Under Option E, the Marshall Isiands health care system would assume full responsibility for detection, Rx and follow-up of radiation-related diseases, as . well as primary care.* We would suggest some initial interdepartmental funding to support whichever option DOE/DOI desires until the status of the "free association" is clarified. After a responsible governing body is identified in the Marshalls, a new "sharing" of primary and secondary health costs might be negotiated with the Marshalls, that would direct an adequate percentage of their budget into health care. We feel the medical administrative expertise does not currently exist. in - the Marshalls to implement and man this new system and would strongly urge the interested parties to obtain the best available health care system analyst ta develop realistic cost/effective short and long-term plans for adequate health care with existing and expected resources. | This is the optimum time to perform this type of study and planning and the outcome will greafMly influence the scope of the BNL medical effort. Serious consideration should be directed toward the utilization of existing expertise in deve loping health care systems for the South Pacific. * Southern California, Loma Linda, The University of and UCLA have * developed well-recognized and highly-effective programs to deal with many of the basic problems confronted by the Marshall Islands. Those problems are basically a maze of anthropolgic and sociologic characteristics determining the health status of the society and each individual. We feel a multidisciplinary approach to restructuring the health care system will be the most cost/effective method in the long run. The University of Southern California has expressed an interest 11