Prevalence and Drivers of Missed Healthcare Appointments in Poland: Insights From a 2025 Survey

Introduction

Missed appointments, also called no-shows, are defined as patient non-attendance to healthcare appointments without prior cancellation and are a growing and challenging issue for healthcare systems worldwide [1–3]. Patients and physicians can both miss scheduled appointments without prior cancellation; however, physician-related no-shows appear to be incidental or insufficiently researched, whereas patient-caused no-shows have been the subject of some studies [3] and have been identified as a significant problem for healthcare systems, both in public and private sectors [3]. The consequences of patient no-shows reach health, economic, and organizational levels, affecting patients themselves by generating longer wait times and further health issues resulting from delayed treatment [4,5]. They also lead to lost appointment bookings and increased administrative work [5]. In the private health sector, they also generate unnecessary financial losses, as a physician’s time is paid even in the absence of the patient [3].

No-shows are associated with economic and organizational burdens on healthcare systems. The financial implications of these missed appointments can be substantial. In 2019, the National Health Service (NHS) in the United Kingdom (UK) reported that a no-show rate of 5% resulted in costs of 216 million GBP [6]. Data from Canada indicate that the no-show rate can reach 10% to 25%, or even 30%, depending on the region [6]. In Poland, the National Health Fund (NFZ) reported that 1.4 million appointments were missed in 2024 [7]. This figure, however, concerns only 40 types of services monitored in the public system, suggesting that the actual number of missed appointments is considerably larger [7].

Poland’s healthcare system is financed through mandatory health insurance contributions paid to the NFZ [8]. All insured citizens are entitled to the wide scope of coverage, free of charge, without a co-payment requirement for visits. The NFZ finances planned and emergency care across inpatient and outpatient health services [8]. Access to most of the services requires a referral, with the exception of 5 specialties that are available directly: psychiatry, gynecology, oncology, venereology, and dentistry [8]. Selected hospitals provide emergency care units which, in case of urgent need, are also accessible without referrals [8].

Alongside the public system in Poland, there is a private sector, whose role is mainly supplemental, offering faster access to services [8,9]. The private sector provides services mostly through primary healthcare and specialist outpatient care, although private inpatient care is also available to some extent. Access to services is provided either through private health insurance or subscriptions and is limited to the selected medical facilities in the network [9]. The widest access to health services is available through out-of-pocket payments [8,9].

In recent years, the issue of no-shows and strategies to mitigate them has become the subject of a public debate in Poland [7,10]. To date, efforts in Poland to reduce and avoid no-shows are limited to educational campaigns and some reminder tools. Since 2020, the NFZ has been sending reminders in text messages, sent 4 days prior to the appointment, but only for first-time visits [10]. Evidence shows that reminders via text messages and phone calls can be effective at reducing missed appointments [11]. One study demonstrated that implementing reminders and follow-up calls after missed appointments reduced the no-show ratio by 50% and decreased wait time significantly [12]. However, the most effective reminders are those sent the same day or the day before the appointment [13]. This also applies to phone call reminders 24 hours before the appointment [14].

Internationally, some countries, such as Norway, have introduced monetary fines to address the no-show problem [13]. However, limited research reveals mixed results on the effectiveness of introducing fines for patients who miss appointments [13]. According to one study, the out-of-pocket mechanism did not have a significant effect on reducing no-shows or appointment cancellations [15]. Additionally, introducing fines and other financial means can be controversial and face public resistance [16]. Preferred methods focus on improving availability, also through telemedicine [11,17], and ease of canceling appointments [18]. It is even recommended to overbook appointments on days with a higher risk of missed appointments [19]. Moreover, the longer the wait time for the appointment after the booking date, the higher the risk of a no-show [20].

Sending reminders is clearly one of the most recommended solutions; however, further research on the most effective methods of delivering those reminders is needed. There is also a lack of evidence on other mechanisms [5].

