A.
Background Note on Problems of Road Safety(2):
1. Road Safety is an area
demanding increasing importance. There are large number of instances of
reported road accidents due to ever-increasing number of vehicles and
increasing cases of road rage. For last three years the number of accidents
reported are about 5 lacs resulting into fatalities of more than 1.3 lacs every
year[3].
Accidents carry high economic and social costs, which are not easy to
ascertain. Generally the cost of road related injuries and accidents are
assessed in terms of (a) medical costs (b) other costs related to
administrative, legal and police expenditure (c) collateral damage in terms of
damage to property and motor vehicle and (d) loss due to income foregone
arising out of absence from work or impairment/disability or untimely death.
Due to lack of sound social safety net, accident survivors often live poor
quality of life and have to live with pain and suffering which are difficult to
estimate. In developing countries like India, where there is very little asset
ownership and lack of social support to families with impaired bread earner, accidents adversely impact the welfare of accident victims and their dependents.2. Paradoxically, higher speed vehicles and better quality roads had their own contribution in increasing the number of serious accidents. However, with better design of vehicles there is a decline in fatalities vis-à-vis increase in number of vehicles. Length of motorable road has increased significantly during last 40 years and accidents reported on every 10,000 kms of road have also doubled. Another worrying factor is the number of accident victims getting injured in the accidents. During the same period, number of injured has gone up from 13 to 45.7 per one lac of population.
3. There are several causes of large number of accidents and fatalities. Road design and upkeep is one technical reason about which the engineering departments are already aware and initiate action as per the availability of the funds. However, the mechanism to take care of road victims has not got the adequate attention. Often accident victims go unattended because people are scared to help the victims lest they should get involved in police case. These accident victims do not get timely medical attention for lack of suitable transportation, inadequate medical facilities in local hospitals and reluctance of the hospitals to admit them for want of upfront fee payment. There is a need for overcoming all these bottlenecks and integrating all these elements into a viable system that can provide a sustainable solution to this hitherto largely unattended problem.
4. Road accident victims are not covered under any immediate relief program/scheme of the government. Every case is dealt in isolation and support extended by government to victims also varies from case to case. In most of the cases, support reaches the victim only after the critical first 24 hrs of medical attention is already over. Saving life in an unfortunate happening of road accident by ensuring treatment in a state of the art hospital has financial implications. Therefore providing network of 108 response number, duly supported with linkages to hospitals mandated to admit and treat the victims without bothering about payments to be received from the victim to state of the art hospital is the need of the hour.
5. Even while some projects in the county have made considerable headway in initiating the ex-ante measures such as road accident reporting, data analysis and engineering interventions, these measures have not been incorporated as a standard business procedure across the state. Furthermore, in the unfortunate occurrence of a road accident, ex-post measures like timely rescue and treatment of accident victims in an appropriate hospital equipped for handling such accidents are not methodically integrated with a comprehensive road safety strategy.
6. One possible ex-post measure that could be attempted is to create a Fund for treatment of road accident victims. The revenue streams for the medical treatment in this Fund would primarily comprise of inflows from Motor Accident Compensation Tribunal (MACT) claims, which are paid to the victim by the insurance company. There would still be a gap between the Funds required for medical treatment and the claims given by the insurance company. This viability gap has to be funded by the Government. It can do so by making budgetary provisions in the annual budget. Alternatively, a cess can be levied on petrol/diesel analogous to the cess for road maintenance. The proceeds from this cess can straight away flow into this Fund. A major bottleneck here is that there is a mismatch in the timing of the Fund flow streams. While the medical expenses have to be paid upfront, there is a considerable delay in settlement of accident claims by the tribunals. This Fund could pay upfront for accident victims’ treatment in an appropriate hospital equipped for treating such cases, with recoupment to the Fund from the MACT award at a subsequent date.
B. Suggestions: In order to handle the issue of road safety after the accident has happened, following issues need to be dealt in detail:
1. Communication System: A mechanism to facilitate communication with victims of road accidents needs to be developed. One method could be to develop linkages with mobile operators to extend the emergency contact facility to control rooms of petrol vehicles and ambulance in the region. A system may be developed whereby the victim presses the emergency contact button and the message may get flashed to the nearest control room of traffic management setup. From there, based on the location of the victim (which may be identified through the location of the mobile) ambulance may be deployed by road safety setup, if the call is related to road accident. Once the ambulance moves to accident site message may be electronically flashed to nearby hospitals about the possible accident victims approaching the hospital. This information will provide ample time to the hospital to take advance action to treat the accident victim. Ambulance, after picking up the victim may report to the control room or road safety setup, which may then log the accident status with police authorities and road safety Fund. Thus, through electronic methods, inter-linkages may be developed and advantages of technology may be derived to provide treatment to accident victims. In order to facilitate this inter-linkage, mobile/telephone operators need to be taken on board and connectivity be mapped with road safety setup.
