Behavioural simulations in health care policy: Current uses and future developments

The process and consequences of change to a health care system can have unintended, detrimental effects. Various types of simulations have been developed in order to try to predict the effects of change in a health care system. Such methods are in widespread use in industrial, military and higher educational institutions. This review essay focuses on participatory behavioural simulations, in which multiple participants are placed into a realistic, interactive simulation environment and asked to respond to a given set of circumstances, such as a change in policy. The processes and outcomes are driven by the actions and interactions of the participants and not by chance, allowing participants to see the consequences of their actions in a safe environment. The use of simulation in health care policy is presented, together with the evidence for its contribution to policy prediction, education and behaviour change among those designing and implementing health care policies. A method based on best evidence for design, implementation and evaluation of future simulations and participants is proposed.