It is necessary to understand the reasons and motivations of patients who miss and fail to cancel their appointments. Forgetfulness is reported as one of the most common reasons for failing to cancel the appointment [21]. Other reasons for no-shows include transportation issues, changes in health status (either improvement or deterioration), and family issues [21,22]. Other factors that can increase the risk of no-shows include longer distance from the medical facility, male sex, previous history of no-shows, younger age, and lower income [13,19,23]. Waiting time is also a significant factor contributing to missed appointments, with a longer interval between scheduling an appointment and the date of the visit increasing the likelihood that patients will either experience changes in their health status or forget about the visit.

Despite the importance of this issue and its broad implications for the whole healthcare system, the number of studies on this subject is limited. Currently, in Poland, there is a lack of research on the patients’ attitudes toward no-shows and strategies for preventing this issue. In a publicly funded health system like that in Poland, no-shows contribute to longer waiting times and economic losses due to underutilization of resources (free slots for visits). Data on no-shows, their reasons, and policy preferences may inform decision-makers on measures that should be implemented to reduce this phenomenon.

This study aimed to characterize the prevalence of no-shows in Poland, identify factors associated with these missed appointments, and identify potential organizational measures to reduce the no-show phenomenon in the Polish healthcare system.

Material and Methods

ETHICAL STATEMENT:

This study was conducted according to the principles expressed in the Declaration of Helsinki. The study protocol was reviewed and approved by the Ethics Committee at the Center of Postgraduate Medical Education (Warsaw, Poland; decision No. 70/2025, as of July 16, 2025). Informed consent was obtained from all individual participants included in the study. Data protection was provided, and the authors received an anonymous data set without any personal data of respondents.

STUDY DESIGN AND POPULATION:

This cross-sectional survey was conducted from August 1 to 4, 2025. Data were collected using computer-assisted web interviews (CAWI). To obtain a nationwide sample of adults in Poland, a dedicated public opinion survey company (Nationwide Research Panel Ariadna [24]) was contracted to collect data on behalf of the authors, who provided the study concept, methodology, and all necessary tools.

Respondents were selected from over 100 000 registered users (from all over Poland) of the research platform managed by the Nationwide Research Panel Ariadna, using quota sampling methods. The stratification model included sex, age, and place of residence and was based on the demographic data on the Polish population, published by Statistics Poland.

Each respondent selected to participate in this survey received a personal invitation with a URL link to the website where the study questionnaire was available. The invitation and study description were sent via text messages and email. Respondents who declared voluntary and informed consent to participate in this survey were asked to fill out the questionnaire. Respondents were required to answer all questions to prevent missing answers. If someone refused to participate, the next respondent was selected following the stratification criteria and requirements for obtaining a sample of adults in Poland that reflect the demographic structure of adult Poles by sex, age, and place of residence. A similar methodology was used in other nationwide cross-sectional studies in Poland [25–27].

MEASURES:

We self-prepared the study questionnaire based on a literature review [1–6,11–15]. Respondents were asked about their use of public and private healthcare services in the last 12 months. The survey question was: “In the past 12 months, have you used any healthcare services (visited a doctor, clinic, or hospital, etc.), either public or private?” The 4 response options were as follows: (1) I used only private healthcare services; (2) I used only public healthcare services; (3) I used both public and private healthcare services; or (4) I did not use any healthcare services in the past 12 months. Use of emergency services was included.

Respondents were also asked about missed appointments (patient no-shows) in medical facilities with the following question: “In the past 12 months, have you ever scheduled a medical appointment but did not attend and failed to cancel it in advance – that is, you did not inform the facility that you would not be coming (no-show/missed appointment)?” The 2 response options were as follows: (1) Yes, this happened to me once; (2) Yes, this happened to me several times; (3) No, this never happened to me; and (4) I had no scheduled medical appointments in the past 12 months. This question identified no-shows among those who used scheduled medical services, and in statistical analysis, those respondents who did not use scheduled medical services in the last 12 months were not included in the analysis of factors associated with no-shows.

Respondents who reported having at least 1 missed appointment in medical facility were asked about most common reason for the no-show.

