The next health commissioner of New York won’t be Governor-elect Spitzer’s top choice for the job.

Shortly before and after the November election, Mr. Spitzer’s team of advisers made an aggressive pitch to Dr. Benjamin Chu, a veteran public health administrator who ran New York City’s Health and Hospitals Corporation during Mayor Bloomberg’s first term.

Dr. Chu, who surprised many when he left his post at the HHC in early 2005 to become president of the Southern California Region of Kaiser Foundation Health Plan and Hospitals, said he told the Spitzer transition team that he wasn’t interested in the job.

“People were calling to see if I was interested,” he told The New York Sun in a telephone interview. “Basically, it didn’t get to the point where it was offered. If I was interested, it would have been a serious candidacy.”

Dr. Chu said it was too soon to leave Kaiser Permanente, where he oversees 11 medical centers, 47,300 employees, 3,600 physicians, and a budget reported to be more than $11 billion. “It’s less than two years. I couldn’t do that to Kaiser Permanente. Maybe if it was two to five years later,” he said.

In recent weeks, several candidates have emerged as possible picks for the job, including Dr. Jon Cohen, who stepped down as the chief medical officer at North Short-Long Island Jewish Health System in August, and the city’s health commissioner, Thomas Frieden, who pushed for the ban on trans fats in city restaurants.

Health care sources say Mr. Spitzer has had personality differences with Dr. Cohen and has been unable to persuade Dr. Frieden to leave the Bloomberg administration. Sources say Arthur Klein, New York-Presbyterian Hospital’s chief operating officer, has emerged as a leading candidate.

Mr. Spitzer is expected to announce more appointments this week. A spokeswoman for Mr. Spitzer, Christine Anderson, said yesterday that she didn’t know if the governor-elect has settled on a candidate for the job.

Mr. Spitzer’s health commissioner is expected to play a crucial role in his administration, being put in charge of carrying out Mr. Spitzer’s sweeping health care agenda. Mr. Spitzer has vowed to cut costs in health care and extend health coverage to hundreds of thousands more children. He has called for putting more focus on managing chronic diseases and lowering the cost of prescription drugs.

Most important, the commissioner will be responsible for executing the recommendations made by the Commission on Health Care Facilities in the 21st Century, which called for the closure of five city hospitals and four upstate hospitals and proposed plans for mergers and conversions of 48 hospitals. The recommendations will become law on January 1; they are required to be implemented within 18 months.

As chief of the city’s hospital system, Dr. Chu aggressively pushed for more capital spending and added services to bring the HHC in league with private hospitals. He equipped every hospital with MRIs, installed a Computerized Physician Entry Order that replaced handwritten doctors’ orders, and put in place a digital imaging system that made X-rays and EKGs instantly accessible on a computer screen.