The Future Elderly Model

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. Developed by Dana Goldman and his colleagues at the Roybal Center, the model uses a representative sample of approximately 100,000 Medicare beneficiaries age 65 and over drawn from the Medicare Current Beneficiary Surveys, national surveys that ask Medicare beneficiaries about chronic conditions, use of health care services, medical care spending, and health insurance coverage. Each beneficiary in the sample is linked to Medicare claims records to track actual medical care use and costs over time.

Read More About the History of the FEM

In September 2005, the journal Health Affairs published a special supplement that featured analyses based on the FEM. Entitled "Health and Costs of the Future Elderly," this special collection of papers examines on a topic central to both health policy and public finance: the evolution of Medicare spending as the U.S. population over age 65 continues to grow during the next quarter-century. The papers focus on issues that are key to understanding this evolution: the health status of Medicare beneficiaries over time and the relationships between technological progress and health spending.

For a summary of these papers, read the RAND research brief:

Modeling the Health and Medical Care Spending of the Future Elderly -- 2008

Dana P. Goldman, David M. Cutler, Paul G. Shekelle, Jay Bhattacharya, Baoping Shang, Geoffrey F. Joyce, Michael Hurd, Dawn Matsui, Sydne Newberry, Constantijn (Stan) Panis, Michael W. Rich, Catherine K. Su, Emmett B. Keeler, Darius N. Lakdawalla, Matthew E. Chernew, Feng Pan, Eduardo Ortiz, Robert H. Brook, A. M. Garber, Shannon Rhodes
Research Brief

To browse these papers, see the links below.

Health and Costs of the Future Elderly

Health Affairs Web Exclusive September 26, 2005

Goldman DP, Shang B, Bhattacharya J, Garber AM, Hurd M, Joyce GF, Lakdawalla D, Panis C, Shekelle P. Consequences of Health Trends and Medical Innovation for the Elderly of the Future, Health Affairs -- Web Exclusive, September 26, 2005, pp. W5-R3-W5-R15.

Read the Articles at

Joyce GF, Keeler EB, Shang B, Goldman DP. The Lifetime Burden of Chronic Disease Among the Elderly, Health Affairs -- Web Exclusive, September 26, 2005, pp. W5-R16-W5-R27.

Read the Articles at

Lakdawalla DN, Goldman DP, Shang B. The Health and Cost Consequences of Obesity Among the Future Elderly, Health Affairs -- Web Exclusive, September 26, 2005, pp. W5-R28-W5-R39.

Read the Articles at

Featured Research

Modeling the Health and Medical Care Spending of the Future Elderly

Medical innovations will improve health and extend life, but they will probably increase, not decrease, Medicare spending. Better prevention and the elimination of obesity could save Medicare money and improve health.

Research Brief (PDF)

Research Areas and Projects

Understanding the relationship between health status and lifetime spending

  • The Future Elderly Model
  • Rising Medicare Expenditures for the Oldest Medicare Beneficiaries
  • The Lifetime Burden of Chronic Disease Among the Elderly
  • Functional Status, Health, and Health Care Costs among the Elderly
  • Health and Medical Spending of the Near Elderly
  • The Consequences of Obesity for Older Americans

Prescription drugs and Medicare Part D

  • Welfare Analysis of Medicare Part D
  • The Value of Pharmaceutical Innovations for the Elderly: The Case of Antidepressants
  • The Economic Impact of Pharmacogenetics

Protecting the vulnerable elderly

  • Nursing Home Workforce Dynamics and Quality of Care
  • Eligibility for Comprehensive End of Life Services: Developing and Piloting a Method
  • Adverse Selection, Population Aging, and the Market for Supplementary Health Insurance
  • Tools for Efficient Allocation of Fall-Prevention Resources
  • Who Will be Available to Support the Elderly? Welfare-State Policy, Fertility, and Population Age Structure
  • Health Impacts of Retirement

Learn More

Research Products

RAND Roybal Center for Health Policy Simulation has a variety of policy tools / simulation tools, funded grants, publications, and presentations available.

Learn More

Selected Testimony

Prevention and Public Health: The Key to Transforming our Sickcare System -- 2008

Kenneth E. Thorpe
Testimony to the U.S. Senate Committee on Health, Education, Labor, and Pensions Hearing December 10, 2008.
Thorpe used results from the RAND Future Elderly Model to support reducing Medicare costs through lifestyle interventions.
Read the Testimony at

Selected Publications

Pharmacy Benefit Caps and the Chronically Ill -- 2007

Joyce GF, Goldman DP, Karaca-Mandic P, Zheng Y Health Affairs, 26(5), 2007: p.1333-1344. Read the Abstract at


  • Study on Extending Exclusive Access to Clinical Trial Data First to Estimate Impacts

    Goldman et al. publish new study in January Health Affairs demonstrating that extending the data exclusivity term for conventional drugs would positively impact innovation, longevity and social welfare.

  • Study Finds Higher STD Rates Among Users of Erectile Dysfunction Drugs

    Anupam Jena, M.D. and Dana Goldman, Ph.D. analyzed 1.4 million insurance records of men over 40 and found that those who used ED drugs were more likely to have STDs than non-users. Results suggest counseling on safer sex practices important for older men.

  • How To Live 100 Years

    For TIME, Dana Goldman et al. use their innovative Future Elderly Model to simulate an hypothetical long-life pill, getting dramatic economic and health spending results.

  • USC & RAND Economists Win Garfield Prize
    USC & RAND Economists Win Garfield Prize Darius Lakdawalla and his co-authors received the 2009 Eugene Garfield Economic Impact on Medical and Health Research award for their study on how methods to lower drug prices affect medical innovation and, ultimately,...