Non-attendance as a factor of waste: challenge for SUStainability in a universal health system

Abstract

Non-attendance to specialized healthcare appointments and diagnostic and therapeutic procedures is a global problem in healthcare, leading to wastage of resources both in public and private facilities. This study aims to estimate financial wastage of resources linked to non-attendance to scheduled health specialist appointments and procedures in the metropolitan region of the Espírito Santo State (ESS), Brazil, for the years 2014-2016.  We studied 1.002.719 specialized healthcare procedures - 666.182 appointments with specialist medical and other healthcare professionals and 336.537 specialized diagnostic and other therapeutic procedures. Data for non-attendance were collected from the administrative procedure scheduling database (SISREG-ES) in the ESS Regulatory Agency, provided by the EES Health Office. Financial values used to estimate wastage stemmed from the SUS and other standard tariff lists for medical procedures, used according to the administrative regime of the three types of service providers. Average non-attendance rate for medical and health specialists appointments was 38.6% (257.025 missed appointments), with an estimated waste of resources valued at R$ 3.558.837,88. For other specialized procedures non-attendance reached 32.1% (108.103 missed procedures) estimated at R$ 15.007.624,15. Total wasted resources reach significant values and highlight the ongoing challenge to managers seeking to attain sustainable universal health care systems.