certain critical workload is necessary to justify ad maintain a clinic or hospital, and without it there is not o@ly increased costs, but frustrated employees who have difficulty|maintaining skills. These appear to be the significant issues in deciding bétween a four atoll versus comprehensive nationwide health plan. The primafy disadvan- tage to the national plan is the stimulated concern of the pe ples from the four that they are not receiving their due advantage in the s rstem. 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 udget. intermittent nature and relatively high costs of these servi s make them difficult to justify long-term however, and’ it may not be goo The to create an impression of preferential services if they cannot be maintai ed. C. Budget The budget which follows reflects an estimate for provi ing health care for the people of the atolls specifically named in 96-2 The divi- Sion primarily affected by this alternate plan is the Divisi of Primary Care and Public Health. divisions The reason for this is that the oth are required to provide services that, to a large extent, mu for the four atolls as well as for a comprehensive health pr be available ram for the entire Marshall Islands. Within the Division of Primary Care and Public Health, showing a decrease are supplies, equipment, personnel cost, he line items ansportation, and maintenance. Offsetting these decreased costs is the additional cost of pwoviding a ship