RAND Roybal Center for Health Policy Simulation

Understanding the relationship between health status and lifetime spending

The Future Elderly Model (Dana Goldman)

The Future Elderly Model (FEM) is a demographic and economic simulation model designed to predict the future costs and health status of the elderly and explore what current trends or future shifts imply for policy.

Rising Medicare Expenditures for the Oldest Medicare Beneficiaries (Melinda Beeuwkes Buntin)

This development pilot will explore the seemingly paradoxical trends of declining disability and increasing expenditures among the oldest Medicare beneficiaries. We will examine the trends in Medicare payments by disability status, disease status, type of service, and age and interactions among these variables over the period 1993-2002. If warranted, we will modify RAND's Future Elderly Model to reflect our findings.

The Lifetime Burden of Chronic Disease Among the Elderly (Geoffrey Joyce)

The high cost of treating chronic disease suggests that reducing their prevalence would dramatically improve Medicare's financial stability. This pilot will examine the impact of selected chronic diseases on the distribution of health care expenditures and the variation in spending over the course of disease. We use a microsimulation model to estimate the impact of these conditions on life expectancy and health care spending from age 65 to death.

Functional Status, Health, and Health Care Costs among the Elderly (Hao Yu)

This research pilot will examine how transitions among functional statuses affect nursing home entry and health care costs by the elderly. The goal is to best predict transitions into nursing homes and various functional states to better identify the elderly who might be candidates for intervention.

Health and Medical Spending of the Near Elderly (Federico Girosi)

The Future Elderly Model (FEM) studied the trajectories of health status and health expenditures for Americans over age 65. This research pilot will extend the FEM to Americans over age 51 to provide a clearer picture of the evolution of health for a large portion of the population. The model will then be used simulate changes in lifestyle and the health care system-e.g., the consequences of smoking cessation for health and solvency of programs such as Social Security and Medicare.

The Consequences of Obesity for Older Americans (Darius Lakdawalla)

This pilot will examine the consequences of obesity for cohorts of the elderly and near elderly. The specific aims are: (1) Further develop the FEM microsimulation model to include BMI as a time-varying health state. We will then develop estimates of how changes in BMI trends affect spending, health status, and functional status of the population over age 65; and (2) Extend the model to the population of all Americans born prior to 1941 and add a richer set of socioeconomic (SES) measures, and add cognition as a health outcome.