Turning 65 in Ontario: the impact of public drug benefit coverage on hospitalizations for acute and chronic disease.

Ongoing access to medication is required for the management of many chronic diseases. We sought to examine the health impact of entering the provincial drug benefit plan at age 65 years. We constructed cohorts of same-aged individuals with incident heart failure, with diabetes and from the whole population using administrative data. The hazard of hospitalization at a given age compared to one year younger for ages 63 to 67 years was determined. On turning age 65, persons were more rather than less likely to be hospitalized for diabetes and acute infection when compared to the prior year. Among residents of low-income neighbourhoods these effects were no longer significant, but the risk of hospitalization for heart failure was increased. A similar effect was not observed for the paired cohorts at the transition from age 63 to 64 years. A health benefit of obtaining drug insurance was not observed in this study; however, the relationship may have been confounded by the effects of retirement and other changes occurring at age 65. Moreover, a benefit experienced by only a small proportion of the population may not be apparent in this analysis, which included many individuals unaffected by the policy.