Two separate financial reports are depicting growing financial problems for nonprofit hospitals nationwide and in New York, where analysts said hospitals have smaller operating margins and are under greater financial strain than in other areas of the country.

In a report released yesterday on the credit quality of the nonprofit health care sector, analysts from Standard & Poor’s described an increase in negative rating changes and outlooks in the first half of 2008, when they downgraded 31 hospitals and health systems; 11 were downgraded in the first half of 2007. They projected the number of downgrades would eclipse upgrades this year and next.

Analysts cited a laundry list of factors contributing to the trend, including the cost of capital projects, the collapse of the auction-rate market, costly debt restructuring, and operating margins that are being squeezed by a greater reliance on government and self-pay payers.

“They are all chinks in the armor. When you put them together, you can definitely start to see some of the stress on the hospitals,” the director of health care ratings for Standard & Poor’s, Liz Sweeney, said.

She pointed to the shift in the payer mix, adding: “We’re just seeing a host of other issues, particularly since last fall. The investment markets have been really weak and a lot of the nonprofit hospitals have heavy reliance on investment income as part of their budgets.”

In a separate report, Moody’s analysts said that for the second year in a row, the median growth of hospital expenditures outpaced the median growth of hospital revenues. Based on fiscal year 2007 financial data, analysts said the median expense growth rate declined to 7.4% in 2007 from 7.8% in 2006, while the median revenue growth rate fell to 7.2% last year from 7.3% the previous year. The median operating margins dropped to 2.1% in 2007 from 2.3% in 2006, analysts found.

Industry analysts painted a bleaker picture for hospitals in New York.

“Hospitals in New York never do as well financially as hospitals nationally,” the director of health care finance for the United Hospital Fund, Sean Cavanaugh, said. “This is the toughest state, perhaps, in the country to operate a hospital.”

He said one factor was the state’s Medicaid program, which offers generous eligibility standards for enrollees. “By the same token, hospitals are more dependent on payments from the state government,” he said.

Others cited New York’s heavy unionization, the state’s history of regulating the hospital industry, and competition between New York City hospitals, which may profit less than hospitals that have monopolies in their regions.

“The typical hospital in New York is under great strain,” Ms. Sweeney said. “There’s less of a cushion in New York for hospitals to have an unexpected blip.”

Some expressed concern that financial pressure on hospitals could have a ripple effect.

“There are not as many resources to go around,” James Knickman, the president of the New York State Health Foundation, which funds programs to expand health insurance and access to care, said. “The attention of senior management is consumed by dealing with the operating cost pressures as opposed to pushing for innovation.”

Mr. Knickman, who sits on the board of Robert Wood Johnson University Hospital in New Jersey, said that in New York part of the concern comes from the state budget. Last week, the state Legislature passed a budget that cut the state’s health care spending by $127 million this year and by $374 million next year. Some said lawmakers were gearing up for steeper cuts next year.

“The state budget is going to force us to look at how we pay for hospitals and how we pay for health care,” Mr. Knickman said.