Officials of nonprofit clinics yesterday urged D.C. Mayor Anthony A. Williams (D) to pursue a lengthy wish list of initiatives that they said would improve medical care for the District's uninsured, but the mayor cautioned that he might be hampered by budgetary realities.

Williams and D.C. Council Chairman Linda W. Cropp (D-At Large) said at the second of three city-sponsored "health care summit" meetings that they will study the list of recommendations made during brainstorming sessions yesterday involving about 75 primary care providers.

A final meeting this month will offer low-income patients a chance to voice their views on health care provided by the city through its network of private contractors and other health care providers, officials said.

Despite the mayor's attempt to tamp down expectations because of the city's fiscal limitations, the meeting at George Washington University's school of public health was optimistic, in sharp contrast with last month's summit session, which focused on hospitals.

At that session, District hospital executives told city officials that their institutions were suffering because Williams overhauled and privatized the city's indigent health care system in 2001. Yesterday, clinic executives said that despite various ongoing problems, the new system operated by the D.C. Healthcare Alliance is a major improvement for the poor.

"I am happy to hear the different perspective," Cropp said.

George A. Jones, executive director of the nonprofit social service and health care agency Bread for the City and chairman of the D.C. Primary Care Association, said the alliance has dramatically improved medical services for low-income residents. Access to free prescription drugs and specialty medical services is far more reliable now than when public D.C. General Hospital dominated the city's indigent care system, he said.

It used to be common, he said, for uninsured clients of Bread for the City to wait up to a year to see a specialist -- if they were lucky enough to win a lottery and get an appointment with Bread for the City's doctors. Now patients wait no more than six weeks to see a specialist, Jones said.

He said the public dialogue about the alliance has been distorted and politicized.

"The District has gone from being one of the neediest communities you can find to probably being one of the most progressive cities you can find," he said. "Now we know that everyone who needs a [visit to a specialist] will get one. . . . This is a much better and more rational system than we had before, and patients are benefiting from it."

Sharon Baskerville, executive director of the D.C. Primary Care Association, told Williams and Cropp at the meeting that the alliance is forcing dozens of nonprofit clinics in the city -- most of which are in the alliance network -- to shift away from depending on grants from private philanthropies to deliver health services.

She asked the mayor to beef up reimbursements for services to the alliance and the much larger Medicaid program and to add incentives for nonprofit clinics to upgrade their operations.

"Rates are too low and payments too slow in coming," Baskerville said.

Williams said he would read the recommendations from the meeting but asked those attending to trim their dozens of requests.

"Everything we do in health care has to be offset from something else," he said.

The D.C. Health Department is preparing to take over the alliance in a restructuring move that would put the $70 million program under the direct control of the government instead of under a private company.

D.C. Health Department Director James A. Buford intends to remove troubled Greater Southeast Community Hospital, which is under bankruptcy court protection, as the leader of the alliance, at least temporarily. He has left open the possibility that the city would remain in direct control for years -- a major departure from the original concept of the program as a private entity that could be replaced with another if it failed to perform.