The New Zealand Taxpayers’ Union recently released a report on figures from district health boards (DHBs) for the 2016-2017 year showing that missed specialist appointments cost taxpayers $29 million.

The report listed several solutions for DHBs to alleviate this issue including charging patients who miss their appointments.

Union spokesman Louis Houlbrooke said DHBs need to become more efficient to keep healthcare cost manageable with an aging population and tackling missed specialist appointments would be one way to meet that goal.

Some DHBs are worse than others with Counties Manakau, Waikato, Lakes District and Auckland missed specialist appointment rates above 10 percent as opposed to South Canterbury DHB’s rate of 2.5 per cent, he said.

Lakes DHB Clinical Support Services manager Roger Lysaght said Lakes DHB has tried a number of options to decrease missed appointments including implementing a text reminder system and employing a registered nurse to manage missed appointments for children under five.

Any missed specialist appointment is a problem as this means that a patient is missing out on secondary or tertiary level health care, he said.

“These same patients can often subsequently present at a later date when they are more acutely unwell.  So the cost to the health system for that initial missed specialist appointment needs to be considered in terms of both quality of life for that patient as well as cost to the health system.”

It would not support a charge for missed appointments because this probably would not encourage attendance or be appropriate, he said.

“Often those people in our community who don’t attend their specialist appointment come from some of our less advantaged communities.

“The concept of charging patients also implies that the reasons for patients not getting to their appointments are patient-related, when we know that there are some systems related causes that contribute towards missed appointments.

“One example of this would be the absence of consistent email communication with patients, although this issue is currently being worked on.”

South Canterbury DHB would also not support charging for missed appointments but does not see it as such a problem due to its high attendance rate.

Outpatients charge nurse manager Floss Dynes said there are a lot of clerical hours used to ensure all clinics have confirmed appointments.

“We work as a team, the consultant and the appointment coordinators to keep cancellations to a minimum.

“Specialist cancellations will usually only occur after all solutions have been exhausted.”

Ministry of Health DHB performance and support acting group manager Jessica Smaling said all DHBs need to manage issues around missed appointments.

“DHBs are working hard to see and treat as many patients as they can with the resources available, so missed appointments are a lost opportunity.

“While a missed appointment incurs cost, the ministry does not support charging people for missed appointments.

“We support a focus on equity and access – encouraging DHBs to understand why people miss appointments, and putting steps in to support higher attendance rates.”



  1. Missed appointments happen because we do not find out enough of what is happening in peoples lives .
    The problem is ours not patients and their whanau !!
    The system and health professionals need to measure, recognise and understand the burden of illness and the burden of treatment that so many people living with long-term conditions try to manage . Not attending appointments can be for so many reasons …. our people and their circumstances and poorly heard and poorly served . One of the biggest barriers is our specialisation which may ask them to attend many appointments on different days at huge cost … including parking!
    Time we took accountability here and redesigned for a person centred approach which recognises the burden and capacity people have to concord not only with our appointments but also our treatments and interventions, and addressed inequity of access and inequity of health outcomes . We know about the Inverse Care Law….. time for action please !
    Suggest every DHB recognise cumulative complexity , work towards Minimally Disruptive Medicine, and ensure sufficient numbers of capacity coaches …


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