Reducing no-shows and empty chairs in a Belgian dental practice
There is no official Belgian figure for how often a dental patient fails to arrive, so the only honest number is the one your own diary gives you. Count two things separately, because they are two different problems: the late cancellation that leaves a gap tomorrow, and the patient who simply does not come. Three things move both: a confirmation the patient can reply to, a reminder in the channel they actually read, and a waiting list that is genuinely called when a slot opens. The third is where the work is, and it is the one a busy practice almost never gets to.
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What is the no-show rate in a Belgian dental practice?
Nobody knows, and any page that hands you a Belgian percentage is guessing. There is no official Belgian figure for dental no-shows, and no EU-wide official figure either. The percentages that circulate in this market come from companies selling reminder software, including direct competitors, which is marketing rather than measurement. We would rather say that plainly than borrow an American or Dutch number and dress it as Belgian.
That leaves your own diary, which is a better source anyway. A long-established practice in a Flemish village and a practice beside a Brussels station with a high turnover of new patients do not have the same problem, and a national average would hide exactly the difference you need to see. Four weeks of counting tells you more than any benchmark on the internet.
Count it as separate numbers rather than one, and record them the same way every week. The shape of the list below is the point: once you have it, you can tell which of the two problems you actually have.
- Appointments cancelled with less notice than your own policy asks for, counted against the day they were due.
- Appointments where the patient did not arrive and did not call.
- The treatment type and the length of each lost slot, because a 20 minute check-up and a 90 minute crown are not the same loss.
- Whether the slot was refilled, and how long that took.
- Whether that patient had been confirmed, reminded, both or neither.
- Which language the patient speaks, if your practice works in more than one. It is the cheapest thing to get wrong.
What is the difference between a late cancellation and a no-show?
One tells you, the other does not. A late cancellation is information: the patient rings on Tuesday to say they cannot come on Wednesday, and you have a day, or an hour, to do something with the gap. A no-show is silence. The chair is empty, the dentist is standing beside it, and you find out at the moment the loss becomes final.
They need different answers, which is why merging them into one figure is expensive. A late cancellation is a scheduling race, and it is winnable, because there is a slot, a list of people who want one, and a window of time. A no-show is a communication failure that happened days earlier, and the only place to repair it is before the appointment, not on the morning of it. A practice that counts one number ends up buying a reminder tool for a waiting-list problem, or the reverse.
| Late cancellation | No-show | |
|---|---|---|
| What you learn | That the slot is free, and usually why | Nothing, until the slot has already passed |
| When you learn it | Hours or a day ahead, sometimes minutes | At the appointment time, or after it |
| What you can still do | Offer the slot to somebody else | Nothing about that slot. Only about the next one |
| What actually fixes it | A waiting list that is worked quickly | A confirmation and a reminder the patient can act on |
| What it costs | The gap, if nobody fills it | The gap, plus the chasing afterwards |
| Who does the work | Whoever is free at the desk, immediately | Whoever has time tomorrow, to rebook |
What actually reduces no-shows?
Three things, and none of them is clever. A confirmation the patient can reply to, a reminder in the channel they actually read, and a waiting list that gets called when a slot opens. It is all ordinary work, and ordinary work is what loses to a full waiting room.
The confirmation is the part most practices already send and few make useful. A confirmation that only informs is a broadcast. A confirmation the patient can answer, in the same thread, with “that no longer suits me”, turns a future no-show into a cancellation that arrives four days early instead of four minutes late. That is the whole trick: you are not preventing the change of plan, you are moving it into the column where it can still be refilled.
The reminder has to arrive where the patient looks, and in Belgium that is not one channel for everybody. Some patients read WhatsApp, some read e-mail at work and nothing at home, and some answer the telephone and ignore every message you send. A practice that sends one channel to everyone is deciding in advance which patients it will keep missing. Language works the same way. In Brussels that is not a rhetorical point, and a patient who gets a French reminder for a Dutch appointment reads it as a message from somebody else’s practice.
The waiting list is the third, and it gets its own section below, because it is where all the time goes.
- A confirmation at booking that the patient can reply to, not a one-way message.
- A reminder timed so that the slot can still be sold again if the answer is no.
- The channel the patient reads, chosen per patient rather than per practice.
- The patient’s own language, Dutch, French or English, and the same one every time.
- One way to cancel that is easier than not turning up. If cancelling is harder than silence, you will get silence.
- A waiting list that somebody works within the hour the slot opens, not when a free half hour appears.
Why does nobody ever call the waiting list?
