Health insurance for Americans approaching age sixty-five: an analysis of options for incremental reform

This article provides a systematic evaluation of the options for incremental health insurance reforms aimed at older Americans nearing age sixty-five. It presents three basic arguments for giving special consideration to this age group: (1) early retirement and its effect on access to employer insurance; (2) changes in health and health care expenses associated with increasing age; (3) the vulnerability to unexpected economic or health "shocks" that will affect people throughout their retirement. The analysis of policy options begins by specifying criteria for evaluating alternative approaches to reform. The proposed criteria emphasize that reforms for this age group should be designed to fit with other financial plans and decisions made during such a transitional stage of life. Policy options should be judged according to fundamental goals such as equity and efficiency, not simply ranked according to the number of uninsured who will gain coverage. After offering a comprehensive catalog and evaluation of available options, the analysis identifies and discusses a preferred approach-which preserves choices while offering universal and subsidized access to Medicare before age sixty-five.     

Patterns of Practice in Mental Health Courts: A National Survey

Mental health courts (MHCs) represent an important new development at the interface of the criminal justice and mental health systems. MHCs are criminal courts for persons with mental illness that were in part created to divert this population from jail/prison into community treatment. MHCs are proliferating rapidly despite limited knowledge regarding their characteristics or their efficacy. We surveyed the entire population of adult MHCs in the United States, n = 90. In the past 8 years, MHCs have been created in 34 states, with an aggregate current caseload of 7,560 clients in MHCs nationally. Most courts (92%) reported using jail as a sanction for noncompliance, if only rarely. Further, jail sanction use was significantly predicted by increased judicial supervision and number of felons in the court. Implications for MHCs and social monitoring are discussed.     

Adolescent sexual activity and pregnancy: Socioenvironmental problems,physical health,and mental health

This paper examines the association between adolescent pregnancy and socioenvironmental, physical, and mental health problems in 1590 inner-city females aged 13–18 who use health clinics. Adolescents who have become pregnant, those who are sexually active but never have been pregnant, and those who are sexually inactive are compared. The sexually active youngsters come from more psychosocially disadvantaged backgrounds than their sexually inactive peers; the sexually active girls who become pregnant come from more psychosocially disadvantaged backgrounds than those who have never been pregnant. Despite this, the youths who have become pregnant do not have more current relationship problems, more stressful life events, or worse physical health than the never-pregnant sexually active youths. Although sexually inactive youths have the lowest rates of mental health problems, adolescents who have been pregnant have lower rates of anxiety and conduct disorder symptoms than those who are sexually active but never pregnant.Supported by the Robert Wood Johnson Foundation. Fieldwork conducted by Survey Research Associates.Research interests include adolescents and children, parenting, and families.Research interests include epidemiology of child and adolescent psychiatric disorder.Research interests include psychiatric epidemiology/deviant behavior.Research interests include mental health and statistical issues.Research interests include health behavior and mental health issues.