Evaluating the impact of Pharmacare on youth with mental health needs: a regression discontinuity analysis of unmet health care and life stress

BackgroundCanadas youth are facing mental health crises due to barriers in accessing timely and affordable care. Ontarios OHIP+ pharmacare program, introduced in 2018, provided free prescription drug coverage to individuals under 25. While OHIP+ increased prescription use, its effects on perceived access and well-being among youth with mental health needs remain unclear. MethodsWe used a regression discontinuity design leveraging the OHIP+ age-eligibility cutoff at 25 to estimate its causal impact on unmet health care needs and self-perceived life stress. The sample included Ontario respondents aged 20-29 (n=1,053) from the 2018-2019 Canadian Community Health Survey who reported needing mental health support. Outcomes were self-reported unmet health care needs and a 5-point life stress scale. Models adjusted for sociodemographic factors and used age in months as the running variable. ResultsLoss of OHIP+ eligibility at age 25 was associated with a 19.0 percentage-point increase in the probability of reporting unmet health care needs (95% CI: 0.5 to 37.6 percentage points) and a 1.33-point increase in perceived life stress (95% CI: 0.45 to 2.21). These effects were consistent across subgroups and robust to multiple sensitivity tests. ConclusionOHIP+ improved access and reduced stress among youth with mental health needs while coverage was in place. However, the abrupt loss of eligibility at age 25 increased unmet needs and psychological strain, underscoring the need for continuous, inclusive pharmacare to support youth well-being. What is already known on this topicPublic drug coverage programs such as OHIP+ have been shown to increase prescription drug use among youth in Ontario, Canada. However, little is known about whether such programs improve patient-perceived outcomes. Existing evaluations have largely relied on descriptive data or aggregate prescribing trends, with few studies examining individual-level outcomes using quasi-experimental methods. What this study addsUsing a regression discontinuity design, this study provides the causal evidence that the OHIP+ pharmacare program reduced unmet health care needs and life stress among youth with perceived mental health concerns while they remained eligible for coverage. The findings show that the abrupt loss of eligibility at age 25 was associated with increased unmet needs and heightened stress, suggesting that age-based cutoffs in drug coverage may disrupt care and contribute to psychological strain during a critical life stage. How this study might affect research, practice or policyThis study suggests that universal drug coverage programs should ensure continuity through young adulthood to avoid worsening access gaps. The findings support the need for a national pharmacare framework that promotes equitable and sustained health support.