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Four months after the implementation of an appointment system for outpatient visits in 49 category III (large, tertiary care) hospitals in Beijing, it is estimated that 1.23 million patients (or 13 percent of the total) took advantage of the system. This level of utilization falls short of the Beijing Health Bureau’s goal of 40 percent utilization for repeat appointments, 100 percent for dental (81.3 percent, actual) and routine prenatal visits (57.8 percent, actual) and 60 percent for post-discharge checkups. The vast majority of patients still opted to show up at the hospital when medical care was needed, and 42 percent of those who did make appointments did so in person at the hospital.

Why are Chinese citizens slow to adopt the new appointment system?

• Not enough telephone lines and operators. A survey showed that busy signals and limited choices of dates and times were some of the reasons that about a third of those who attempted to make appointments by telephone were dissatisfied. Yet, hospitals are reluctant to invest in a call center because they have little trouble filling physicians’ schedules.
• Lack of available appointments with top specialists. With the lack of a primary care (gatekeeper) function in China, access to top specialists is based more on the patients’ prowess in securing appointments rather than clinical need. Since specialists are a scarce resource, many hospitals are reluctant to fill these specialists’ schedules by telephone.
• Lack of triage to direct patients to appropriate department. The appointment system does not accommodate patients who rely on coming to hospitals to find out which doctor they need to see. Some hospitals have started telephone services staffed by healthcare professionals to guide patients through the process.
• Lack of standardized rules. Some patients complain about the different rules imposed by individual departments and/or specialists. To encourage participation by all departments and physicians in the appointment system, some hospitals are implementing rules to penalize departments and individual physicians that schedule fewer than 50 percent of appointments in advance. Penalties are in the form of demerits and pay cuts.
• The resale market for appointments and Internet bookings. About 3 percent of appointments are made online, and often by people who are reselling the appointment to a true patient. A prepaid appointment that costs 15 RMB can be sold for 400 RMB or more.

Clearly, managing patient expectations is a top challenge for hospitals. Should patients expect to see the doctor they want to see within a week or a month? Is it reasonable to reserve some appointment slots for walk-in patients? How much waiting time is acceptable? The reality is that the appointment system cannot solve the fundamental issue: There are 1.78 million specialist appointments available, and 12 million patients competing for them. In other words, only one out of 67 patients seeking to see a specialist will actually secure an appointment. This goes back to the problem of the lack of a gatekeeper system, as well as the general public’s lack of information about how to seek appropriate care and their tendency to default to big-name doctors and specialists.

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