Respondents were also asked about their support for introducing a penalty fee for patients who miss a scheduled medical appointment under the public healthcare system (funded by the NFZ) without cancelling it in advance, with a 5-point Likert scale. Moreover, all respondents were asked about 6 potential solutions that would make it easier for them to cancel a medical appointment they were unable to attend.

Moreover, 9 questions on personal characteristics were addressed. A pilot study was conducted. A group of 7 adults, aged 18 to 67 years, completed the same questionnaire twice, 10 days apart. Responses were compared and analyzed. After this analysis, 1 question was modified and 3 answer variants were modified to reduce the potential risk of bias.

STATISTICAL ANALYSIS:

Data were analyzed with SPSS version 29 (IBM Corp, Armonk, NY, USA). Frequencies and proportions are used to present categorical variables. The chi-squared test was used to compare differences between categorical variables. Logistic regression analyses were conducted. First, analysis was conducted to identify factors associated with no-shows among those who had scheduled appointments in the medical facility in the last 12 months. The second analysis included data on all respondents to identify factors associated with support for the idea of introducing a penalty fee for patients who miss a scheduled medical appointment under the public healthcare system, without canceling it in advance. In bivariable analyses, all variables were analyzed separately. Variables that demonstrated statistically significant associations in bivariable models were then included in the multivariable logistic regression analysis. The strength of the associations was presented as odds ratios (ORs) and 95% CIs. Statistical significance level was set at P<0.05.

Results

FACTORS ASSOCIATED WITH NO-SHOWS:

Among respondents who had visited a healthcare facility in the last 12 months (n=1014), the frequency of no-shows in medical facilities decreased with the age of the respondents (Table 3). Those who had children reported more no-shows, as did those with a higher number of co-residents in the household (Table 3). Moreover, those with current employment status also reported more no-shows in a medical facility in the last 12 months.

In the multivariable logistic regression model, among respondents who had visited a healthcare facility in the last 12 months, age below 60 years (P<0.05), having children (aOR, 2.09; 95% CI, 1.28–3.40; P=0.003), and moderate (aOR, 1.80; 95% CI, 1.19–2.72; P=0.005) or poor (aOR, 2.60; 95% CI, 1.47–4.60; P=0.001) household financial status were associated with higher odds for no-shows in a medical facility in the least 12 months (Table 3).

There was no significant effect of sex, educational level, marital status, place of residence, and type of healthcare services (public or private) used in the last 12 months on the odds for no-shows (Table 3).

SELF-DECLARED REASONS FOR NO-SHOWS IN A MEDICAL FACILITY:

Respondents who declared at least 1 no-show in medical facilities in the last 12 months (n=142) were asked to indicate the major reason for the missed appointment (Table 4). The most common reason was forgetting about the appointment (42.3%). Moreover, 27.5% of respondents were unable to reach the facility by phone (27.5%), and 23.9% declared worsening of health conditions or being suddenly ill (23.9%). Sex and age differences were analyzed. Men, compared with women, more often (31% vs 16.9%; P=0.04) indicated worsening of health condition as a major reason for a no-show (Table 4). Respondents aged 60 years and over chose “other reasons for no-show” more often than the younger age groups (P<0.001). No other differences in major reasons for no-shows by sex or age were detected (Table 4).

PREFERRED SOLUTIONS TO REDUCE NO-SHOWS IN MEDICAL FACILITIES:

All respondents (n=1162) were asked about the preferred solutions to reduce no-shows in medical facilities (Tables 5, 6). Respondents with higher education, status of being married or in informal relationship, residence in big cities, current employment, good household financial status, and use of public and private healthcare services in the last 12 months more frequently supported the idea of introducing a penalty fee for patients who miss a scheduled medical appointment (no-show) under the public healthcare system without canceling it in advance (Table 5).

