Single-centre analysis finds hybrid operating room break-even, conditional capital recovery

A Korean tertiary hospital’s hybrid operating room generated enough attributed procedure-fee revenue to cover its operating costs at the observed level of use, according to an 18-month financial appraisal. The study found that monthly throughput reached 18.6 high-acuity index cases, above modelled cash break-even estimates of 10.3 to 15.3 cases. However, recovery of the approximately 3.0 billion Korean won capital outlay depended strongly on emergency surcharges and on how much revenue was genuinely additional to the hospital, rather than displaced from other departments or operating rooms.

The research was a single-centre, room-attributed break-even and revenue-coverage analysis conducted from November 2024 through April 2026. It evaluated 335 high-acuity index cases and 677 cases involving other room activity. From the hospital perspective, revenue was calculated using only National Health Insurance procedure fees; device purchases, pharmaceuticals, non-covered services and anaesthesia charges were excluded. Construction and salary costs were based on actual expenditure, the biplane imaging platform was assigned the institution’s approximate 3.0 billion won outlay, and a physician incentive was treated as a cost. The investigators used scenario, one-way and probabilistic sensitivity analyses with staged maintenance assumptions and followed the CHEERS 2022 reporting guidance.

At the observed activity level, the hybrid room produced 699.7 million won in insured procedure-fee revenue from the 335 high-acuity index cases. Including the 677 other cases, attributed room-level revenue averaged 51.1 million won per month and rose to 76.8 million won when reimbursed surcharges were included. These figures placed monthly throughput above the estimated cash break-even range. In operational terms, the room therefore appeared able to sustain its running costs, but the analysis was not a controlled comparison with conventional operating rooms and did not establish that every clinical or financial benefit of hybrid technology had been captured.

Capital recovery was less certain. Under the most favourable revenue-attribution scenario, in which all attributed revenue was treated as incremental to the hospital, the staged-maintenance capital cost was projected to be recovered in 5.6 years when surcharges were included. The corresponding probabilistic analysis produced a median recovery estimate of 6.3 years, with an 88% probability of recovery within 10 years. Using base procedure fees without the surcharges, the model did not recover the capital outlay within the equipment’s assumed 10-year service life. The result was therefore not simply a consequence of the room’s observed case volume; it also reflected the reimbursement structure and the assumptions used to assign revenue.

The sensitivity analyses showed how sharply the financial conclusion could change with the attribution assumption. When 75% of attributed revenue was considered incremental, the probabilistic median rose to 12.1 years and the probability of recovering the investment within 10 years fell to 35%. If only 50% of the revenue was incremental, the capital cost was not recovered within the 10-year service life in the model. These are modelled projections rather than observed capital paybacks, and the study had no comparator centre. Its revenue definition also excluded several potential income streams, while its use of one hospital, one reimbursement system and a limited observation period limits generalisation. Even so, the authors identified three comparatively robust outputs: the operating threshold, the incremental-revenue fraction required for financial viability, and the probability of recovery within 10 years. The findings suggest that a hybrid operating room can be financially self-sustaining at sufficient utilisation, but whether it is a sound capital investment depends on sustained case volume, actual surcharge reimbursement and whether its activity adds revenue rather than redistributing it within the hospital.

Subject of Research: Financial sustainability of a hybrid operating room under Korea’s National Health Insurance fee schedule

Article Title: Break-even and revenue-coverage analysis of a hybrid operating room under the Korean National Health Insurance fee schedule: a single-centre financial sustainability appraisal

Article References: Kim, M.-K., Suh, I.-Y., Park, J.-S., & Park, G.-S. (2026). Break-even and revenue-coverage analysis of a hybrid operating room under the Korean National Health Insurance fee schedule: a single-centre financial sustainability appraisal. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15594-9

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15594-9

Keywords: hybrid operating room, break-even analysis, health-care finance, Korean National Health Insurance, capital recovery, revenue attribution, sensitivity analysis, tertiary hospital, interventional radiology, financial sustainability, Break-even, revenue-coverage