Because a slot opens at the worst possible moment and filling it is not one phone call. It is a search through the list for patients whose treatment fits the length of the gap, then calls in order, each of which is a ring, a voicemail, a call back, a “let me check with work”, and a diary that has to still be right when they say yes. It is fifteen to thirty minutes of one person’s attention at eleven in the morning, and at eleven in the morning there is a patient standing at the desk.
It is also worth more here than the lost revenue suggests, because the people who would have taken that slot are waiting. When VRT telephoned 40 randomly selected Flemish practices in March 2023 and tried to book an appointment, 25 of the 40 had a patient stop, 4 more were retiring and taking nobody, 8 could book only after a long wait, and just 3 could offer an appointment within two months. That is an access test on 40 practices rather than a national statistic, and it should be read as one. It is still the clearest available picture of what a wasted hour means in this market. The gap in Wednesday’s diary is an appointment somebody on your list wanted and could not get.
The arithmetic below is an illustrative scenario. It is not a measured Tilcao result, not a Belgian average, and not a claim about your practice. The four assumptions are invented for the example and printed beside it so you can replace them with your own diary’s numbers. The shape is the point, not the total.
| Assumption in this scenario | Value | What it adds up to |
|---|---|---|
| Slots that open late in a week | 4 | 4 gaps to fill |
| Patients rung before one accepts | 3 | 12 calls a week |
| Minutes per call, including the ones nobody answers | 4 | 48 minutes a week |
| Working weeks in the year | 45 | About 36 hours a year at the desk |
Is this the SMS reminder our practice software already sends?
No, and the difference is worth being precise about, because Belgian dental software has sold appointment reminders for years. An appointment reminder, afspraakherinnering in Dutch and rappel de rendez-vous in French, is about an appointment that already exists. A recall, rappel de contrôle or relance in French and simply recall in Flemish practice speech, is about a patient who has no appointment at all and should. Belgian systems use rappel for the first sense, so the two get conflated constantly, and a page that blurs them is describing a feature your practice management software already has.
Both belong on this page, for different reasons. The reminder protects tomorrow’s diary. The recall fills next month’s, and in Belgium the recall has a hook that no neighbouring market has.
That hook is the mondzorgtraject, the trajet de soins buccaux, the oral care trajectory run by RIZIV/INAMI, the national health and disability insurance institute. From a patient’s nineteenth birthday, having had reimbursed dental care in the previous calendar year keeps them inside the trajectory and on the lower personal share. Skip a calendar year and their own share rises for treatments such as fillings, root canals and extractions. A Flemish or Walloon patient therefore has a concrete financial reason to come back within the calendar year, which is a far better recall message than telling them they are due.
It also changes the logic your recall rules need. For under-18s, two preventive oral examinations are reimbursed per calendar year and they have to fall in different semesters, so recall for a child is semester-aware rather than “six months since the last visit”. Scaling is reimbursed once per quadrant per calendar year, which is its own rhythm again. Do not restate the amounts on your own website. They change, RIZIV/INAMI publishes them, and a wrong figure in front of a patient costs more than the page earns. Link there instead.
What should a confirmation from a Belgian practice actually say?
Enough that the patient never has to ring back to find out, plus one line most Belgian confirmations are currently missing. Date, time, practitioner, how long it will take, which entrance or where to park, what the appointment is for, and how to cancel. Then the identity document.
From 1 October 2026, dentists applying electronic third-party payment, the derdebetalersregeling or régime du tiers payant under which the sickness fund is billed directly, must verify the patient’s identity at every patient contact by reading an eID, an electronic foreigner card, a Kids-ID or an ISI+ card. A voluntary monitoring phase ran from 1 February to 30 September 2026, and telephone advice is exempt. For a confirmation message the consequence is one short sentence: bring your identity card. A patient who arrives without one is a delay, and a delay is how the rest of the morning starts running late.
The cancellation route has to be the easiest thing in the message. A practice that asks for notice, often 24 hours, should put that in writing. But if the only way to cancel is a telephone call during opening hours, you have made cancelling harder than not turning up, and patients will pick the easy one. A reply in the same thread, in their own language, is the low-friction version of the same rule, and it is also how a cancellation reaches you early enough to refill the slot.
What does Tilcao do about it, and what does it not do?
It does the three ordinary things above, at the hours a practice cannot. It confirms at booking in a thread the patient can answer, sends the reminder in the channel and the language that patient uses, and when a slot opens it works the waiting list straight away rather than when someone finds a free half hour. Bookings go into the practice’s own diary on real availability, and every conversation leaves a structured summary and an audit trail, so the record and the diary cannot drift apart.
What it does not do matters more on this page than what it does, because this is the page where vendors overreach.
