Dynamic Microsimulation of Health Care Demand, Health Care Finance and the Economic Impact of Health Behavior Part II: Survey and Review

Interim Reports on work of the International Institute for Applied Systems Analysis receive only limited review. Views or opinions expressed herein do not necessarily represent those of the Institute, its National Member Organizations, or other organizations supporting the work. Abstract This report is the second part of an investigation of the potential of dynamic microsimulation for modeling and projection of health care demand, health care finance and the economic impact of health behavior. While the first part (Spielauer, 2002) provided a theoretical and methodological background of dynamic microsimulation in this research area and compared the microsimulation approach with the cell-based macro-approach, this paper contains a survey of existing microsimulation projects and draws some conclusions with regard to health care modeling. The purpose of this survey is to capitalize on the expertise acquired by what is now more than 40 years of dynamic microsimulation model development with regard to modeling health care demand, health care finance and the economic impact of health behavior. Based on literature research, 33 dynamic microsimulation projects were identified for which documentation is available. While a short description and classification of these projects is given in the appendix of this report, 9 projects are reviewed in more detail. All of these 9 models include health-related variables, however, the range of health-related issues that can be studied using these models varies widely, as health is not the central focus of the majority of the models. Consequently, this review does not exclusively concentrate on the treatment of health issues in microsimulation models, but the selection of models was also made with the intention to cover most approaches towards dynamic data-based microsimulation with regard to the general structure and modeling options. The review focuses on the modeling of demographic and health behaviors and on the way these models are integrated into the whole model structure, including policy and accounting issues. After giving a brief description of each of the selected models, the modeling approaches are summarized and commented by means of five distinguished criteria. These are the use of alignment techniques, the model's complexity and range of variables used, the theoretical foundation of the model, the type of starting population used, and the extent and detail of financial issues covered. The conclusions are then summarized in a series of " lessons " that can be learned from existing projects.