Trial reportBMJ open2018
Effectiveness and cost-effectiveness of fining non-attendance at public hospitals: a randomised controlled trial from Danish outpatient clinics.
Trial report in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Behavioural economic interventions to reduce health care appointment non-attendance: a systematic review and meta-analysis.BMC health services research · 2023Pooled it
- Prevalence and Drivers of Missed Healthcare Appointments in Poland: Insights From a 2025 Survey.Medical science monitor : international medical journal of experimental and clinical research · 2026Article
- Non-Attendance in Hospital Appointments Based on Data From the Entire Region of Southern Denmark: Descriptive Analyses and Predictive Factors.Clinical epidemiology · 2025Article
- Temperature predicts attendance at appointments for pelvic-floor muscle related dysfunction differently in publicly and privately funded appointments.Gynecology and pelvic medicine · 2024Article
- Article
- Policy-makers' conception of patient non-attendance fees in specialist healthcare: a qualitative document analysis.BMJ open · 2023Article
- Mapping out the arguments for and against patient non-attendance fees in healthcare: an analysis of public consultation documents.Journal of medical ethics · 2023Article
- Causes of Patient Nonattendance at Medical Appointments: Protocol for a Mixed Methods Study.JMIR research protocols · 2023Article
- Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review.Journal of clinical medicine · 2023Review
- To charge or not to charge: reducing patient no-show.Israel journal of health policy research · 2023Article
- Effect of a Mobile Health App on Adherence to Physical Health Treatment: Retrospective Analysis.JMIR rehabilitation and assistive technologies · 2021Article
- Article
- Preserving equipoise and performing randomised trials for COVID-19 social distancing interventions.Epidemiology and psychiatric sciences · 2020Article
- Implementation of an ICU Recovery Clinic at a Tertiary Care Academic Center.Critical care explorations · 2019Article
- Clinic Nonattendance Is a Risk Factor for Poor Kidney Transplant Outcomes.Transplantation direct · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesFines have been proposed as means for reducing non-attendance in healthcare. The empirical evidence of the effect of fines is however limited. The objective of this study is to investigate the effectiveness and cost-effectiveness of fining non-attendance at outpatient clinics. DESIGN, PARTICIPANTS AND
setting1:1 randomised controlled trial of appointments for an outpatient clinic, posted to Danish addresses, between 1 May 2015 and 30 November 2015. Only first appointment for users was included. Healthcare professionals and investigators were masked.
interventionA fine of DKK250 (€34) was issued for non-attendance. Users were informed about the fine in case of non-attendance by the appointment letter, and were able to reschedule or cancel until the appointment. A central administration office administered the fine system.
main outcome measuresThe main outcome measures were non-attendance of non-cancelled appointments, fine policy administration costs, net of productivity consequences and probability of fining non-attendance being cost-effective over no fining for a range of hypothetical values of reduced non-attendance.
resultsAll of the 6746 appointments included were analysed. Of the 3333 appointments randomised to the fine policy, 130 (5%) of non-cancelled appointments were unattended, and of the 3413 appointments randomised to no-fine policy, 131 (5%) were unattended. The cost per appointment of non-attendance was estimated at DKK 56 (SE 5) in the fine group and DKK47 (SE 4) in the no-fine group, leading to a non-statistically significant difference of DKK10 (95% CI -9 to 22) per appointment attributable to the fine policy. The probability of cost-effectiveness remained around 50%, irrespective of increased values of reduced non-attendance or various alternative assumptions used for sensitivity analyses.
conclusionsAt a baseline level of around 5%, fining non-attendance does not seem to further reduce non-attendance. Future studies should focus on other means for reduction of non-attendance such as nudging or negative reinforcement. TRIAL REGISTRATION NUMBER: ISRCTN61925912.
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