When Waiting to See a Doctor is Less Irritating: Understanding Patient Preferences and Choice Behavior in Appointment Scheduling

How do patients choose care in the healthcare market, a service sector that spends almost 18% of the GDP in the United States every year?  Knowledge of patient preferences and choice behavior in care seeking—i.e., what patients want—is essential for managing modern healthcare enterprises as the healthcare sector becomes more patient-centered.

There is a myriad of factors that impact patients’ decisions.  Previous research has identified that behavioral factors, such as physician competency and bedside manner, are important when patients make their choices.  However, more “tangible” factors that are particularly important to healthcare management, such as delay to care, have thus far received limited attention in the literature.

In the paper “When Waiting to See a Doctor Is Less Irritating: Understanding Patient Preferences and Choice Behavior in Appointment Scheduling”, Nan Liu, Stacey R. Finkelstein, Margaret E. Kruk and David Rosenthal focus on the primary care setting and study patient preferences and choice behavior in outpatient appointment scheduling.  They conduct four discrete choice experiments on two distinct populations and identify several tangible factors, called “operational” attributes, which affect patient choices.  These factors are called operational attributes because they can be directly or indirectly influenced by operations management strategies used in a practice, e.g., forming provider teams.

All four experiments consistently establish that patients have strong preferences in the following operational attributes when scheduling appointments: (1) appointment delay (i.e., lead time to appointment), (2) flexibility of appointment times, (3) doctor of choice, (4) in-clinic waiting, and (5) out-of-pocket payments.  Among these, appointment delay and doctor of choice are the two most important factors.

Patients make trade-offs among these attributes in their choices, and three trade-offs are noteworthy.  The first one is the doctor-delay trade-off, similar to the classic quality-speed trade-off.  For instance, patients may want to wait for a few more days in order to see their own doctor.  For this trade-off, the authors identify an interesting gender effect.  When delay to care is relatively long, females perceive greater utility loss than males, and females (versus males) are more averse to not seeing their doctor of choice.  Using behavioral theory, the authors find that these differences in perceived utility loss are accounted for by gender differences in risk attitudes.  These findings on patient heterogeneous preferences bear important implications for both healthcare policy makers and managers.  Because patients are different, a one-size-fits-all practice model would not work well for all patient populations.

The second trade-off is between appointment delay and in-clinic waiting.  For example, patients may choose to schedule an appointment several days later rather than to walk in today and endure long in-clinic waiting to see a doctor.  This finding suggests that, in the design of (health) service systems, it is important to consider customer (patient) wait that occurs in these two different time scales.

The third trade-off seems obvious, but is often overlooked and has quite useful practical implications.  Patients are willing to trade changes of operational attribute levels for a relatively small amount of money ($10 or so), suggesting that “pricing” (e.g., via offering transit incentives, local market coupons, or free tickets to fitness programs) might be a powerful lever to induce patient choice behavior and attendance.

Read the full article at: https://doi.org/10.1287/mnsc.2016.2704.


Liu N, Finkelstein SR, Kruk ME, Rosenthal D (2017) When Waiting to See a Doctor is Less Irritating: Understanding Patient Preferences and Choice Behavior in Appointment Scheduling. Management Science. Forthcoming.