Online Reporter
A major challenge at road accidents resulting in serious injury is who is going to pay for the required ambulance and emergency hospital care, with those at the scene and summoned police officers asking about medical aid cards or guarantees of payment.
State hospitals are usually the destination for most of the injured and to give them their due, they almost always provide the emergency care while still trying to sort out the question of payment.
Many Zimbabweans are not covered by medical aid, even a basic scheme that gives unimpeded access to public hospitals and often the costs of emergency and follow-up care exceed limits.
But often the badly injured have to be ferried to hospital in private vehicles without paramedics in attendance, increasing risks, since the available public ambulances are dealing with other patients or are too far away.
Once at a facility, the national air evacuation service is available and can move patients to a referral hospital, but initial move from a vehicle wreck is still a weak link.
By law, private hospitals are obliged to take in emergency patients if they are the closest hospital or if there is some other good reason, but again payment issues arise and few will want to have that debt hanging over them for a long time to come.
For major accidents, usually when entire families are involved, or a single community such as a village or a church or a school, the Government steps in with the ad hoc declaration of an emergency, meaning that if all else fails, the Government will pick up the tab for the emergency care or basic funeral costs.
But while this mitigates the problem in some cases, it cannot be applied to all accidents and in any case is an emergency measure, rather than a routine matter, that needs clearance for each declaration and financial commitment.
So now the Government wants to build up a fund and establish a system that covers this emergency ambulance evacuation, emergency medical costs at State hospitals and funeral expenses regardless of whether those involved are rich or poor, have or have not medical aid, or any other financial question.
They will simply be treated promptly with those involved knowing that the fund will pick up the bill once the paperwork has been done.
The Cabinet approved the principles of the Road Accident Fund Bill last week, allowing the Attorney General to start the detailed legal drafting to fulfil those principles before the Bill is submitted to Parliament for debate and any improvement and then sent to the President to be turned into law.
The fund will be financed from a 20 percent levy of the compulsory third party insurance premiums all vehicle owners have to pay, with the Treasury doing any necessary top-up through the national Budget.
With a good chunk of the insured risk moving from the third party policies to the Road Accident Fund the levy on premiums should largely be paid for by reduced payouts on the policies.
But if increases are needed and approved, any increase in premiums should be very small and in return will give far better coverage and less risk for vehicle owners.
The third party insurance payouts are limited to third parties, not the person causing the accident, and in any case require blame to be assigned.
There are also limits on how much can be paid out for each accident while there is no limit on what can be recovered from the blameworthy driver for any excesses.
We hope the Bill, while maintaining the absolute access to emergency treatment, will have provisions for recovery of at least some costs from medical aid societies, funeral insurance schemes and the more advanced comprehensive insurance policies where this is practical.
Absolute guarantees still need high-grade administration and tight accounting, and as is usual with financial Bills, there will no doubt be a block of pages devoted to ensuring both for the new fund.
Having the initial emergency finances sorted out automatically should also improve efficiency, everyone from the ambulance driver and the paramedics to the State hospital system knowing that they can do their medical jobs without having to worry about eventual payment.
Those involved in dealing with road accidents often bring up the fact that care given in the first hour is usually the most critical when it comes to saving lives or minimising subsequent restorative medical care.
The new system means that no one will hesitate to call out the emergency services or to respond to an emergency. And that prompt call out saves lives, the most important consideration.
This is where some extra costs might start appearing, people who before took a lot of risk by not seeking medical care because they were petrified about the costs now being willing to go to hospital for the check over, and those hidden complaints suddenly being diagnosed, early and when largely curable.
We see this when we recognise that those on medical aid are more likely to seek attention for other complaints than those required to pay from their own pocket.
But these sort of things can be taken care of in a well drafted Bill, so adjustments can be made in light of experience.
Even a Government contribution can be offset against the sort of emergency ad hoc decisions now made in major accidents and which will no longer be necessary.
These are just details. The important point is that once the Bill is law and the fund set up, Zimbabweans will have guaranteed access to appropriate medical care from the scene of the accident onwards, regardless of their financial position or ability to pay or even their degree of blameworthiness. This will save lives.
