When Ontario made prescription medications free for people under 25, the goal was to improve access to care. New research suggests it also helped prevent some youth mental health crises before they escalated.
In 2018, OHIP+ was launched to provide public drug coverage for youth, helping overcome financial barriers to prescription medications for those under 25.
For Antony Chum, an associate professor in 91ɫ’s who studies how public policy shapes health outcomes, it also created what he describes as a "natural experiment" – an opportunity to track differences before and after free drug coverage was introduced. He examined this "experiment" alongside postdoctoral researchers Peiya Cao and Yihong Bai, as well as PhD student Kristine Ienciu.
“We wanted to see if removing financial barriers and providing free prescriptions to those under 25 actually translated to a reduction in acute, life-threatening mental health crises,” says Chum, who is also a Canada Research Chair in Population Health Data Science, adding the team focused on emergency department visits of suicide-related behaviours.
The study, published in , draws on linked census and health care data to analyze emergency department visits between 2016 and 2020 that document suicide and self-harm behaviours among Ontarians aged 19 to 24.
The researchers tracked monthly rates of these visits before and after OHIP+ was introduced, using statistical models to isolate the policy’s impact from underlying trends. They compared outcomes between lower- and higher-income individuals to assess who was most affected, and applied matching techniques and additional tests to ensure the results were robust.
At the conclusion, Chum says he and his team were surprised by the results, which showed that after OHIP+ was introduced, there was a significant and immediate drop in emergency department visits related to suicide and self-harm – a change that was faster and larger than expected.
Looking more closely at the results, the researchers also found notable reductions among young people considered high risk, including those with a history of mental health diagnoses or prior suicide-related behaviours. The effect was also more pronounced among lower-income youth, who are more likely to face cost barriers to medication, and among young women, who tend to use mental health services at higher rates and may be more likely to benefit from improved access to treatment.
The findings suggested OHIP+ had its strongest influence on those who needed it most, says Chum.
“It shows that public investments in drug coverage pay off in profound ways,” he says, adding the most notable impact may be in prevention of mental health emergencies. “Better access to medication may help stabilize symptoms earlier, reducing the likelihood that someone reaches a crisis point requiring emergency care.”
Chum notes the findings require further study to understand the effect of changes to the system. In April 2019, OHIP+ was revised to restrict eligibility to youth without private insurance, shifting the program from universal to more targeted coverage. That change raises important questions about how it may have influenced the results observed here and whether the early gains seen under full coverage were sustained, weakened or reversed.
Nonetheless, he hopes the study clarifies how reducing cost barriers can improve health outcomes, particularly as Canada advances pharmacare legislation, including plans to provide universal, first-dollar coverage for certain contraceptives and diabetes medications.
“We hope this research provides timely evidence as Canada moves forward with broader national pharmacare reforms,” says Chum. “We want policymakers to see that expanding pharmacare is an essential, effective part of Canada’s youth mental health strategy.”