Panel Size and Overbooking Decisions for Appointment-based Services under Patient No-shows

Many service systems that work with appointments, particularly those in healthcare, suffer from high no-show rates. While there are many reasons why patients become no-shows, empirical studies found that the probability of a patient being a no-show typically increases with the patient’s appointment delay, i.e., the time between the call for the appointment and the appointment date. This paper investigates how demand and capacity control decisions should be made while taking this relationship into account. We use stylized single server queueing models to model the appointments scheduled for a provider, and consider two different problems. In the first problem, the service capacity is fixed and the decision variable is the panel size; in the second problem, both the panel size and the service capacity (i.e., overbooking level) are decision variables. The objective in both cases is to maximize some net reward function, which reduces to system throughput for the first problem. We give partial or complete characterizations for the optimal decisions, and use these characterizations to provide insights into how optimal decisions depend on patient’s no-show behavior in regards to their appointment delay. These insights especially provide guidance to service providers who are already engaged in or considering interventions such as sending reminders in order to decrease no-show probabilities. We find that in addition to the magnitudes of patient showup probabilities, patients’ sensitivity to incremental delays is an important determinant of how demand and capacity decisions should be adjusted in response to anticipated changes in patients’ no-show behavior.