In multivariable logistic regression analysis, age 60 years and over (aOR, 2.19; 95% CI, 1.36–3.53; P=0.001), higher education (aOR, 1.40; 95% CI, 1.07–1.83; P=0.01), residence in cities with 500 000 or more residents (aOR, 1.74; 95% CI, 1.13–2.71; P=0.01), current employment (aOR, 1.47; 95% CI, 1.07–2.01; P=0.02), and good household financial status (aOR, 1.83; 95% CI, 1.23–2.71; P=0.003) were significantly associated with support for introducing a penalty fee for patients who miss a scheduled medical appointment (no-show) under the public healthcare system without canceling it in advance (Table 5).

Women, older respondents, and those who used healthcare services provided within the public system more often (P<0.05) indicated receiving a text message reminder as a preferred solution to reduce no-shows in medical facilities (Table 6). Older adults, those who were married, those with poor household financial status, and those who used health services provided by the public or public and private healthcare more often indicated (P<0.05) receiving a call from a registration staff member as a preferred solution to reduce no-shows. Respondents who reported at least 1 no-show in a medical facility in the last 12 months more often (P<0.05) indicated receiving an automated phone call (eg, from a bot) as a preferred solution to reduce no-shows in medical facilities (Table 6). Respondents with poor household financial status and those who reported at least 1 no-show in a medical facility in the last 12 months more often (P<0.05) indicated a verbal reminder from the doctor during the previous visit as a preferred solution to reduce no-shows in medical facilities (Table 6). Mobile solutions, such as the possibility to cancel scheduled appointments online via the medical facility’s website or mobile app, as well as the possibility to cancel online via the internet patient account or through the official governmental mobile apps (mojeIKP or mObywatel), were selected more often (P<0.05) by respondents with male sex, younger age, higher education, residence in larger cities, current employment, good household financial status, and use of health services provided within the private or public and private healthcare system (Table 6).

Discussion

PRACTICAL IMPLICATIONS:

This nationwide survey highlights priorities for Polish healthcare policy and management for reducing the no-show rate. Policymakers should expand digital reminder systems, such as short text messages and voice bots. Moreover, national e-Health solutions, such as the internet patient account (mojeIKP), may serve as a digital infrastructure for other systems. These systems may address the gap in forgotten visits and enable patients to cancel appointments in advance, if needed. Interventions should target high-risk groups: adults aged 18 to 49 years, families with children, and financially disadvantaged patients, who face higher odds of non-attendance. Although 67.5% of respondents support penalty fees, evidence suggests that improving accessibility and communication, addressing forgetfulness (42.3%), and overcoming contact barriers are more effective approaches than punitive measures. Personalized communication, which also underlines the economic costs of no-shows, should be applied in Poland. Further studies should assess the prevalence of missed appointments across different types of care, particularly primary care and outpatient specialist care. Moreover, the effectiveness of different digital tools and demographic-specific strategies targeted at reducing missed appointments should be monitored in further studies.

STUDY LIMITATIONS:

This is a cross-sectional survey; therefore, data on the no-shows in medical facilities were self-reported, and medical documentation was not verified. Recall bias can occur in this type of study. The most common reasons for no-shows in medical facilities were listed; however, the analysis was limited to the 5 most frequently mentioned situations in the public debate and scientific literature. A self-prepared questionnaire was used, without full validation, which is also a limitation of this study. Moreover, respondents were asked about preferred solutions that would reduce the risk of no-shows, but only 6 potential solutions were analyzed. Selection bias may also occur. The CAWI technique was used, so those without internet access were excluded. However, only 4% of households in Poland without internet access were unable to participate in this study.

Conclusions

This study provides the first comprehensive baseline data on missed medical appointments (no-shows) in Polish healthcare, a previously understudied topic in Central and Eastern Europe. This survey found a high rate of missed appointments in Poland. The main cause of no-shows was patient forgetfulness, followed by communication failures. Transport barriers were not a significant cause of no-shows. Younger age, having children under 18 years old, and moderate or bad financial status were associated with a higher risk for no-shows. The findings support investment in digital communication systems over punitive measures, highlighting the need to expand reminder services and improve accessibility through multi-channel platforms by organizations tasked with funding health services. The study offers evidence-based guidance for targeted interventions, with future research needed on SMS reminders, digital tools, and demographic-specific strategies.