Article Text

Download PDFPDF

185:poster The ideas behind charging for non-attendance in healthcare: an analysis of key policy documents in Denmark and Norway
  1. Joar Røkke Fystro,
  2. Eli Feiring
  1. Department of Health Management and Health Economics, University of Oslo


Objective Patients who miss their appointments without giving notice burden healthcare systems. Longer waiting lists and unused resources, which could have benefited other patients, are the ramifications. To amend this problem of non-attendance, a charge—sometimes called a fee or fine—has been considered and in some places implemented. While Denmark declines, so far, charging for non-attendance, in public hospitals, Norway charges patients. Moreover, the charge in Norway has increased the latter years, amounting to three times the user fee for outpatient services. We desired to investigate the underlying ideas of such charging. There are different conceivable justifications for charging for non-attendance and these justifications are treated differently, in as much as the two countries have reached different conclusions.

Methods We conducted a qualitative document analysis. A conceptual framework was constructed and key policy documents from the two countries were deductively analysed. The framework consisted of ideal type justifications for utilising non-attendance charges: from being an inducement, that the charge should compensate losses incurred, to being a punishment.

Results There is considerable attention towards the problem of non-attendance in both Denmark and Norway, because non-attendance negatively affects efficient healthcare delivery. Nonetheless, we found conflicting ideas behind using a non-attendance charge between the countries and, interestingly, within the policy documents themselves. While the charge is above all understood in a purely utilitarian sense in the Norwegian documents, there are more considerations about charging as a retributive stance in the Danish documents.

Discussion Use of non-attendance charges challenges the role of law and formal sanctions in healthcare, as well as—some critics allege—threaten universal access to healthcare. There is an important distinction, with ethical implications, whether a charge is an incentive, utilised to motive patients to attend, or whether the charge intends to punish patients for non-attendance.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: .

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.