Marina Krakovsky in Slate suggests that long US doctor appointment waiting times (weeks!) are a consequence of a bad equilibrium. She doesn’t say it in those terms but that doesn’t stop it being true.
When a patient calls in the morning asking to see a doctor who uses open access, the office offers an appointment for that same day. Why are there openings available? Well, the main reason most doctors defer today’s work to some time in the future is that today’s schedule is clogged with appointments made weeks ago. Doctors following the same-day scheduling model, on the other hand, are free today because they saw yesterday’s patients yesterday. Using open access, doctors might still schedule some early-morning appointments in advance, for follow-up visits or for patients who actually prefer a future appointment. But the key is that they keep most of their time free for same-day visits and fill up their schedules as the day goes.
So in one equilibrium, there are long waiting lists which mean that schedules are set weeks in advance. In another, that isn’t done and so everyday there are openings. Each outcomes feeds on itself. So to get out of the bad waiting equilibrium you need a big push to clear the lists and then you can move to the good no-waiting situation. Of course, this makes for a hard transition.
Of course, the no-waiting equilibrium is also fragile unless you have sufficient slack in the system — that is, on average more slots available than there is demand. This is because if you have a bad day, that creates a backlog and this can feed back on itself so that waiting times slowly increase. The slack reduces the chances of that but means that someone has to pay for the unused doctor capacity.
[Update: The Aplia blog looks at this issue]