The past year has been brutal for South Florida hospitals -- and this year is likely to be worse.

The Baptist Health system, which has been immensely prosperous in the past, suffered a $71.7 million loss in its 2008 fiscal year. Miami Children's lost $72 million insurance. Holy Cross lost $25 million, and Mercy $34.8 million.

All four of these suffered serious losses in their investment portfolios, but others, particularly Jackson and Homestead, are beginning to feel the effects of the recession as their number of uninsured patients grows.

''It's going to be a particularly tough year, more so for the public-financed facilities,'' said Linda Quick, president of the South Florida Hospital and Healthcare Association.

Both Broward public hospital districts and, to a lesser extent, Miami-Dade's Jackson Health System depend on property taxes, which are declining as housing prices fall.

Rising unemployment has worsened the situation. Quick said a recent survey showed that every 1 percent increase nationally in unemployment leads to 100,000 newly Medicaid-eligible patients -- a prospect that sends shivers down the backs of hospital executives because Medicaid reimbursement rates are often below their costs.

Still, many executives have been surprised that the recession hasn't brought more uninsured patients to their emergency rooms.

Broward Health reports that uncompensated care has increased ''only minimally.'' An official at the University of Miami Hospital said that increases in uninsured were ``not terribly material.''

Ralph Lawson, CFO for Baptist Health South Florida, said the system's Homestead Hospital, serving an area with many migrants and other uninsured, saw bad debts and charity care almost double, but the other hospitals in the system have stable revenue and volume. ``This has been a little bit of a surprise to me.''

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