Several of the Washington area's largest companies have mounted a controversial drive to oust hospitals, doctors and labor from control of an organization formed in 1983 to bring together all participants in the health care system in order to restrain medical costs.

Frustrated by the belief that the joint effort has failed, executives are trying to turn the National Capital Area Health Care Coalition into a much more aggressive tool for business interests. One of their main goals, proponents say, is to increase the clout of the coalition and to use that clout to bargain for lower rates with doctors and hospitals.

"Employers ought to speak loudly," said Thomas J. Owen, chairman of Perpetual Savings Bank, one of the proponents of the change. "If employers are the ones who are going to foot the bill, they should do most of the talking."

The 135 members of the coalition are scheduled to vote today on the proposed restructuring of the organization, which would create two classes of membership -- one for business members, who would have voting rights, and another for hospitals, insurers, labor groups and others, who would be limited to an advisory role. Other businesses pushing the change include George Hyman Construction Co., Washington Gas Light, Woodward and Lothrop and C&P Telephone.

The vote today comes amidst growing employer sentiment throughout the country that the escalation of their health care expenses is continuing, despite efforts to monitor more carefully employe use of doctors and hospitals and to shift more of the cost of health care to workers.

Last year, medical costs rose 7.7 percent, four times the general inflation rate. As in the early 1980s, employers are once again reporting double-digit increases in their insurance premiums, and they are again vowing tougher action.

Officials familiar with the proposed restructuring of the health care coalition expect the plan to succeed.

However, the effort has brought bitter reaction from many other groups whose role would be de-emphasized as a result of the change, including Blue Cross and Blue Shield, hospitals and unions.

"They {businesses} see they have not achieved their goal of significantly reducing the cost of health care, and they're getting frustrated," said Robert Petersen, president of the area's Columbia Typographical Union, one of two labor representatives on the coalition's board.

Dunlop Ecker, president of the Washington Hospital Center, the city's largest private hospital, says the advisory role of hospitals in the revised coalition would be "basically meaningless" and "would shunt the {health care} provider community off to one side."

Although businesses contend that they want the continued participation and advice of hospitals, unions and other nonvoting members, representatives of these groups said they would have to rethink participation in the coalition.

Despite the complaints, proponents of the plan say the coalition faces financial trouble and perhaps even its demise unless it can show business members a more tangible return for their dues, which ranges from $350 to $1,250 per year. In the past year, membership in the coalition, which has an annual budget of about $200,000, has dwindled from 180 to 135, according to Dindy K. Weinstein, executive director.

Executives pushing for the restructuring say that interest has declined because many businesses have come to view the coalition as little more than a debating society, with too many different interests trying to be accommodated. Even if their motion today fails, they predict companies will move to form the same type of organization separately.

"The problem is that the coalition is slow to act and it is very difficult to act," said Al Burfeind, vice president for human resources at George Hyman Construction Co. in Bethesda, another principal proponent of the change. "In order to attract business members, we need to act quickly and decisively and show bottom-line results."

Burfeind and other executives said one of the first tasks of a revised coalition would be to obtain and release data comparing costs and quality of local hospitals.

The coalition also plans to use its collective purchasing power to negotiate lower rates with health care doctors and hospitals. Executives already say they have begun discussions aimed at creating a special mental health and substance-abuse program at a lower cost for coalition members.

Officials said that while large employers in other cities, such as Chrysler in Detroit, have used this tactic successfully, business leverage in Washington has been limited by the nature of the employer base here.

"What we've got in Washington is a lot of medium and smaller employers who don't have purchasing power," said one local executive. "They don't have clout."

Unlike many other health care coalitions across the country, which are largely business driven, the local coalition was formed with the intent of bringing together all parties in the health care system.

In its brief history, the area coalition has conducted a range of education activities, such as workshops on AIDS in the workplace and health benefit management, and considered various legislative issues, including malpractice reform and a District proposal to require insurers to offer mental health benefits.

However, backers of the proposed change said the organization's current structure presents too many conflicts of interests and inhibits more aggressive action, such as that carried out by business coalitions in Miami, Houston or Hartford, Conn.

For instance, they questioned how the coalition could select individual doctors or hospitals with whom to contract if at the same time representives of those groups were sitting on the board of the coalition.

Another commonly expressed concern was that the coalition has not been able to take strong stands on legislative issues like health regulation for fear of offending various constituencies. As an example, Romayne Berry, operating vice president for benefits and insurance at Woodward and Lothrop, criticized as not cost-effective the recent decision by local health planners to give permission to a consortium of hospitals to carry out heart transplants.

Other groups, however, said that by changing its character, the coalition would lose much of the credibility it enjoys in government bodies because of its broad-based membership. They also questioned the assumption that the proposed restructuring would make the group more effective and more attractive to companies.

Citing such community groups as the Greater Washington Research Center or the Cultural Alliance, Barry Wilson, vice president of the area Blue Cross and Blue Shield plan, said that the local business community "has always supported worthwhile communitywide efforts ... whether or not the individual company got direct benefits for that {charitable} contribution. We think that would continue."