Fystro J R, Feiring E J. Mapping out the arguments for and against patient non-attendance fees in healthcare: an analysis of public consultation documents. Med Ethics 2023; 49: 844-849.

The argument for and against the imposition of fines.

Recent studies show that patient non-attendance rates vary between 5% and 25%. Norway has a universal, tax-financed healthcare system and a standard non-attendance fee (currently €139) has been applied since 2009.

Since 2009, the Norwegian government has instigated five public consultations on non-attendance fees in healthcare. Reviewing comments from these consultations, it appears that such fees are broadly supported and accepted by the public. However, a number of objections were identified:

  • There is little evidence that such fees are effective and do not act as a motivational tool - there may be other reasons for non-attendance, such as unforeseen personal crises

  • In line with other studies, fees were considered resource-demanding to implement

  • Socially vulnerable groups, with an increased risk of poor health, are likely to be unequally disadvantaged by non-attendance fees

  • Due to the additional income, there is a perverse incentive for providers not to seek alternatives strategies to reduce non-attendance.