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Devising suitable approaches to model use of healthcare services and associated expenditure is at the centre of healthcare modelling. Current models focus on predicting total healthcare expenditure at the aggregate level, without accounting for potential interactions between healthcare services. This project aims to develop and test mathematical models designed to: i) model the use of a comprehensive set of healthcare services and total healthcare expenditure as the sum of healthcare service-specific expenditure; and ii) to better understand the potential interactions between different healthcare services. The Medical Expenditure Panel Survey (MEPS) is the primary source of data for the analysis. The models developed as part of this project are tested in a series of case studies. In a first case study, devised models are used to assess the potential savings that could be produced by implementing a set of prevention policies to tackle obesity. Models are then used to project healthcare expenditure up to 2025 by reweighting and projecting MEPS data. A third case study assesses the potential cost associated with substituting informal home healthcare services with formal home healthcare services and gauges the relationship between use of informal home healthcare services and other healthcare services. In a final case study, a generalized propensity score matching approach is used to evaluate the dose-response effect of increasing levels of use of office-based services on inpatient care and other healthcare services in patients with type II diabetes. The resulting models can be used as self-standing tools or may be implemented in more complex attempts as, for example, microsimulation models. Future research should further investigate the dynamics of interaction and substitution between healthcare services to inform policy strategies aimed to curb raising healthcare expenditure.

This thesis examines how the design of messages affects the extent to which individuals comply with requests or requirements from public actors. More specifically, it presents results from seven field experiments on changing messages sent to the public and professionals as part of routine public sector activities: issuing requests for overdue tax payments, sending reminders for upcoming hospital appointments, and providing antibiotic prescribing feedback to general practitioners. These are all cases where non-compliance can create harm or inconvenience to others. The trial messages are constructed to test the two main approaches to increasing compliance: one, ‘deterrence’, sees individuals as utility maximizers who are concerned solely with advancing their private interests, and who respond only to the threat of sanctions; the other, ‘non-deterrence’, claims that compliance is influenced by factors such as social norms, perceptions of fairness, ethical concerns, and the provision of public goods. I attempt to increase the impact of both approaches by applying concepts from behavioural science, such as framing effects and the omission bias. The results indicate that deterrence-based messages consistently increase tax compliance, sometimes to a substantial extent. Non-deterrence messages also can increase compliance with both healthcare and taxation policies, although the effects are sometimes small. The largest effect sizes for non-deterrence approaches came from social norm messages. Non-deterrence approaches may be more effective for populations who had previously been compliant. Importantly, I provide evidence that both deterrence and non-deterrence messages can be enhanced through the application of concepts from behavioural science. These trials strengthen the limited evidence base on the real-world effects of messages intended to increase policy compliance. They demonstrate that compliance may depend on specific choices about how messages are constructed and delivered. In the process, they show how behavioural science offers a useful framework for governments making these important choices.

Unhealthy behaviour often entails short-term indulgence at the expense of long-term health. This thesis examines an hypothesis that temporal discounting, a measure of the extent to which a person devalues delayed benefit, predicts unhealthy behaviour. The work also evaluates temporal discounting as a psychological model for unhealthy behaviour, in particular unhealthy behaviour that is enacted in spite of healthy goals, and behaviour with painful consequences. Studies examining relationships between temporal discounting and health behaviour are systematically reviewed, with the finding that discounting of reward correlates with many forms of appetitive unhealthy behaviour. It is proposed that while steep discounting predisposes to unhealthy behaviour, goal-incongruent behaviour is better explained by the interfering effect of prelearned or innate values. Also, conventional discounting fails to account for the fact that many people prefer to expedite inevitable pain or illness. An explanation is that people dislike waiting for pain, termed 'dread'. The empirical work of this thesis establishes how dread depends on delay, by asking participants to titrate the timing and severity of their own pain or that of others. For the average participant, the dread of pain accumulated at a decreasing rate as pain was delayed. Dread was found to be less marked when deciding on behalf of socially close others. Unexpectedly a tendency to dread future pain in one-off choices did not predict saving a budget of pain relief in sequential choices. Further experiments examined social discounting for pain, finding that participants appear more averse to causing pain in others than in themselves, a tendency that is discounted with social distance. Conclusions are that temporal discounting of reward is a promising marker of appetitive unhealthy behaviour, with a considerable evidence base, while dread offers a candidate marker for engagement in health-promoting behaviour with painful consequences, a possibility which demands further investigation.

This thesis explores how innovative behavioural and virtual environment simulations could benefit healthcare and health policy. In the first half of the thesis I review the use of behavioural simulations in healthcare and contextualise an evidence-based approach for development and analysis. This approach is informs the successful design and completion of two simulations - The Crucible and Lateral Play. The Crucible was designed to improve leadership skills and understanding of the Health and Social Care Act amongst clinicians. Lateral Play was designed to aid organisational development of Imperial College Health Partners, the Academic Health Sciences Partnership in North-West London. Detailed analysis demonstrated, for the first time, the measurable positive effect of Behavioural Simulations on participant learning and behaviours. In the second half of the thesis I examine and demonstrate the potential for virtual world simulations to enhance major incident preparation, reviewing the evidence behind major incident training the potential benefits of using virtual world environments via a user-needs analysis and expert advisory group. I describe the successful design, development and assessment of three virtual world scenarios for multidisciplinary major incident training in the context of a bomb blast. Face and content validity is demonstrated and performance assessed in both technical and non-technical skills. Finally, I determine the feasibility of utilising a virtual trauma scenario for long-distance training between the UK, Canada and Southern Africa. The thesis concludes with an overall discussion of the pertinent findings, limitations and implications for future practice and research.

Computer-generated, web-based environments, known as 'virtual worlds', allow for novel and innovative methods of high-quality remote interaction. Virtual worlds have been used in various organisational contexts, including healthcare, though there remains potential for new ways that they may be used to facilitate non-clinical healthcare-related interacitons. This Thesis investigated use of virtual worlds to improve collaboration and engagement in healthcare. Results of research detailed here contribute to new understanding of how interpersonal interactions are altered in a virtual world context, and of drivers, barriers and implications of possible use of virtual worlds in a number of non-clinical healthcare-related contexts, which had not previously been empirically tested.