Missed hospital appointments cost Dutch healthcare up to €120 million in a year
Hospitals across the Netherlands recorded at least 800,000 missed patient appointments last year, causing estimated losses ranging from 40 to 120 million euros, according to research by EenVandaag among Dutch hospitals.
All hospitals surveyed reported serious disruptions when patients fail to attend, arrive late or cancel too late. These missed appointments—commonly called “no-shows”—affect both in-person and telephone consultations.
Hospitals attribute no-shows to various reasons. While some patients have valid personal circumstances, far more cases stem from forgotten appointments, language barriers, poor computer skills or claims of never having received an appointment notice.
Hospitals estimated that each missed appointment costs between 50 and 150 euros, depending on the specialty and procedures planned. The UMCG alone calculated the yearly damage at 3.5 to 5 million euros.
Child health, ophthalmology and dermatology departments were most affected. At the Franciscus Hospital in Rotterdam and Schiedam, pediatrician Paul de Laat said that on the children’s outpatient clinic, up to one in seven patients fails to appear. “One day that might be one patient, another day it’s three,” he told EenVandaag. “Sometimes you end up with a very quiet day simply because people don’t show up.”
The University Medical Center Groningen (UMCG) reported that its ophthalmology department sees about 250 to 300 patients daily, but still misses nine to ten appointments each day. “That may sound like a small number, but every missed appointment is one too many,” department manager Jasper van Rooijen told EenVandaag. “Especially now that waiting lists are increasing and the pressure on staff keeps growing.”
“Every missed appointment means extra administrative work, time loss for care providers and no reimbursement for the hospital,” Van Rooijen added.
To tackle the problem, hospitals use multiple methods, including emails, text messages and letters to remind patients. Increasingly, they also rely on artificial intelligence.
“The AI model we use predicts which patients are most likely not to show up,” De Laat explained. “We then call those patients proactively. Calling everyone is impossible—we handle about 700,000 appointments per year.”
Four hospitals already send invoices to patients who miss appointments without a valid excuse. These “no-show fees” range from 35 to 50 euros. Three more hospitals plan to introduce the practice.
Other hospitals choose not to charge fees because the administrative burden exceeds the losses from no-shows. Some hospitals, including UMCG, send patients back to their general practitioner to obtain a new referral after repeated no-shows.
Ad Melkert, chairman of the Dutch Hospital Association (Nederlandse Vereniging van Ziekenhuizen NVZ), which represents all hospitals except academic centers, said reducing no-shows is critical. “Preventing no-shows is important for all of us. Pressure in healthcare is high,” Melkert said. “We want to prevent scarce capacity from going unused. To avoid wasting healthcare time and resources, it’s important to keep no-show rates as low as possible.”
According to Melkert, the NVZ supports charging fees if needed. “These fees are used only to prevent excessive no-show numbers and to raise awareness among patients,” he told EenVandaag. “Regardless of how hospitals implement measures, the NVZ strongly supports an active policy. That contributes to better use of available capacity and ultimately helps maintain good, accessible and affordable care in the Netherlands.”
