title: Modeling Health Care Spending Growth of Older Adults.
abstract: To forecast out-of-pocket health care spending among older adults. Long-term forecasts allow policy makers to explore potential impacts of policy scenarios, but existing microsimulations do not incorporate details of supplemental insurance coverage and income effects on health care spending.
  
  
  
  Dynamic microsimulation calibrated to survey and administrative data.
  
  
  
  We augment Urban Institute's Dynamic Simulation of Income Model (DYNASIM) with modules that incorporate demand responses and economic equilibria, with dynamics driven by exogenous technological change. A lengthy technical appendix provides details of the microsimulation model and economic assumptions for readers interested in applying these techniques.
  
  
  
  The model projects total out-of-pocket spending (point of care plus premiums) as a share of income for adults aged 65 and older. People with lower incomes and poor health fare worse, despite protections of Medicaid. Spending rises 40 percent from 2012 to 2035 (from 10 to 14 percent of income) for the median beneficiary, but it increases from 5 to 25 percent of income for low-income beneficiaries and from 23 to 29 percent for the near poor who are in fair/poor health.
  
  
  
  Despite Medicare coverage, near-poor seniors will face out-of-pocket spending that would render them, in practical terms, underinsured.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Hatfield
authors.affiliation: Income and Benefits Policy Center, Urban Institute, Washington, DC.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Favreault
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: McGuire
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chernew
mesh_terms: D000368:Aged; D003198:Computer Simulation; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007182:Income; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D018803:Models, Economic; D012959:Socioeconomic Factors; D014481:United States
keywords: Health care costs; Medicare beneficiaries; health insurance; simulations