What is the average appointment no-show rate?
The most cited figure is 23%: a 2018 systematic review of 105 studies found an average no-show rate "of the order of 23%" across medical specialties, from 13.2% in Oceania to 43.0% in Africa. In the US, a 12-year study at a large Veterans Affairs medical center measured 18.8%.
No-show rates in the research
The review is Dantas and colleagues, No-shows in appointment scheduling: a systematic literature review, published in Health Policy in April 2018. It screened 727 papers from the Scopus database and analysed 105. The VA figure comes from Kheirkhah and colleagues, Prevalence, predictors and economic consequences of no-shows, BMC Health Services Research, 2016, which covered fiscal years 1997 to 2008 at the Michael E. DeBakey VA Medical Center in Houston.
Every number on this page is traced to the original study, with what it does and does not prove. Most of the research is in healthcare, because that is where no-shows are measured carefully, but the pattern applies to any business that books appointments: dental, med spa, home services and consultations.
What does a no-show cost?
In the VA study, the average cost of a no-show was $196 per patient in 2008, and the mean no-show rate across 10 main clinics was 18.8%. That is one health system's internal cost figure, not a universal price, but it shows the scale: an empty slot still carries the cost of the staff, room and equipment reserved for it.
For a private business the better number is your own. Multiply the no-shows in a normal month by the average value of the appointment, then by how often an empty slot is not refilled. A dental practice with 60 missed appointments a month at an average of $150 has $9,000 of booked revenue at risk before counting any rescheduling. Our automation ROI calculator runs the same arithmetic with your figures.
Who is most likely to miss an appointment?
The 2018 review found the characteristics most often linked to no-shows were younger adult age, lower socioeconomic status, living far from the clinic and having no private insurance. The two strongest predictors across studies were a long lead time between booking and the appointment, and a history of previous no-shows.
Both strong predictors are things a CRM already knows. Lead time is the gap between the booking date and the appointment date. No-show history is a count on the contact record. That makes them useful for targeting: a patient who booked six weeks ahead and missed twice last year gets an extra confirmation step, while a regular who booked yesterday gets the standard reminder. It is also why long waiting lists raise no-show rates, and why filling cancellations from a short-notice list matters.
Do text reminders reduce no-shows?
Yes, with moderate-quality evidence. A 2013 Cochrane review found attendance of 78.6% with mobile phone text reminders against 67.8% with no reminder, across seven studies and 5,841 participants, a risk ratio of 1.14. Text reminders performed about the same as phone call reminders, and two studies found the cost per attendance was 55% and 65% lower for texts.
Attendance with and without text reminders
| Comparison | Result | Evidence |
|---|---|---|
| Text reminder vs no reminder | Attendance 78.6% vs 67.8% (RR 1.14, 95% CI 1.03 to 1.26) | 7 studies, 5,841 people, moderate quality |
| Text reminder vs phone call reminder | No meaningful difference (RR 0.99); phone attendance 80.3% | 3 studies, 2,509 people, moderate quality |
| Cost per attendance | 55% and 65% lower for texts than calls | 2 studies |
The review is Gurol-Urganci and colleagues, Mobile phone messaging reminders for attendance at healthcare appointments, Cochrane Database of Systematic Reviews, 2013. A 2023 systematic review by Werner and colleagues in BMC Health Services Research looked at 61 studies of behavioural interventions against missed appointments; 56 of them tested reminders, and the authors found "significant evidence supporting the effectiveness of reminders (either by SMS, telephone, or mail) across various settings", while results on the best delivery method were mixed.
Why do reminders alone not fix the problem?
Because reminders lower no-shows without removing them. In the VA study a centralized phone reminder system cut the no-show rate only from 16.3% to 15.8%, and the authors concluded it "only modestly reduced the no-show rate." What works better is a reminder that makes it easy to confirm, cancel or rebook, plus a process to refill the slot.
A reminder that recovers the slot
That fits what we see in booking systems. A reminder that says "reply C to confirm or R to reschedule" turns a silent no-show into an early cancellation you can fill. A reminder that just states the time does not. The design points that matter:
- Timing: one reminder when booked far ahead, one a day or two before, one on the day.
- Two-way replies: confirm, cancel and reschedule by reply or link, written straight to the calendar.
- Targeting: an extra step for long lead times and past no-shows, the two strongest predictors.
- Refill: a cancellation triggers an offer to a waitlist, so the slot is not lost.
- Consent and hours: reminders need consent and should arrive at sensible times; see our page on what time businesses can text customers.
Our no-show reduction builds and appointment booking automation follow that pattern, and the dental case study shows it in a real practice. In another build, the home care agency in our Care Star Healthcare case study reported its no-show rate fell by about 40% (client-reported).
Do virtual appointments have fewer no-shows?
On average, yes. A 2025 meta-analysis of 45 retrospective studies found patients in virtual care were less likely to miss appointments than those seen in person, with an odds ratio of 0.61, a moderate reduction. The studies varied a lot, so the size of the effect in any one clinic can differ.
The study is Greenup and Best, Systematic review and meta-analysis of no show or non-attendance rates among telehealth and in-person models of care, BMC Health Services Research, May 2025. For a business, the practical reading is that removing travel removes one of the reasons people miss appointments. Offering a video or phone option for follow-ups is a scheduling decision a CRM can support with a second calendar type.
How should you read no-show statistics?
Treat published rates as ranges, not targets. They come mostly from clinics, over different years and countries, and each measures no-shows slightly differently. The number that should drive your decisions is your own no-show rate by service, lead time and reminder path, measured before and after any change.
- The 23% average is global and cross-specialty. It does not describe a typical US dental or med spa practice.
- The $196 cost is from 2008 and one health system. Do not use it as your cost.
- The Cochrane result is a relative lift. Starting from a lower no-show rate, the absolute gain is smaller.
- Vendor figures such as "reminders cut no-shows by X%" usually come from a single customer and are not in this page for that reason.
Questions about no-show statistics
What is a good no-show rate for a clinic?
There is no single benchmark. The better goal is a falling rate against your own baseline, measured by service and lead time, with every cancellation offered to a waitlist.
Are phone call reminders better than texts?
In the Cochrane review they performed about the same, and texts cost less per attended appointment. Many practices use texts first and call only the high-risk appointments.
Does charging a no-show fee reduce missed appointments?
Some behavioural studies test deposits and fees, but the 2023 review found reminders were by far the most studied intervention and evidence on other approaches was limited. If you use a fee, state it at booking and in the reminder.
Sources and further reading
- Dantas LF, Fleck JL, Cyrino Oliveira FL, Hamacher S. No-shows in appointment scheduling: a systematic literature review. Health Policy, 2018;122(4):412-421.
- Kheirkhah P, Feng Q, Travis LM, Tavakoli-Tabasi S, Sharafkhaneh A. Prevalence, predictors and economic consequences of no-shows. BMC Health Services Research, 2016.
- Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R, Car J. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database of Systematic Reviews, 2013.
- Werner K, et al. Behavioural economic interventions to reduce health care appointment non-attendance: a systematic review and meta-analysis. BMC Health Services Research, 2023.
- Greenup EP, Best D. Systematic review and meta-analysis of no show or non-attendance rates among telehealth and in-person models of care. BMC Health Services Research, 2025.
