PHDs face a difficult economic environment as the financing and delivery of health care services increasingly requires providers to adopt commercial business practices. Advertising and other marketing techniques are now viewed as tools to maintain or increase market share and remain competitive. The result is that advertising by health care institutions has become as sophisticated as that used by other industries and is increasingly subject to laws regulating advertising. In order to maintain market share in the face of competition from health maintenance organizations, physician groups and specialty care providers, PHDs have been prompted to abandon the strategy of simply advertising to enhance community image. Instead PHDs are employing advertising and marketing to aggressively promote PHD services within their communities. However, constraints on PHD advertising and marketing do exist and this section explores some of them.