~ll- of screening is to invite patient dissatisfaction, litigation, loss of credibility and poor medical practice. We have emphasized the problems inherent in "expanded" screening because the research goais of the radiation related diseases are clearly defined in the "189", but the “expanded health care program" is relatively undefined. We have attempted to define the basic "189" in Option A and the spectrum of "expanded health care programs" in options B through D. The synthesis we are attempting to achieve is the full. mandate of Option A, plus as much of Option Db as is feasible under present jurisdictional and funding constraints. DOE clearly has responsibility for Options Aand B and the Trust Territories (under DOI) the remainder of primary and secondary care under Options C and D. However, with the new movement to "free association" the responsibility will shift to the administration and people of the Marshall Islands. 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 healti 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 tc implement and manage this new system and would strongly urge the interested parties to obtain the best available health care system analyst to 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 greatly influence the scope of the BNL medical effort. Serious consideration should be directed toward the utilization of existing expertise in developing health care systems for the South Pacific. §052230 The University of