This topic has discussed the options available to PHDs in responding to the rapidly changing health care marketplace and regulatory environment. Service diversification, geographic expansion and collaborative activities each offer mechanisms for PHDs to thrive in the new environment and to continue to provide the best possible care to the residents of their districts.

As PHDs move toward implementing strategies to respond to health care reform, any specific strategy should be explored with the assistance of legal counsel. It is hoped that this document will help districts in identifying these options and legal counsel in framing their specific legal opinions.