Every winter, India finds itself debating reasons behind mounting AQI. This one now repeats with such precision each year it can be forecast almost like the monsoon. Data from hospitals and health insurers tells a grimmer story. It is becoming a health emergency for children.
An analysis of pollution-related claims indicate children under 10 account for 43% of all hospitalisations, disproportionately making them the single-largest demographic group most vulnerable to toxic air. Children breathe more air relative to body weight, and hence are likely to absorb more pollutants and PM 2.5 particles.
Each bout contributes to long-term health consequences and recurring health burden for families.
While Delhi continues to record the highest share of claims at 38%, the pattern is not just confined to the northern belt. Bengaluru and Hyderabad now exceed many northern cities in the ratio of pollution-related claims against all health claims. Tier-2 towns such as Indore, Jaipur and Lucknow are also reporting a faster rise in hospital visits around this time.
What is perhaps most concerning is pollution is now affecting organs far beyond the lungs. We see claims emerging from cardiac complications, arrhythmias, hypertension episodes, skin flare-ups, allergic conjunctivitis, and even pregnancy-related issues. This echoes findings from The Lancet Commission and ICMR, which confirm particulate pollution triggers inflammation across multiple systems.
With seasonal and environmental risks becoming more common, insurers would need to rethink how to incorporate these risks into underwriting, coverage design and pricing.
This is crucial because it is not just the spike in hospitalisation claims, but also the steady rise in the cost of treatment. As per our report, treatment costs for respiratory illnesses rose by 11% between FY23 and FY24. Meanwhile, treatment costs of cardiac complications grew by 6%. The trends reflect longer hospital stays and more intensive intervention. With average claims near ₹55,000 and daily hospital costs approaching ₹19,000, the burden on families, especially those without insurance, continues to deepen. This makes affordable, well-structured health coverage more important than ever.
What lies ahead
To be fair, the health insurance industry has begun moving in the right direction. OPD-inclusive health plans are seeing accelerated adoption as families now recognise pollution-related illnesses require frequent consultations, diagnostics and doctor advice. Some insurers have begun building real-time, location-sensitive risk models that help anticipate seasonal spikes and prepare networks accordingly. Digital platforms are playing their part too by making these plans easily accessible for the customer.
But the harder work still lies ahead. As pollution becomes a recurring national health burden, the industry must take a more proactive approach. That means dedicated pollution-linked health plans, annual lung screenings, proactive respiratory check-ups for children and structured disease-management programmes for asthma and COPD patients.
It means partnering with the healthcare sector. It also means expanding the definition of coverage. If pollution-triggered illnesses are now unavoidable for urban families, then the products that protects them must evolve just as predictably.
Ultimately, pollution will not be solved by health insurance/healthcare alone. The industry must shift from reacting to hospitalisations to reducing them. Data makes it clear the pollution crisis is turning into a generational health challenge and unless we actively work upon it, we risk normalising harm that will impact generations to come.
(The writer is Joint Group CEO, PB Fintech)
Published – December 22, 2025 06:27 am IST
