Are Patients Patient? The Role of Time to Appointment in Patient Flow

T he current state of outpatient healthcare delivery is characterized by capacity shortages and long waits for appointments, yet a substantial fraction of valuable doctors’ capacity is wasted due to no-shows. In this study, we examine the effect of wait to appointment on patient flow, specifically on a patient’s decision to schedule an appointment and to subsequently arrive to it. These two decisions may be dependent, as appointments are more likely to be scheduled by patients who are more patient and are thereby more likely to show up. To estimate the effect of wait on these two decisions, we introduce the willingness to wait (WTW), an unobservable variable that affects both bookings and arrivals for appointments. Using data from a large healthcare system, we estimate WTW with a state-of-the-art non-parametric method. The WTW, in turn, allows us to estimate the effect of wait on no-shows. We observe that the effect of increased wait on the likelihood of no-shows is disproportionately greater among patients with low WTW. Thus, although reducing the wait to an appointment will enable a provider to capture more patient bookings, the effects of wait time on capacity utilization can be non-monotone. Our counterfactual analysis suggests that increasing wait times can sometimes be beneficial for reducing no-shows.