Lorraine Williamson
Every year, around nine million outpatient appointments are missed in Spain’s public hospitals—largely because patients simply don’t turn up.
The scale of the problem, uncovered by El País through regional data analysis, paints a stark picture of wasted time, money, and opportunity in an already overstretched health system.
While official figures vary due to inconsistent regional tracking, estimates suggest that over 20% of initial outpatient consultations never go ahead. The figures are backed by research from Enrique González Díaz, a gynaecologist and medical coordinator at León’s University Hospital.
Stark regional contrasts
The no-show rate isn’t uniform across the country. In Andalucia, nearly one in five patients miss their appointments. In the Canary Islands, it fluctuates between 20% and 30% depending on the hospital. By contrast, in Madrid it’s 9.4%, and in regions like Navarre and the Basque Country, the figure drops to just 3.8% and 4.8% respectively.
This suggests that local factors—such as healthcare infrastructure, urban access, and administrative policies—play a significant role in patient attendance.
Who’s missing and why?
A study conducted in León, analysing nearly 200,000 first-time consultations, found that younger men are significantly more likely to miss their appointments. But demographics aren’t the only factor.
Waiting times matter. When delays exceed 120 days, the chance of a no-show jumps to 12.7%. With waits under 60 days, that figure halves to 6.2%. Living outside the city also increases the odds, suggesting that distance, travel costs, and transport options are barriers for many.
Some specialties fare worse than others
Certain departments are hit harder by absenteeism. Psychiatry, dermatology, gynaecology, and ENT record the highest rates, with up to 18% of patients failing to attend. Cardiology and surgery, in contrast, report much lower levels—under 8%.
The reasons behind this are partly systemic. Longer waiting times, understaffed clinics, and appointment scheduling issues all contribute. Some patients may have lost interest or found alternative care by the time their slot arrives.
Can reminders make a difference?
Yes—and the data proves it. Since León began sending SMS reminders in March 2023, the no-show rate has dropped from 10.6% to 8.2%. In Aragon, a simple phone call reduced absenteeism from 13% to 11%. While modest, these improvements demonstrate that low-cost interventions can make a measurable impact.
What experts recommend
Health management expert Conrado Domínguez argues that no-shows aren’t just an inconvenience—they reveal deeper cracks in the system. Poor planning, extended wait times, and low patient engagement are key contributors. Fixing them, he says, requires more than just punitive measures.
Healthcare policy professor José Ramón Repullo agrees. He warns against financial penalties or co-payments for missed appointments, arguing that such approaches unfairly penalise the vulnerable. Instead, he advocates for flexible systems that make it easier to reschedule or cancel.
Could AI be the solution?
The problem, according to researchers, isn’t random. Missed appointments follow predictable patterns—and that opens the door to smarter solutions.
Enrique González Díaz is now developing a predictive model using artificial intelligence. The aim? To identify high-risk patients in advance, allowing clinics to intervene early with personalised reminders or alternative options. It’s a glimpse into a future where data-driven healthcare could reduce waste and improve access.
The bigger picture
Every missed appointment is more than a scheduling glitch—it’s a lost opportunity for care, early diagnosis, and patient wellbeing. As Spain’s healthcare system faces growing pressure from an ageing population and rising demand, tackling absenteeism is no longer optional. It’s essential.
Redesigning patient engagement
With digital tools and better planning, Spain has a chance to flip the script—from missed opportunities to proactive, accessible care. But it will require a shift in how hospitals think about communication, logistics, and patient-centred care.
Source: El País