- It does not judge whether a patient should come in. Pain, swelling and anything clinical go to a named person, on your own rule.
- It does not invent or apply a missed-appointment fee. If your practice has a policy, the agent states it in your words. If you have none, it says nothing about it.
- It does not chase. Contact limits and opt-outs are practice configuration, and a patient who asks to be left alone is left alone.
- It does not pretend to be a person. Article 50 of the EU AI Act has applied since 2 August 2026, so patients are told they are dealing with an AI system.
- It is not a practice management system. It is not on the MyCareNet approved-software list, holds no eHealth certificate, and needs neither to move an appointment.
- It does not promise you a no-show percentage. Tilcao is pre-pilot, there is no measured result to publish, and a number with no measurement behind it is worth nothing to you.
Questions practices ask
What counts as a no-show in a dental practice?
An appointment the patient did not attend and did not cancel, so the practice finds out only when the time passes. It is worth keeping separate from a late cancellation, where the patient did tell you, just too late to refill the slot comfortably. Most practices record the two together, which makes both harder to solve, because a late cancellation is a scheduling problem and a no-show is a communication one.
What is the average no-show rate for dental practices in Belgium?
There is no official Belgian figure, and no EU-wide official figure either. The percentages quoted around this market come from companies selling reminder software, so they are marketing rather than measurement, and importing an American or Dutch number does not make it Belgian. Count your own for a month, split into late cancellations and genuine no-shows, and you will have something more useful than any published benchmark.
Can we charge a patient who does not turn up?
A practice can publish a policy asking patients to cancel a set time in advance, often 24 hours, and stating that unannounced missed appointments may be invoiced. Whether and how you apply that is a question for your own professional association and your own adviser, not for a software vendor, and nothing here is legal advice. Tilcao never invents a fee and never enforces one. It repeats the policy you wrote, in your words, if you ask it to.
Do SMS reminders reduce no-shows?
A reminder helps when the patient can act on it and the practice can act on the reply. A one-way SMS tells the patient something they may already know and gives them nowhere to say that it no longer suits them, so fewer would-be no-shows become cancellations you could still refill. The channel matters as much as the message, because the reminder only works if it lands where that particular patient actually looks.
What is the difference between an appointment reminder and a recall?
An appointment reminder, afspraakherinnering in Dutch and rappel de rendez-vous in French, concerns an appointment the patient already has. A recall, rappel de contrôle or relance in French, concerns a patient with no appointment who is overdue for a check-up. Belgian practice software uses rappel for the first sense, which is why the two are so often conflated, and they need completely different messages.
What is the mondzorgtraject and what does it have to do with no-shows?
The mondzorgtraject, trajet de soins buccaux in French, is the RIZIV/INAMI oral care trajectory. From the age of 19, a patient who had reimbursed dental care in the previous calendar year stays inside the trajectory and keeps the lower personal share, and skipping a calendar year raises their own share for treatments such as fillings, root canals and extractions. That gives a Belgian patient a concrete reason to come back within the year, which makes it the strongest recall argument available here. Check the current rules on the RIZIV/INAMI site rather than restating amounts on your own.
Can Tilcao fill a cancelled slot from our waiting list?
That is what the Scheduler role is for. When a slot opens it looks for patients on the list whose treatment fits the gap, contacts them in order and books the first one who accepts. Whether it can write that booking depends on how your diary is reachable, and no Belgian dental practice system publishes an open, documented booking API. The realistic route is the online agenda layer in front of your practice software, which we check against your actual setup before a pilot rather than after.
Does Tilcao telephone patients, or does it only answer calls?
Both, inside the workflows your practice has approved. Outbound contact for confirmations, reminders, waiting-list offers and recalls runs on rules you set, including how often a patient may be contacted and how they opt out. Patients are told at the start that they are dealing with an AI system, as Article 50 of the EU AI Act has required since 2 August 2026.
Will patients in Belgium mind being contacted by an AI about an appointment?
Some will and the practice should assume so, which is why the opt-out has to be real rather than decorative. A patient who asks for a person gets one, a patient who asks not to be contacted is not contacted again, and the practice decides the frequency ceiling rather than the vendor. A dental conversation is health data under Article 9 of the GDPR, so the practice stays the controller and Tilcao acts as processor under a written agreement.
How would we know whether any of this worked?
By the numbers you started counting before you changed anything: late cancellations and no-shows per week, with the length of each lost slot beside it. Add how many freed slots were refilled and how long the refill took, because that is the one the waiting list moves. Tilcao publishes no no-show results of its own, and will not until a pilot has produced measured ones.