Design, Validation, and An Application of the Future Adult Model

A Dynamic Microsimulation Model of Health-Related Outcomes in the United States

by Bryan Tysinger

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This dissertation describes, validates, and utilizes the Future Adult Model (FAM), a dynamic microsimulation model developed for policy analysis of health and health-related outcomes. FAM is based on the Panel Study of Income Dynamics and projects health risk factors (e.g., smoking, body mass index), health outcomes (e.g., diabetes, functional limitations), and health-related economic outcomes (e.g., employment, disability benefits). The first paper describes the model, targeting the description to an audience of model consumers and users. The second paper focuses on the internal consistency and external validity of two key outcomes in FAM: body mass index and diabetes. Internal consistency is assessed by comparing a decade of projections to the host PSID data. External validity is assessed comparing to Behavioral Risk Factor Surveillance System data. The third paper utilizes FAM to assess the potential fiscal consequences of health innovation in the US over the next three decades. This analysis includes analyses of Social Security Old Age and Survivor's Insurance, Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid expenditures, as well as revenues from federal and state taxes. Prevention of any of the chronic diseases considered could result in fiscal savings, with the largest savings for hypertension prevention. Though the potential savings of disease prevention are large, they are no panacea for solvency issues facing entitlement programs like Medicare and Social Security.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    The Design of the Future Adult Model: A Life Course Dynamic Microsimulation

  • Chapter Three

    Validating risk factor and chronic disease projections in the Future Adult Model

  • Chapter Four

    The Long-Term Fiscal Benefits — and Costs — of Better Disease Prevention

  • Chapter Five

    Conclusion

  • Appendix

Research conducted by

This document was submitted as a dissertation in June 2021 in partial fulfillment of the requirements of the doctoral degree in public policy analysis at the Pardee RAND Graduate School. The faculty committee that supervised and approved the dissertation consisted of Roland Sturm (Chair), Dana Goldman, Emmett Keeler, and Jay Bhattacharya.

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under award number P30AG024968, the Peter G. Peterson Foundation, the Ford Foundation, and the Leonard D. Schaeffer Center for Health Policy & Economics.

This report is part of the RAND Corporation Dissertation series. Pardee RAND dissertations are produced by graduate fellows of the Pardee RAND Graduate School, the world's leading producer of Ph.D.'s in policy analysis. The dissertations are supervised, reviewed, and approved by a Pardee RAND faculty committee overseeing each dissertation.

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