would greatly enhance health care in the outer islands. A second optéon would be to depend upon the Marshall Islands HMO to deliver the basic health care delivery and to superimpose upon that system intermittent medical field trips. These field trips could be mounted very much like the Brookhaven quarterly field trips but would of course require visiting a number of new atolls. It would appear in this option that basically two identifiable populations exist. They are (1) those people who have received significant acute and possibly long term low level radiation, e.g., Rongelap, Ailignae and Utirik, and (2) all other atolls which have received above ambient Micronesian background radiation or who have people with a legitimate claim for health care under the mandates of this bill. Under this option it would probably be advisable for the BNL medical program to continue to monitor the acute exposed population and if requested, to act as a consultant group to such other support agencies as would require their expertise. It would seem desirable to identify a second field survey group without a nuclear identity, such as the Public Health Service or a coalition of universities who could mount periodic health care visits to the remaining atolls.. BNL has been working on developing such an affiliation over the last year with a group of universities in the Los Angeles area including the University of Southern California, UCLA and Loma Linda University (the College of Medical Evangelists). That group could work in coordination with or independently from the Public Health Service should they become the responsible agency. From a practical standpoint it would be impractical and fiscally unwise to attempt to develop a-"westernized health care system" in the Marshall Islands. The reasons for this I think are amply demonstrated in the liter- ature citing the problems of developing a cost-effective health care delivery system in a third world nation. 90003491 A basic text dealing with this specific -6-