The prevalence of robotic-assisted surgery (RAS) and patient demand for access is accelerating internationally and in Australia, with an array of soft-tissue and orthopaedic robotic platforms now available. Hospitals and health services are recognising that RAS programs are an enabler for improving clinical outcomes and patient experience, that in turn attract and retain surgeons and patients to their service. While the benefits for patients and surgeons of having access to RAS program are demonstrable, the financial risks are notable for hospitals and health services. These include a large initial investment, the complexity and operating cost of RAS programs and lags in government and health insurer funding models reflecting the profile of costs and benefits of RAS. Successful RAS programs overcome these financial risks through analysis, governance, and reporting clinical, financial and operating metrics to drive continuous improvement. RAS programs that are high volume can amortise the costs of initial investment effectively. In combination with effective governance and continuous improvement, RAS program operating costs can be reduced to achieve a cost per procedure that is equal to or less than the reimbursement provided by funding models. Measuring and reporting clinical, financial and operating metrics can achieve modifications to funding models over time, that align them to the cost profile of an RAS program. While the financial risks of establishing and operating an RAS program are significant for hospitals and health services, programs that are appropriately governed, high-volume, cost-efficient and report leading clinical, financial and operating outcomes will be financially sustainable.