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Abstract
Clinics have frequently adopted overbooking to deal with their prevalent patient no-show problem. However, the unique aspect of patient responses and its implications to the effectiveness of overbooking have been largely ignored. In particular, the implicit linkage, that the long waiting time caused by overbooking can negatively affect patients' future show-up decisions, causing higher no-show rate in the future, has not been considered. The contribution of this paper is to take this new perspective in studying overbooking, through a game theoretic model between the clinic and the patient population. Our results show that overbooking may or may not improve clinics' net profit, depending on the patient population characteristics. Based on our analysis, we propose a selective dynamic overbooking strategy, which can serve as an incentive mechanism to reduce patient no-shows and increase the clinic's profit at the same time. Discussions with practitioners confirm that the model results and insights are inspiring and useful.
Keywords
Clinic scheduling, overbooking, game theory
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1. Introduction
Currently, there are approximately 200,000 non-psychiatric outpatient clinics in the United States and nearly all of them have the patient no-shows problem. As one of the most serious operational issues, clinic no-show rates have often been significant in practice, ranging from 5% to 60% [10]. Customer no-shows are not unique in the healthcare industry. The most well-known example is the airline industry where passengers miss flights for various reasons.
Because of the successful stories in the airline industry, overbooking has been proposed and implemented in healthcare organizations to stabilize their revenue streams and improve healthcare access; see [4, 5]. On the other hand, clinic overbooking raises many concerns. The most significant concern is the prolonged patient waiting time. Since a physician operates as a single server system, overbooking typically leads to longer waiting time for not only the overbooked patients but also the patients afterwards. As noted by Dyer [2], long waiting time makes the patients believe that "the healthcare provider does not treat them with respect and they are disinclined to show any respect in return." For the patients, one way to counter the long waiting time is to arrive late. However, to deal with late arrivals, many clinics impose policies such as rescheduling patients' appointments...