2. Hospital System: There is a need to “lay down guidelines for establishing and upgrading trauma care systems at all levels including district hospitals and tertiary care medical college hospitals and creating a grid of medical, allied medical and rehabilitation facilities to provide first aid, care during transportation, emergency care in the hospital and rehabilitation.”[4] The hospitals providing medical treatment for accident victims should be empanelled based on the facilities that they possess. There should be comprehensive and transparent criteria for empanelment of these hospitals specifying thresholds in terms of bed capacity, medical/surgical facilities, medical/paramedical staff strength, diagnostics and radiological capacities. These hospitals should agree to cost of packages for each identified medical/surgical intervention/procedure as approved under the scheme. An MOU may be signed with the empanelled hospitals to treat the road victims through cashless settlement mechanism. The Fund may utilize the services of Third Party Administrators (TPAs) which may be traditional TPA or any other institution assigned the task of managing claims on behalf of road safety set up for claims processing.
3. Claim Settlement System: Once the accident victim is admitted in the hospital, the hospital would provide cashless treatment to him. The details of the beneficiary and the treatment given to him would be recorded in the hospital database. The hospital periodically would upload transaction details to TPA server. Claims would be processed in TPAs office and statement would be prepared and sent to the Fund periodically. Based on this statement, the Fund would make payment to TPA. The TPA would settle the claim of the empanelled hospital. If treatment is not within the pre-defined packages, pre-authorization is obtained from the TPA by the hospital before proceeding with the treatment.
4. Mechanism for audit of claims: There should be an elaborate system of auditing medical claims raised by the hospitals. The basic purpose of the claims audit is to investigate potential mis-billings, frauds and analysis. The idea is to (i) verify that the services charged have actually been rendered, (ii) see the pattern and nature of accidental injuries and claims and (iii) analyse and then assess the expenditure as per demographic profile of the victims. This would mean that there is a comprehensive system of records/documentation which is regularly cross-checked by independent auditors and advises are received for further improvement in the system. It should also ensure that pre-authorization has already been taken in case services beyond the approved packages have been rendered.
5. Mechanism for insurance claim cases: Individuals in many cases may not be very keen on pursuing the case as the treatment has been provided by the Fund. Hence, it is imperative for the fund management to take up the insurance claim cases and follow them up till the award is delivered and Fund is recouped. For this purpose, the Fund management could utilize the services of reputed law firms on commission basis.
6. Fund flow assessment: The Fund would receive periodic returns from TPAs regarding hospital claims. It will also receive regular returns regarding insurance reimbursements. Based on these, there would be continuous assessment of Fund flow. The projections of deficit in the Fund so arrived at, would form the basis for raising demand with the State/ Centre for recoupment of the Fund.
7. Administrative arrangements: An SPV needs to be constituted for operating the fund and for carrying out the functions of coordination with various stakeholders like hospitals, TPAs, auditors, legal firms and Government bodies. There will be a Fund Manager who will be responsible for the fund management, which will include deployment of surplus funds, cash flow management, fund projections and advising on mechanism of raising funds.
8. Legal and Policy matters: In order to make this system operational there may be a requirement to carry out amendments in Motor Vehicle Act, Laws and Rules related to Insurance of motor vehicles and road accident victims. Changes required in the legal and policy matters affecting the above mechanism have to be suggested.
[1] Article by Mr.Ajay S Singh,
ICAS. Mr.Singh is currently working as Director in Department of Economic
Affairs, Ministry of Finance, Government of India.
[2] This article only focuses on
key issues and recommends some approaches of sorting them out.
[3] Ministry of Road Transport
annual report on road safety- http://morth.nic.in/showfile.asp?lid=1058
[4] Report of the Committee on
Road Safety and Management, Ministry of Road Transport & Highways, Govt. of
India - http://morth.nic.in/writereaddata/linkimages/SL_Road_Safety_sundar_report4006852610.pdf
