Can pharmacare reduce suicide-related behaviors? A quasi-experimental study in Ontario youth

Canada's Ontario Health Insurance Plan Plus (OHIP+), implemented in 2018, provided universal prescription drug coverage to youth under 25. Because youth face elevated risks of suicide-related behaviors (SRBs) and frequently encounter cost-related barriers to accessing mental health medications, this study evaluated whether OHIP + impacted emergency department (ED) visits for SRBs among Ontario youth.

We used linked data from the 2016 Canadian Census and the National Ambulatory Care Reporting System, identifying SRB-related ED visits between April 2016 and March 2020. A single interrupted time series (ITS) and a comparative ITS (CITS) with Coarsened Exact Matching were employed to assess changes in SRB-related ED visits associated with the implementation of OHIP+. The CITS compared low-versus high-socioeconomic status (SES) youths, based on the assumption that low-SES youths are more likely to benefit from public drug coverage due to greater financial barriers.

OHIP + implementation was associated with an immediate reduction of 9.4 SRB-related ED visits per 100,000 youth per month (95% CI: -18.2 to -0.6). In the CITS analysis, low-SES youth experienced a significantly greater reduction compared to high-SES youth (difference: -19.6; 95% CI: -37.7 to -1.5). Sex-stratified models indicated that these effects were driven primarily by reductions among females.

Public drug coverage through OHIP+ was associated with a significant reduction in ED visits for SRBs, particularly among low-income and female youth. Our findings underscore the potential of pharmacare to reduce acute mental health crises and promote health equity among vulnerable youth.