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Faultlines in covering birth defects
The high cost of medical care of children born with anomalies are a huge burden on parents, especially since private players are reluctant to extend health insurance to such children
By
migrator
migrator
Chennai
As many as three per cent of children are born with congenital anomalies ranging from cleft lip palate to club foot, heart defects and neural tube defects. However, the absence of private insurance leaves several parents of children with birth defects in the lurch.
Though the Tamil Nadu government scheme supports a broad range of anomalies, the reach is still limited, observe experts, who urge insurance companies to come together to insure all mothers to meet the cost of treatment for the section that needs financial help.
M Raja is a distraught man; his son has been diagnosed with metabolic disorder and needs enzyme replacement therapy every month, costing over Rs 2.5 lakh. He has managed to collect funds for the last six years and with some assistance from an MNC, he has met the treatment costs. However, he doesn’t know how to budget for his son’s lifelong condition.
“I have another child. I don’t know how I will meet the piling expenses. Every month is a struggle,” he says. Like Raja, there are several parents who have children born with birth defects and in need of finances for treatment, but with private insurance companies not extending cover, they are left to fend for themselves, says Dr Sujatha Jagadeesh, Consultant Geneticist and Dysmorphologist, MediScan and the Fetal Care Research Foundation (FCRF).
Sujatha says both the treatment and testing costs take a toll on finances. She says, “Once a birth defect is diagnosed, we need to investigate it further. There is a series of tests to be done, making the whole process cumbersome and unaffordable for many.”
She points out that a chromosomal test during pregnancy costs anywhere between Rs 20,000 and Rs 25,000 and a further molecular test can cost around Rs 3,000 to Rs1.5 lakh. Add to this several hospital visits. “Such huge expenses burden parents. Even for upper middle-class families, the cost is a huge burden,” she says.
Defining birth defect
Moreover, insurance companies hesitate to cover birth defects due to the high costs incurred. J Jayanthi, deputy general manager, New India Assurance, says, “It takes a lot of time, effort and money. Most of these are hereditary or genetic.
However, we do have policies to cover external defects and there are group policies availed by many organisations. These are tailor-made and the defects covered come with a higher price.”
Similarly, there are policies that cover birth defects after a waiting period---- like the ones offered by Cigna TTK Health Insurance. Sandeep Patel, MD & CEO, says, “Congenital external anomalies/defects are excluded under the ProHealth Insurance plans.”
Sujatha says that the hesitation in covering birth defects is due to the lack of a clear definition of the conditions. She says, “Defining criteria and recruiting more mothers in the programme are workable solutions. In fact, FCRF even had a consultation with a group of insurance companies to work out a formula that will benefit those with birth defects.
We suggested that if they insure all healthy mothers, it will be a viable proposition if some of them have children with birth defects. But they had questions as to whether they must fund neonatal costs as well. The problem here is there is a lack of definition of birth defects—we are not referring to defects that stem out during the birthing process. Now, insurance companies don’t know what they are stepping into.”
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