Medical insurance companies should cover congenital heart defects to ditch parents’ sense of sinking

On World Heart Day, I bring you the best wishes of all my colleagues involved in cardiac care for children. We should all be committed to giving ourselves and our children a healthy life. I say this because it is now clear that over 90% of our health is in our hands.

Today, unfortunately, India is the diabetes capital of the world. We need to correct this ignominious label and we can do it quite easily. Indeed, this disease called type 2 diabetes is, in the vast majority, a self-inflicted disease and linked only to our diet. This condition of diabetes and pre-diabetes is at the root of most of the cardiovascular health problems that exist among us today. So we need to inculcate good food practices in ourselves and in our children.

Unlike when I was growing up, it is now clear that excessive consumption of sugar (both the sweet and the hidden form) is the root of the onset of diabetes. The old paradigm from the 1970s that fat is the cause of atherosclerosis and obesity is now thrown out the window.

The mantra today is to avoid having sugar and processed carbs which cause high levels of insulin, which as we know is a storage hormone. Persistently high levels of insulin cause our arteries to stiffen and this is why we all fall prey to the dreaded trio of diabetes, cardiovascular risk and kidney disease. Above all, the overconsumption of fructose, an integral part of the sugar molecule and omnipresent in fruits, which has gone unnoticed because it has a zero glycemic index, is now identified as a major culprit. Excess fructose (like alcohol) should be avoided as it leads to fatty liver disease and all its undesirable consequences. The other thing to avoid are vegetable seed oils, which are said to be pro-inflammatory, as inflammation is now known to be another factor causing cardiovascular disease.

Today, a healthy diet of saturated fat, protein, and fiber-rich carbohydrates is recommended. Healthy kids look cute but really aren’t healthy. On the contrary, we must make our children slim and active.

The bulk of our work in the Pediatric Cardiac Society of India (PCSI) is caring for children born with structural abnormalities of the heart or congenital heart diseases. I wish our patients, who were born with congenital heart defects (CD), a healthy and fulfilling life.

The treatment of coronary artery disease, both medical, interventional and surgical, has now achieved a high level of success in improving the quality of life of patients. The government opened several hospitals such as AIIMS and set up programs for the benefit of families of low socio-economic status. Eligible people must take advantage of it so that their children can benefit from the knowledge and technology. But there is a downside. While the lower socioeconomic strata are covered by government plans and the wealthy can afford even more expensive treatment, the tax-paying middle class still has nowhere to go. Public hospitals are overcrowded and have long waiting lists. Private hospitals are expensive and go beyond out-of-pocket payment for most.

There must be medical insurance to cover this class of society, but there is no private insurance today that covers birth defects. This is in direct violation of the Insurance Regulatory and Development Authority (IRDA) recommendation of 2019, in which it states that no internal or external birth defects can be ruled out. And yet this situation persists. The reason for this is that most parents apply for insurance coverage only after a birth defect is detected. Now that would be a 100% loss for the insurance company. Hence, the reluctance to cover congenital conditions.

We, at PCSI, have proposed a way out: insurance must be taken out during the first three months of pregnancy. At present, it is too early to determine the presence of coronary artery disease (fetal echo can detect heart defects only after 18 weeks). Therefore, insurance companies would not consider it a pre-existing condition.

The mother, her prenatal care, future prenatal checks, childbirth and the child for a predetermined period of her life – all would be covered.

With an incidence of only 1 live birth in 100, coverage of coronary heart disease by insurance cannot be a loss for insurance companies. It would provide the middle class with prenatal echocardiography which will go a long way in preventing the birth of poor prognosis conditions and high level coverage in private hospitals for those carried to term. Private hospitals would also benefit from a better ability to pay domestic patients, as they too constitute an important arm of health care in our country. The introduction of such insurance would therefore be a win-win situation for all and I urge insurance companies to introduce this product and to advertise it widely. If travel insurance can work and become compulsory, even when accidents are so rare, why not this one?

Hopefully we will see a new dawn for young parents who can then stop running from pillar to pillar after the surprise diagnosis of a life-threatening birth defect in their newborn baby.

I call on society, government and insurance companies to consider this proposal carefully.

Dr. Rajesh Sharma is President of Pediatric Cardiac Society of India and Senior Consultant, Cardiac Surgeon at Apollo Indraprastha Hospital, New Delhi. The opinions expressed in this article are those of the author and do not represent the position of this publication.

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