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 Table of Contents  
Year : 2015  |  Volume : 59  |  Issue : 1  |  Page : 67  

Importance of mediclaim policies covering congenital anomalies in India

1 Department of Community Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
2 Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
3 Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
4 Department of Neonatology, Manipal Hospital, Bangalore, Karnataka, India

Date of Web Publication9-Mar-2015

Correspondence Address:
Shasanka Shekhar Panda
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-557X.152877

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How to cite this article:
Panda M, Panda SS, Das RR, Mohanty PK. Importance of mediclaim policies covering congenital anomalies in India. Indian J Public Health 2015;59:67

How to cite this URL:
Panda M, Panda SS, Das RR, Mohanty PK. Importance of mediclaim policies covering congenital anomalies in India. Indian J Public Health [serial online] 2015 [cited 2023 Mar 20];59:67. Available from:


Pediatric diseases are a heavy burden on the economy of developing countries such as India. The survival of newborns depends not only on the quality of care provided but also on the financial status of the parents. An unfortunate fact concerning pediatric surgical cases is that children suffering from congenital anomalies are not covered by existing Mediclaim policies. Most of the population belong to the low socioeconomic group. Lack of knowledge about the causes of congenital malformation and inadequate screening can be attributed to this. These cases then become difficult to manage, as they require multiple surgeries and multiple hospital admissions.

The Government should be appreciated for including neonates in the Janani Shishu Suraksha Karyakram (JSSK) scheme launched on June 1, 2011, and allowing provisions of free treatment for neonates. This scheme makes arrangements to supply the various equipment and other resources required to manage sick newborns till 30 days after birth, which would have been otherwise difficult. Entitlements under this scheme are: Free and zero-expense treatment; free drugs and consumables; free diagnostics; free provision of blood; free transport from home to health institution; free transport between health institutions, in case of referrals, and drop back home; exemption from all kinds of user charges. [1] However, this scheme does not provide support for newborns with congenital anomalies after 30 days of birth. Therefore, schemes like these need appreciation and extension.

None of the Mediclaim policies in existence cover congenital anomalies. The insurance companies must be motivated to include these diseases in their schemes so that these cases can be managed well. In my opinion, if properly administered, a "limited" managed care product with appropriate precautions and premium levels will be successful and profitable, and can compete with the indemnity products presently available in India.

   References Top

Guidelines for Janani-Shishu Suraksha Karyakram - National Rural Health Mission. Maternal Health Division, Ministry of Health and Family Welfare, Government of India, Nirman Bhavan, New Delhi, 2011. Available from: [Last accessed on 2015 Jan 05].  Back to cited text no. 1


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