A Rich Incentive

Rarely are students told, when they call Harvard University Health Services (UHS), “Sure, you can come in anytime. How about tomorrow at 9:00 a.m.?” Wherever you go, scheduling a doctor’s appointment is a difficult task but UHS’s high level of appointment cancellations and no-shows makes squeezing in a visit unnecessarily difficult.

Last year, 12,000 of 180,000 UHS appointments were cancelled fewer than 24 hours ahead of time or missed altogether. These “dinkas” (short for “did not keep appointment”) swamped—or, rather, didn’t swamp—the busy dermatology and mental health services, representing about 15 percent of all appointments in those departments. As a result, many students who need to use these services often have to wait longer to find an appointment. Fortunately, UHS officials have come up with a smart idea to the combat the problem: charge the AWOL students.

According to UHS Director David S. Rosenthal ’59, students who miss their scheduled appoints will be assessed a $10 fee. We hope that this charge will be sufficient to deter students from skipping out on their appointments, or at least encourage students to call in and cancel ahead of time. The proceeds of the fee will help fund undergraduate health programs such as the Community Health Initiative, helping to further student wellness on campus.

Whether $10 will be a sufficient disincentive is anyone’s guess—ours is that it’s about right. Setting the fee too high would be more effective, but it would also over-punish students for their carelessness (even though it is a harmful and inconsiderate sort of carelessness). And a fee that is too low would not serve as an effective deterrent. In any case, UHS officials should continue to monitor the dinka rate and students’ responses to paying the fee, and they should adjust the charge accordingly.

We do have a particular concern in the implementation of UHS’s billing students. UHS currently plans to tack the fee onto students’ termbills, which is a reasonable way that many Harvard departments charge students necessary fees. The Office of the Registrar, for example, term-bills add-drop fees.

But if a $10 charge for, say, a missed mental health appointment, appears on a student’s termbill, then a student’s parents, or anyone else who views a student’s termbill, might discover a medical detail that the student had wished to keep private. UHS should adopt the same policy for paying a “dinka fee” that they do at the UHS Pharmacy: a student can choose to term-bill the fee, or the student can choose to pay it in person. This, of course, would require a student to actually go to UHS to pay the fee, an event that failed to occur in the first place, but perhaps UHS could offer a grace period for payment before they slap an extra Hamilton on a termbill.

We are optimistic about UHS’s new initiative to open up more appointments in overcrowded practices such as dermatology and mental health. No one looks forward to going to the doctor, but if students can’t have the courtesy to keep their own appointments, then they ought to pay a price for it.