Baseline investigations of folate status in Aboriginal and non-Aboriginal West Australians prior to the introduction of mandatory fortification.

OBJECTIVE: In September 2009, Australia implemented mandatory folic acid fortification of wheat flour for bread-making to reduce the incidence of neural tube defects. Our study aimed to establish baseline folate status data in Aboriginal and non-Aboriginal Western Australians. METHODS: Patients who presented at a health service or collection centre for blood tests were invited to participate. One hundred and ninety-one Aboriginals and 159 non-Aboriginals were recruited between April 2008 and September 2009. Participants completed a five-minute questionnaire and had blood taken for red blood cell (RBC) folate and serum vitamin B12. Data were analysed using SPSS (version 17.0.2, SPSS Inc., Chicago, IL, USA). RESULTS: Ten per cent (95% confidence intervals (CI): 5, 19) of the Aboriginal women participants and 26% (95% CI: 16, 40) of men had RBC folate concentrations below 250 ng/mL, the cut-off associated with folate deficiency. None of the non-Aboriginal women (95% CI: 0, 4) and 4% of the non-Aboriginal men (95% CI: 2, 12) had RBC folate concentrations below 250 ng/mL. All participants were vitamin B12 replete. None of the 96 Aboriginal and 8% of non-Aboriginal women aged 16-44 reported consumption of supplements with a daily intake of >400 µg folic acid during the previous week. CONCLUSIONS AND IMPLICATIONS: This study established a baseline of RBC folate, folate consumption and supplement use in Aboriginal and non-Aboriginal groups. We identified 10% of Aboriginal women and none of non-Aboriginal women participants with low folate concentrations. The higher prevalence of folate deficiency in Aboriginal participants suggests they are more likely to benefit from a universal program of folate fortification.

Health care financing and public responses: use of private insurance in Western Australia during 1980-2001.

OBJECTIVES: The aim was to identify and explain trends and cut points in payment classification (privately insured or otherwise) for episodes of hospitalisation in Western Australia. METHODS: Hospital morbidity data from 1980 to 2001 were used to produce trend lines of the proportion of hospital separations in each payment category in each year in age and clinical subgroups. RESULTS: The most significant changes in payment classification over time were found in all groups between 1980 and 1984, corresponding to a period when free public hospital care in Australia was abolished (Sep 1981 to Feb 1984). The trend associated with this policy change rebounded significantly just before the introduction of Medicare in 1984. These observations were consistent over all age groups except in the oldest group (70+ years). This trend was more pronounced for the surgical subgroup compared with other broad clinical categories. More recently, a trend towards increasing public episodes was reversed from 2000 following introduction of incentives for private health cover and sanctions against deferred uptake in younger people. CONCLUSION: The public appeared to adopt a short-term crisis reaction to major policy change but then reversed towards past patterns of behaviour. The implications for policy makers include the need to understand the underlying culture of the population; to realise that attitudes become fixed as people age; and to recognise the difference in the effectiveness of incentive- and deterrent-based policies.