ALBANY— A state commission yesterday recommended broad health care policy changes that could turn State University of New York hospitals and county nursing homes over to the private sector, and create “hybrid” health clinics in the place of hospitals that close.

But the state Commission on Health Care Facilities in the 21st Century wouldn’t say if it also decided on its most important duty: Recommending what hospitals and hospital wings and services should closed. A Commission spokesman, David Sandman, said the politically contentious closings will be announced next week, but he wouldn’t answer when asked if that decision had been made.

Mr. Sandman said the law creating the commission requires closed-door sessions when specific facilities are discussed. “That is a legal requirement,” he said.

“We would be concerned, if as alleged, the commission violated Open Meetings Law by debating and voting on a hospital closure plan in private,” said a spokeswoman for Assembly Speaker Sheldon Silver, Eileen Larrabee.

“This may be the only time the public has a chance to respond to the plan’s recommendations,” said Blair Horner of the New York Public Interest Research Group. The decision “may have a life-and-death result on the public and they should have a chance for public debate.”

The commission appointed by Governor Pataki to rein in Medicaid and other health care costs provided a map for a more efficient health care system. Its recommendations include:

• Universal health care. “New York state should ensure that health coverage is universal, continuous, affordable.”

• Allow SUNY’s state-subsidized teaching hospitals in Syracuse, Stony Brook and Brooklyn to operate more like profit-making hospitals and explore privatizing the facilities. “Massachusetts, Michigan, and Wisconsin have take this approach and spun off their teaching hospitals to allow them to function more effectively in the market,” the commission stated in its report. The report also notes strong opposition from the New York State United Teachers and the Public Employees Federation unions, which represent workers at the hospitals.

• Study whether to privatize county nursing homes which account for 10% of the beds in the system statewide and serve some of the poorest New Yorkers. “Many of these 44 county-owned facilities lose money each year and pressure from taxpayers to hold the line on property taxes is stronger than ever. Further, the face of long term care is changing with the growth of home and community based services. This shift calls into question the appropriateness of the county homes’ traditional institutional model.”

• Create clinics or offices that provide the much needed services in hospitals that will have to be closed because of their overall cost or because most services are provided by other facilities. “The commission repeatedly identified communities whose needs could be well served with less than a “full service” hospital but which require more than an ambulatory care center. “In these areas, there tends to be a single hospital with low utilization, weak finances, and inferior quality. While such institutions may appear to be candidates for closure, they cannot be closed unless an alternative set of services remains available to community residents.”

There was no immediate comment from the leaders of the Senate and Assembly, which would have to implement many of the changes. Governor Pataki referred all comment to the commission.

Governor-elect Spitzer made closing hospitals and bringing greater efficiency to the health care system a major campaign issue. He had no immediate comment.