscopic packages and seeking reimbursement so that the money can be used to purchase replacement consumables. But this is only a temporary arrangement,” Dr Bakshi said.
He warned that unless robotic surgery is formally included under MJPJAY, either the hospital will have to absorb the recurring costs or patients may eventually have to pay.
“At present, patients are not being charged. But once the consumables supplied with the robot are exhausted, either the hospital will have to bear the expenditure from its own resources or the patient will have to pay. That is exactly why we have sought inclusion under the scheme,” he said.
The hospital has also requested the inclusion of bariatric surgery under MJPJAY, a demand doctors say has remained pending since 2012.
“We have been performing bariatric surgeries for more than a decade, yet they are still not covered under the scheme. Even Madhya Pradesh included bariatric surgery under its state health insurance several years ago,” Dr Bakshi said.
Dr Ravindrakumar Shetye, Assistant Director (Health Services), State Health Assurance Society (SHAS), which implements MJPJAY, confirmed that JJ Hospital's proposal remains under consideration.
