Most patient care risks at hospitals associated with Y2K computer problems have been eliminated, experts say, even though the health care industry was among the last to address the issue. And medical devices such as pacemakers are not expected to create problems either.

"I would not hesitate to be a patient on New Year's or any time around that," said Fred L. Brown, chairman of the American Hospital Association, which represents more than 5,000 American hospitals. "Hospitals are always planning ahead for emergencies, and they've done it with Y2K."

But analysts specializing in the health industry's computer readiness for the year 2000 say unexpected glitches may still occur--especially at smaller and financially strapped facilities, clinics and doctors' offices.

The chairman of the President's Council on Year 2000 Conversion last week reflected this fear when he singled out the health industry for attention. In a general assessment of Y2K preparedness, John Koskinen said, "We are still concerned in this country about readiness in areas such as health care."

Margaret Anderson, director of policy for the Center for Y2K and Society, a Washington-based, nonprofit institute that has tracked health care readiness, said in her latest assessment that "Health care in the United States will suffer from a low-grade 'flu bug' throughout the year 2000."

She said that many of the hundreds of thousands of health care providers in the nation have upgraded their equipment so that it will not be affected by the shift to the year 2000, "but some smaller hospitals, clinics and doctors' groups are not ready. Most of those not ready have at least dealt with systems that affect patient care, but it also appears that some have not done that."

These differing levels of Y2K readiness are apparent locally. According to Terry Hsu, chief information officer for the Inova Health Systems in Northern Virginia, the 1,407-bed group of hospitals has a "zero tolerance" program for Y2K disruptions. He said the system has spent $30 million in the past three years to upgrade its computers earlier than usual to make sure no problems occur.

At MedStar Health--the region's largest hospital group, which includes Washington Hospital Center, the National Rehabilitation Hospital and several facilities in Baltimore--$20 million has been spent on computer upgrades and outside consulting in the past two years. In addition, MedStar has developed detailed contingency plans and will have increased staff and command posts at its hospitals on New Year's Eve, according to its chief information officer, Alton Brantley.

But at D.C. General Hospital, funding has been a critical issue in trying to replace or upgrade computerized hospital equipment. After final testing last week, officials there said they were ready for the new year, having replaced old computer equipment with the help of federal money.

Experts are concerned, however, that in some of the smaller clinics in the District, Y2K problems remain.

"Some of the clinics are so overwhelmed with daily demands that they really haven't had the time and attention to look hard at Y2K problems," said Sharon Baskerville, executive director of the D.C. Primary Care Association, an umbrella organization for health care providers that concentrate on the city's uninsured residents.

"Some hired a Y2K consultant to work on a few things, but we've found major gaps in what they found," she said. "One group recently learned their consultant missed the fact that their telephone and voice mail system was not Y2K compliant and was in danger. But they just don't have the money to replace it."

The Y2K, or year 2000, computer problem refers to the inability of some computers and software to properly read the date 2000, thereby causing glitches that can disrupt their functioning. Many older computer systems use two-digit dates for years, and computer specialists believe that these systems would read "00" to mean 1900, causing problems.

Over the past few years, Y2K experts have predicted possible health care problems ranging from prescription drug shortages to inoperative intensive care equipment to malfunctioning hospital telephone systems and elevators. But now the experts say longer-term problems in billing and medical records are the most likely results of the computer bug.

"We all hope and believe that the health care system will be functional in the first week of January," said Gary Setterberg, senior vice president of the Rx2000 Solutions Institute, a nonprofit clearinghouse for Y2K information for health care providers, based in Minneapolis.

"But the bad news is that Y2K is not a one-time event, and nobody knows what the full extent of Y2K failures in health care might be as they play out over the weeks and months of 2000," Setterberg said.

If computers in hospitals, nursing homes and doctors' offices are not fully upgraded for Y2K, he said, they will not be able to properly communicate with insurance companies and Medicare, making it difficult to file claims and get paid.

"It will be like a record with a bad scratch," Setterberg said. "You'll be able to play it for a while, but every time the Y2K glitch comes up, the problem will get a little worse and the record will skip more. And after a while, it won't work at all."

For its part, the federal government has spent $390 million during the past two years to make sure the Medicare and Medicaid programs are ready for 2000. According to Gary Christoph, chief information officer for the federal Health Care Financing Administration, government computers will be Y2K ready. But he doesn't believe that all health care providers can say the same.

"We've undertaken an unprecedented outreach effort to provide education and technical support to the provider community," Christoph said. But the response has not been uniform, and it remains unclear how many doctors and clinics have made the necessary upgrades.

"I'm betting that a few are waiting for something to break, then they'll try to fix it," he said. Setterberg of Rx2000 estimates that only 50 percent of health care providers have tested their billing systems to make sure they will be able to file Medicare and Medicaid claims.

One arm of the health care industry that gets high grades from Y2K experts is the sector that makes medical devices. There was great concern several years ago that potentially date-sensitive devices ranging from pacemakers to defibrillators could malfunction, but those worries have eased as the machines have been updated and upgraded.

"It's not a non-issue, because some firms are still putting second- and third- generation modifications on their Web sites, fixing things they thought were already fixed," Setterberg said. "But there is much less risk in medical devices than anyone thought there would be."