Health law: balancing legal, economic, and ethical concerns.

• Author: Pankau, Barbara R.
• Position: Florida

In March 1984, The Florida Bar Journal published its first issue devoted to health law issues. The comments in the introduction referred to the vast size of the health care industry and its prevalence in Florida. Florida has a large elderly population, and most health care is delivered in the last years of life.

Other comments were that Congress and state legislatures were struggling to address issues emerging from the dynamic health care industry, including reconciliation of cost control with delivery of quality of care. The 1984 introduction mentioned that health law attorneys also were struggling to respond to rapidly changing industry conditions and to digest the pervasive and ever changing legislative and regulatory requirements.

The more things change, the more they stay the same. Today, legislative and regulatory activity is prolific. Industry change and development are profound. The authors in this issue of the Bar Journal have endeavored to address some of the prevalent, current issues which confront health care lawyers in this last decade of the 20th century. The breadth of the topics reflects the diversity of the health care specialty. We congratulate the authors who have provided an excellent survey of complex issues, despite stringent page limitations.

In this regard, some consider provider consolidation to be the prevalent movement in the health care industry today. Stuart Lock, man and Tracy Silverman discuss some of the creative methodologies health care attorneys have devised to satisfy client needs in this area in "Formation of Hybrid-Type Organizations: Virtual Mergers of Healthcare Systems." This article acknowledges that "hybrid type organizations" (HTOs) such as "joint operating agreements" are complex and challenging to structure. It discusses ways to accomplish appropriate structures and mentions the benefits such HTOs offer health care systems as attractive alternatives to more traditional forms of consolidation.

Steve Siegel writes about affiliations among individual providers in "Consolidation of Physicians and Other Noninstitutional Providers." Among other issues, Attorney Siegel discusses motivations for consolidation and the providers' concerns (such as loss of autonomy) and ways to resolve the concerns. His article surveys the forms of consolidation in the affiliation continuum, including independent practice associations, management services organizations, and group practices.

In their article "Managed Care...