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Hospitals in the Netherlands have
the
problem of 'no shows'. People make
an appointment with a specialist
and
then don't show up. Afterwards they
demand
another appointment at a later time.
This is costly because the
expensive specialist is just sitting
there waiting for the next
patient
(who shows up on time). It affects
about
20% of all appointments. It makes
waitinglists longer and wastes
taxpayers money.
An alternative unacceptable to
people
is to just make them show up for a
long timeslot and let them wait
for their turn. People refuse to
waste
time and wait that long or
something.
The proposed (costly) solutions now
are: SMS notifcations, reminders by
snailmail, telephone confirmations
etc.
If only the hospital would facilitate
patients to exchange appointments
among each other.
You would make an appointment to
see the specialist and from that
moment your file and everything is
ready. The appointment is weeks or
months in the future like now, but
when you go to the waiting room
you
just ask: 'anyone selling their
appointment?'
People with money and no patience
can then walk right from making
the
appointment to being treated by the
specialist on the same day. They
pay
for it.
People with time and patience sell
their appointment to the highest
bidder. They can even put it up for
sale on the wall of the waitingroom
or the hospital's website. They earn
while waiting.
The seller gets the appointment of
the buyer.
Coutesy Call
http://www.alphacomm.nl/courtesycall/
SMS reminder about hospital appointment [rrr, Oct 21 2004]
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Nope. This would just encourage people to make spurious appointments in the hope of selling their slot on. It would just make matters worse. |
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DrBob, you can only make an
appointment with a specialist for a
treatment if he
sees a medical need after an
examination. And before
you can make that first
appointment
with the specialist you need a
referral from your doctor first.
Enough validity checks. You might
see old/
poor people hanging around in the
waiting room, constantly trading
their appointments and neglecting
their own health. But then they will
end up at the ER. Before that
happens there will surely be a
chance that they can't sell their
appointment. |
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I work in a major medical facility in the US. We have patients cancel appointments often as well, but we handle it like this: patients are free to drop in and ask if there are any cancellations, and they are referred to as 'checkers' (because they are checking to see if there are openings). If there are, they are ushered in if the patient with the next time slot is not right there waiting (with time slots an hour apart, most times the patient is not there- not everyone wants to come in early and have to sit and wait that long). If there are no open slots right then, they may put their name on a list and sit and wait for a no-show (if they leave for coffee and a no-show occurs, they don't get the slot if they're not there waiting). No cost to the patient requesting the open slot, and the clinic doesn't lose $ on that appointment that was otherwise empty. I would not want to have to BUY an open slot, when I can go get one for free in our current system. |
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Mamamoose, your solution is
better. It also favours those with
time and patience. A combination
of both systems would be even
better. Those with no patience are
treated quickly (at a price) and
those with patience can even earn
money with selling their
appointment. In other words: rich
guy walks in and says 'I buy your
appointment' and doesn't wait a
bit. Anyone else can just hang
around as a 'checker' waiting for a
free slot to open before the fixed
appointment. The checker can
even sell such an opening if a
buyer walks in and does not want
to wait for an opening. |
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Make people pay for an appointment; if they show up (or cancel with more than 24 hours notice), the payment is refunded. (It's a problem in UK as well.) |
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Angel, that is only a stimulus but
will not result in 100% 'shows'. You
will also see aggressive people
harrassing the staff because they
were in a traffic jam or whatever
lame excuse they have for not
showing. With aggression against
the staff more employees will take
sickleaves which will make the
waitinglists longer. In a
combination of my and
Mamamoose' solution people will
have most free choice. People like
that, it makes them happy and
they are more likely to accept the
situation. Sitting there waiting and
thinking 'I am making money now'. |
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I don't think your plan will result in 100% shows either. In fact, I think it may result in a decrease in shows. There will now be professional scalpers that make as many appts. as they can during the day and sit around and wait for someone to pay them for a spot. If nobody pays for a spot, it goes unused. Of course now there are a bunch of appt. spots that are taken just for the purpose of selling, making those of us who show up for appts. have to make our appts. further in advance. |
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End result: if I want to see a doctor, I can either wait for months or go in today and pay the scalper a premium for an appointment. |
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I've heard too many horror stories concerning hospital staff mixing up people and procedures to ever be comfortable with this. I've even heard of hospitals misplacing people entirely. Give 'em all GPS transponders, I say. |
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Worldgineer, it is not possible to
make more than one appointment.
The specialist won't let you. You
can't make 'false' appointments
because you personally have a
medical need to get the
appointment. Unless you damage
your own health first to get an
appointment or you fake the
symptoms to fool the specialist
(difficult).
And why go through all that
trouble for the 50 euros max (my
guess),
someone *might* be prepared to
pay
you? After all, there is no
guarantee that you can sell you
appointment, in most cases you'll
just have to use it for yourself. I
don't expect people to
use this to make money, but as a
nice bonus that may happen to
them while they are waiting.
Already *the chance* that
someone
might walk in and start bidding for
their appointment will make them
feel better while waiting. They
might even want to show up an
hour in advance for it, which
decreases the number of no-
shows! We are talking about the
Dutch here, remember that. The
tiniest incentive to get a little
money can move the masses.
Loyaltycards, supermarketstamps
etc are very popular here,
more than anywere else, nearly the
national religion. If already
supermarket offers with only a few
cents to win can make the Dutch
bike 3 blocks extra to go to
another supermarket, then surely
this *chance* to 'win' an extra 10
or 30 euros in the hospital
waitingroom will make their hearts
beat faster! |
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RayfordSteele, the appointment is
in not connected with the case and
treatment of the patient. As
Mamamoose wrote, it is already
common practise to take other
people's appointments. When you
finally get to see the specialist,
you have to identify yourself and
he looks up your files. If sending
SMS-reminders is already too
expensive, then GPS surely is. And
what's the purpose of knowing
where the missing patient exactly
is? He is not in the waitingroom,
that is what matters. |
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Reensure, there is no financial gain
there, no matter how much
information you give them.
Reminders are only effictive
because it appeals to the
consience of people. |
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There are no-shows because
people decide they have
something better to do and it
costs them nothing to get another
appointment. That's the basis of
this accessible health care system. |
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The irony is that the same people
that cause the no-shows are also
angry that *other* people don't
show up, because it wastes their
taxpayers money. They personally
want the privilege to not show up,
but they want everyone else to
behave normally and not waste
taxpayers money. Therefore only a
design with rewards instead of
punishments will work. |
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I am just thinking of a torturous
situation for the average
Dutchman in the waiting room in
such a system. |
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He can sell the 15:00 o'clock
appointment he made 3 months
ago, so he shows up at 9:00 with
his own sandwiches, coffee,
paperwork
etc. to spend the day in the
waitingroom. Waiting for someone
to walk in and buy his valuable
15:00 appointment. Then
suddenly there is a no-show for
the 13:00 appointment. He is
allowed to
take it because everyone (also the
'checkers' with no appointment for
that day) arrived after him. But
then he would loose the chance
that he
could sell his appointment if a
last moment buyer would walk in
between 13 and 15... Should h
give the no-show
appointment to the next checker
in line or take it and then go
home? He already took the whole
day off from work because it's for
a hospital visit, so he sits there in
'free' time (you are allowed to skip
work an x-number of hours per
month for it). What to do? |
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who will buy my fishbone? |
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who will buy my fishbone? |
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