Research shows that introducing fees to curb no-shows at Danish daycare centers and healthcare appointments may backfire, experts warn. A 2015-2016 hospital study found that fees did not reduce absences, and Israeli research revealed that parents sometimes viewed penalties as payment for being late rather than a deterrent.
Why Fees Fail to Stop No-Shows
A school leader in Vemb, West Jutland, recently proposed charging parents a fee if they fail to cancel childcare during holiday periods on time. The suggestion aims to solve a common problem in childcare in Denmark. Many children are registered for care during vacations, but far fewer actually show up. This wastes staff resources and creates planning headaches for institutions across the country.
Lessons from the Healthcare Sector
Denmark has already tested this approach in hospitals. Between 2015 and 2016, two departments at regional hospitals in Viborg and Silkeborg introduced fees for patients who missed appointments without canceling. The conclusion was clear: fees did not work. Professor Jakob Kjellberg from Vive, the National Research and Analysis Centre for Welfare, led the study. He explains that most people do not miss appointments deliberately. Instead, they forget or struggle to plan far ahead. Most people feel embarrassed and regretful when they fail to show up, he notes.
Social Class Makes a Difference
The effectiveness of fees varies by income and education level. Among middle-class families, fees had a modest positive effect. However, among socially vulnerable groups, fees performed poorly. In some cases, financial penalties actually increased the problem. Kjellberg points to research from Israel where daycare centers introduced fees for parents who picked up children late. Instead of reducing tardiness, more parents arrived late. They began to see the fee as a legitimate payment for extra time rather than a penalty.
When Fees Become Prices
The Israeli study became known as “A Fine is a Price.” It demonstrated how economic incentives can change behavior in unexpected ways. When people pay a fee, they may feel entitled to the service or behavior they are paying for. This psychological shift undermines the deterrent effect that policymakers intended. In the Danish context, this means that charging parents for missed childcare slots could normalize the practice rather than discourage it.
Better Solutions Already Exist
Fortunately, there are proven methods to reduce no-shows that do not involve fees. Simple reminders work far better than financial penalties, according to research.
SMS Reminders Cut Absences
Text message reminders have shown strong results in reducing missed appointments. Danish children’s dental services use this approach effectively. Parents receive multiple alerts in the days leading up to an appointment, typically three days before, two days before, and one day before. This system significantly lowers the number of children who do not appear for dental checkups. The key is making it easy for people to remember their commitments without adding stress or cost.
Make Cancellation Simple
Professor Kjellberg recommends making cancellation processes as straightforward as possible. If parents can cancel a childcare booking with a quick text or app notification, they are more likely to do so when plans change. Complicated procedures or limited time windows create barriers that lead to no-shows. The goal should be to remove friction from the system rather than add financial penalties.
Understanding Human Behavior
The core issue is not willful disregard for commitments. Most people genuinely want to honor their agreements. Life circumstances, memory lapses, and planning difficulties are the real culprits. Policies that recognize these human factors tend to work better than punitive measures. Institutions that invest in user-friendly reminder systems and flexible cancellation options see better results without damaging trust between families and service providers.
Broader Implications for Public Services
The debate over fees touches larger questions about how Denmark manages public services and citizen behavior. As institutions look for ways to optimize resources, the temptation to use financial incentives grows.
Trust Over Punishment
Denmark’s welfare system traditionally relies on high levels of social trust. Citizens expect services to be accessible and fair. Introducing fees for what are often honest mistakes could erode this trust. When people feel they are being punished rather than supported, their relationship with public institutions changes. This shift can have long-term consequences beyond the immediate problem of no-shows.
Resource Management Challenges
Daycare centers and schools face real budgetary pressures. During holiday periods, staff must be scheduled based on expected attendance. When large numbers of registered children do not appear, labor costs rise unnecessarily. These inefficiencies strain already tight budgets. However, addressing the symptom with fees may not solve the underlying coordination problem. Better communication tools and predictive planning methods offer more sustainable solutions.
Lessons for Other Sectors
The findings from healthcare and childcare research apply to other public services as well. Libraries, sports facilities, and municipal services all deal with similar challenges. The evidence suggests that investment in technology and communication yields better returns than enforcement mechanisms. As Denmark continues to modernize its public sector, these insights become increasingly relevant. Policymakers and administrators can learn from past experiments to design systems that work with human nature rather than against it.
Sources and References
The Danish Dream: Childcare in Denmark: Guide for Expats
The Danish Dream: Best Child Care in Denmark for Foreigners
DR: Vi glemmer sjældent vores aftaler med vilje: Langt de fleste er faktisk lidt flove
FM: Finansministeriet
