Choosing and Booking – and Attending? Impact of an Electronic Booking System on Outpatient Referrals and Non-attendances

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Patient non-attendance can lead to worse health outcomes and longer waiting times. In the English National Health Service, around 7% of patients who are referred by their general practice for a hospital outpatient appointment fail to attend. An electronic booking system (Choose and Book—C&B) for general practices making hospital outpatient appointments was introduced in England in 2005 and by 2009 accounted for 50% of appointments. It was intended, inter alia, to reduce the rate of non-attendance. Using a 2004–2009 panel with 7,900 English general practices, allowing for the relaxation of constraints on patient of hospital, and for the potential endogeneity of use of C&B, we estimate that the introduction of C&B reduced non-attendance by referred patients in 2009 by 72,160 (8.7%).

Original languageEnglish
Article numberHEC3552
Pages (from-to)357-371
Number of pages15
JournalHealth Economics
Issue number2
Early online date4 Aug 2017
Publication statusPublished - 1 Feb 2018

Bibliographical note

© 2017, John Wiley & Sons, Ltd. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details


  • gatekeeping
  • general practice
  • non-attendance
  • outpatients
  • referrals

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