1! XIII. Utilization of United States Public Health Service Alternative It was requested that costs be developed for having an agency such as United States Public Health Service implement and provide comprehensive health care for the Marshall Islands. It would be presumptious to assume that costs could accurately be defined for a USPHS program. In develop- ing a cost difference, it was assumed that the basic program, equipment, supply levels, and facilities would be the same as considered in developing the other budgets. The area where major cost differences would occur was felt to be in Personnel Cost. Again, it is not known specifically how USPHS would staff the program but, the estimate for cost increase with a USPHS administered program for the first year is approximately $225,000 increasing to $466,560 in the fifth year. This would be true of both the comprehensive program and the four atoll program. In addition to the higher cost is the consideration of program acceptability to the Marshall Islands. Without exception, each areaof investi- gation concluded that U. S. skill levels were desired but the Marshall Islands did not want a "U. S. administered program". While this attitude cannot be quantified, it certainly would have an affect on the utilization of the program with a resulting effect on the benefit for the dollars invested. Because of higher costs and, more importantly, the unacceptability of this alternative, it is recommended that it not be given serious consideration.