In the last few years, several private hospitals in the city have closed, filed for Chapter 11, had their bond status downgraded, or sold off major assets to raise cash.

While the financial status varies widely at the 73 hospitals in the city, those in the industry say fiscal pressures are mounting on the facilities, which are not generally known for their business acumen.

“There are a lot of hospitals in New York that are operating with no cushion,” the director of health care ratings at Standard & Poor’s, Liz Sweeney, said. “They’re operating with enough cash to make maybe the next payroll.”

In the last few weeks, Fitch Ratings and Moody’s Investors Service downgraded the credit rating at Lenox Hill Hospital on the Upper East Side to junk status.

At the same time, St. Vincent’s Catholic Medical Centers, the city’s largest Catholic hospital network, and the Brooklyn Hospital Center, a 464-bed facility in Kings County, are struggling to pull themselves out of bankruptcy.

St. Vincent’s, which has already shut down or decided to shut down at least three of its hospitals (including St. Mary’s in Brooklyn, the most recent to be put on the chopping block),has been battling with the union that represents many of its employees.

Earlier this week, Local 1199 took out a full-page newspaper advertisement criticizing the institution for “heartlessly and cruelly” dismantling services and paying fat salaries to new executives brought in to help turn around the institution. A spokesman for the hospital, Michael Fagan, said the executives were hired because of their expertise in “reorganization” and that their salaries reflected their skills.

While private, nonprofit hospitals in New York City have done worse financially than their counterparts in other parts of the country for the last several years, Ms. Sweeney said a number of positive bond ratings have been issued lately.

An S&P report on Mount Sinai Medical Center and New York University Medical Center found that in the first six months of 2005, the facilities generated income and were on pace to turn a profit for the first time in five years.

Between January and June, they recorded a $16.8 million profit, compared with a multimillion-dollar loss the year before. S &P attributes the improvements to a slight increase in patient volume, more sound business practices, and higher managed-care reimbursements.

The institutions are in the process of a financial separation.

Hospital trade groups, however, paint a bleak picture, pointing to decreased government reimbursement rates, increased costs for everything from new equipment to medical malpractice premiums, and a host of other problems that have spiraled since the Health Care Reform Act of 1996 deregulated the industry. Earlier this week, the Healthcare Association of New York State announced that hospitals statewide lost $127 million in 2004, marking the seventh consecutive year of losses.

“Financial difficulties have been exponential in the last couple of years,” the president of the Greater New York Hospital Association, Kenneth Raske, said. “We have had one hospital after another that has either closed or filed for bankruptcy, the likes of which we haven’t seen” in years.

Hospitals have been laying off employees, closing facilities, and selling assets to trim some of the fat, and industry sources said they expect that there will probably be some more of that in coming years.

Mount Sinai, for example, sold an apartment building it owned for $60 million in 2004. The Continuum Health Partners, which includes Beth Israel Medical Center, sold a 14-story hospital on the Upper East Side for $185 million.

Governor Pataki has convened a task force to review the “health care capacity and resources” in the state. The Commission on Health Care Facilities in the 21st Century will assess everything from the Medicaid reimbursement system to the number of beds. The commission is charged with making recommendations by December 2006 on how to deal with those problems.

The chairman of the task force, Stephen Berger, said the current system encourages hospitals to move into more lucrative (and competitive) specialty areas, like complicated cardiac and thoracic surgeries. Restructuring the system to address those issues and others will be crucial, he said.

Others agreed, and said that smaller community hospitals that serve poor populations, like St. Vincent’s non-Manhattan hospitals, will continue to hemorrhage money if changes aren’t made.

They say it may boil down to redefining how health care is delivered. Mr. Berger said the public often wants an emergency room in their neighborhood in case “my kid breaks his leg in the middle of the night,” but that having seven floors on top of the emergency room does not always make sense.