t
C, Follo«-up (as in Option A)
~ Change tertiary care to primary or
secondary care, as available.
in consideration of restraints.
(1)(7)(€9)(10)(11)- Plus
iacreased logisticr
requirements of added care:
i Follow-up: As in Option A ~ plus increased
5
logistic, and manpower required for care...
pxisting Policy
As in Option A - The increased
patient care demanded by Option B
Lf
will require a slight. increase in
and is, therefore, not DOE'sres-
Pa
mo
,
Existing needs and demands ©
agency agreement with DOI could
be reached to provide this supplement. In addition, 1f, under the
“projected needs and demands
"Kwajalein taxes are to paid directly
to.the Marshall Isiands, some fixed
| portion might be diverted to primary medical care under a DOD/Kwaj-
Raley
resulting in increasing population. “ghey Marsiall
are asking for birth control educations ' ™
+
.
to vote for "free association”
Existing Facilities
:
As in Option A - plus the increaseToad oft
further patient care would strain the ‘existing.
a
As in Option A = Plus significant’ decredse no
‘already meager T.T. support of medical’care due
1
£
When:
formerly on Bikini through thi
_ entire screening procedure.
i
1
'
]
a8
As, in:OptionA --but with’
veh
hostility * iticreased coopetation.,”"Pppulatiénundér care, stall t
bed
LOW
operating’polsetee.
Po TK al ORMagence’ I09222b
ra
“ young and old mal
a
i
Total Cost
:
As in Option A
(explaining the c
discussed in the
that this option
Flexibility
There is increz
stationed at Ebey
‘in fact, it woulc
Avoidance of unte
: The added flexi
. Shaky credibilit,
The critical poir
« credibility gap a
' frequently and by
as soon as it is
Risk
The risks to DC
. (publicity, coop:
The risks to ti
disease will be «
* Cost/effectivene:
As in Option A
Timing
‘As in Option A
existing schedul:
The increased screening requirements can be handled b. ‘better |
Demographic Pépulation Characteristics:..
diseases (age and
atherosclerosis i
effort is below t
As in Option A- “but better cooperation will hopefully,TaproveCompitar
This option “4S still below current “operating procedures!" :
We would, actually, nee
_ to cut back on our present
commitments to comply with
Option B, e.g., we have already ™
put almost all of the people
:
The aadberonlldycobee
utilization of manpower, adding one Physician Asst. or nurse practitiéner. na
°
Timing: As inOption A - However,“increased | coverage should raise. eredibilit
As in Option A - plus;
(every 2%5 months) for followup of non-radiation related
- problems (already being done)
1
(13)
(and quality of data).
‘
regular intermittent visits
will be a small increment in the existing screening
program. The added primary and secondary care“and?
follow-up - both short/long term maybe a slgaificant
amount {dependent upon the diseases selected and their prevlance). (Ste:facilities |por
age
if, L
as well).
Manpower:
,
_ groups wherever we can Jocate
Ey
F:syyg
; LO,
.
Der ae ee
"
will be used to d
findings would be
‘\
Screening, care and’
follow-up of exposed and control”
for each health dollar (below minimacia
Mass"
» cheno MiB
(1) (5) (6) (7) (8)
not currently ass
i
ae
Where:
facilities resulting in severely diminishiag™returns
Financial:
As-in Option A — BNL is
active commitment.
How:
—ee en |
rr
mary medical care will probably reduce.mortality’
screening, cate and fol-ow-up.,
them,
Marshall Islend Government agreement.
*” As in Option A - plus an ever inersssing base | a’
‘population - crude growth rate 3% -- Wetter pri- .
‘pranning at_other levels”
y
“free association" agreement the DOD-
As in Option A - Theneed for better-prinary
.
‘eare is evident to many Marshallese. ~They are.
‘currently and have historically, demanded
better care.
As in Option A
to be expanded to
‘ecurrencly exceeding Option BR in ite
ponsibility, perhaps some inter-
it
yfa
VERE oof
’
oop
ae
selected “risk hazard appraisat"
Who:
Performance or re
Ag. in Option A - plus *™
i
elated to primary patient care
As in Option A -"plus current operat
cedures already includes this added group and*
“others.
,
power and logistics (funding).
[Since the increase is directly
ol Ai
a
What:
Selecti
Set forth the cri
t
Treatment:
VY.
attaining the objectives, with!
each approach being stated in!
terms of:
“¢
care center, as available.
’
evelop
to expand’the .
'Restatement of refined objectives
“hoe
care center to primary orsecondary
assistance.
aeke my
Treatment as in Option A for
|
screening data base. The relative improvement’ in
recent health "statistics" should be of"some =.
ad sax correlated high risk diseases.
radiation-related diseases. For all
other diseases change “tertiary"™
as in Optic.-A - plus, need to
“risk tables" (age and sex specific)
j
Develop possible approaches tof
wep oe Cb yed wadugtg 1mfw am
Screening:
pathologic conditions as in Option A
+ plus additional screening for age
a
IV. Analysis
Til, Translation
va bye
Present levels of care
keSercening for radfation-related
8.
‘
te
l
I
Il Constraints
_Esprablish the ideal objectives.
4
f
™~
ake
GPTION B
he deo “tion and treatme..t of radiation-related ciseases plus the care
nd fi; ow-up of patients in the Exposed and Control Groups Found to
have noo-radiation related diseases