No Appointment, No Mercy: How Rejection in Healthcare Affects Patients' Needs and Practice Reputation - Can AI Scheduling Soften the Blow or Make it Worse?

Appointment denials can threaten patients’ psychological needs and lead to retaliation (e.g., negative reviews). However, it remains unclear whether AI-led appointment scheduling can mitigate or intensify this impact. In a preregistered 2x2 experiment (N = 180), we examined the impact of exclusion (receiving vs. not receiving an appointment) and agent (medical assistant vs. AI) on psychological need threat and retaliatory behavior. Rejection significantly threatened self-esteem, leading to negative word-of-mouth. While meaningful existence and control were also affected, they did not mediate retaliation. Importantly, no significant differences emerged between agents – neither in need threat nor in attribution processes – across both rejection and inclusion conditions, suggesting that AI neither softened nor exacerbated the impact of appointment outcome. This provides a positive outlook for AI adoption, as algorithm aversion appears to be less of a barrier in administrative functions compared to medical decision-making.