The impact of overbooking on primary care patient no-show

Abstract

Overbooking has been widely adopted to deal with primary care’s prevalent patient no-show problem. However, there has been very limited research that analyzes the impact of overbooking on the major causes/factors of patient no-show and most importantly, its implications on patient no-show. In this paper, we take a novel approach and develop a game-theoretic framework (with queueing models) to explore the impact of overbooking on patient no-show through its effect on two important factors shown to affect no-show: appointment delay (time between a patient requesting an appointment and his actual appointment time) and office delay (the amount of time a patient waits in the office to see the doctor). While overbooking reduces appointment delay (which may positively affect patient no-show rate), it increases office delay (which may negatively affect patient no-show rate). Our results show that, considering both impacts of appointment delay and office delay, patient no-show rate always increases after overbooking. Further, there exists a critical range of patient panel size within which overbooking may also lead to lower expected profit for the clinic. Correspondingly, we propose two easy-to-implement strategies, which can increase clinic’s expected profit and reduce no-show at the same time.