City leaders have begun conferring with three financially stressed District hospitals on how they might combine operations -- the first step toward reducing the city's vast oversupply of hospital beds while improving basic medical care for 80,000 uninsured residents.

Howard University Hospital, D.C. General Hospital and Greater Southeast Community Hospital, which serve some of the city's poorest neighborhoods, last week separately presented their ideas for collaboration in memos to D.C. financial control board members, Mayor Anthony A. Williams (D) and members of the D.C. Council.

Then Williams, control board Chairman Alice M. Rivlin and members of the control board and D.C. Council met Monday night with hospital officials to discuss how the three institutions can participate in Williams's plans to reform a health care system that spends far more on hospital care than on keeping people healthy enough to avoid hospitalization.

Afterward, Rivlin and Williams offered no details about what transpired in their effort to protect the "safety net" hospitals that provide most of the care to the city's impoverished residents.

"It's a work in progress," the mayor said as they walked away together.

City officials are reluctant to publicize the talks for fear of hardening the hospitals' negotiating positions or provoking interference from hospital board members. So far, sources said, none of the three has offered to make major cuts in duplicative services.

D.C. General chief John Fairman, for example, wrote a memo with vaguely worded suggestions focusing mostly on ways the hospitals could share administrative services, not medical services, according to a source familiar with the memo.

Even Greater Southeast, which needed a financial bailout from the city last month, has not suggested dramatic changes in operations that might improve its financial situation, another source said. Greater Southeast is a nonprofit hospital on Southern Avenue in Southeast Washington that is reorganizing under bankruptcy court protection.

The city has pledged to provide to the hospital as much as $8.5 million through August and to extend that support indefinitely if necessary because Greater Southeast is the only major health facility east of the Anacostia River. It is seen as the critical link in the health care system for residents in Ward 8, which has few doctors.

D.C. General, on Massachusetts Avenue SE, is owned by a quasi-independent city agency that also operates clinics and school health programs and depends on District taxpayers for nearly $50 million in annual subsidies.

Housed in an aging structure that needs major renovations, the hospital is the city's biggest trauma center. For thousands of residents without insurance, D.C. General's emergency room also serves as the de facto family doctor -- an expensive and inefficient way to provide health care.

Howard University Hospital, on Georgia Avenue NW, is the teaching hospital for the university's medical school. Although its financial performance has improved slightly in the past few District mayor, describing the proposal for three hospitals to combine some operations years, it remains heavily dependent on multimillion-dollar federal subsidies.

The next step in Williams's health reform campaign is to have broad-based community meetings involving scores of health care providers and patient advocates.

That is expected to lead to the midsummer launch of a city commission that will spend six months preparing recommendations on how to bring more basic health services to the poor and how to reduce duplication of services by hospitals. Williams and the D.C. Council chairman will serve on it, along with five Williams appointees and three members named by the council.