cee certain critical workload is necessary to justify and maintain a clinic or hospital, and without it there is not only increased costs, but frustrated employees who have difficulty maintaining skills. These appear to be the significant issues in deciding between a four atoll versus comprehensive nationwide health plan. The primary disadvan- tage to the national plan is the stimulated concern of the peoples from the four that they are not receiving their due advantage in the system. To deal with this, it would seem logical to have their atolls be part of the initial phase of a national plan so they can experience some benefits first. Then eventually the improved health care can spread throughout the remaining atolls. This initial phase for the four could include an extra support package of air and/or ship services, as detailed in the attached budget. The intermittent nature and relatively high costs of these services make them difficult to justify long-term however, and it may not be good to create an impression of preferential services if they cannot be maintained. C. Budget The budget which follows reflects an estimate for providing health care for the people of the atolls specifically named in 96-205. The divi- sion primarily affected by this alternate plan is the Division of Primary Care and Public Health. The reason for this is that the other divisions are required to provide services that, to a large extent, must be available for the four atolls as well as for a comprehensive health program for the entire Marshall Islands. Within the Division of Primary Care and Public Health, the line items showing a decrease are supplies, equipment, personnel cost, transportation, and maintenance. Offsetting these decreased costs is the additional cost of providing a ship