IN RECENT years, Washington has been spared much of the troubling news facing other big cities' public and private hospitals. Elsewhere, hospitals have already had to become far more efficient by eliminating services and by laying off hundreds of employees. They have cited financial losses from, among other sources, uninsured patients and Medicaid reimbursements that did not match costs. More than 60 hospitals have already closed in just Chicago, Los Angeles, and New York City in recent years, and some of the nation's strongest and most affluent medical institutions are struggling with large budget deficits.

Now, some Washington hospitals are beginning to suffer the same fate, and it's easy to understand why. Hospitals here provide $176 million a year in indigent care, or a rather staggering $3,384,000 a week. Abandoned babies and patients who have no public or private health insurance are part of the problem; so are elderly patients who are healthy enough to leave the hospitals ... if only there were more nursing home space available for them. Those are some of the reasons why Howard University and George Washington University hospitals this week cut a total of more than 400 employees, or 10 percent and six percent of their work forces, respectively. For now, the work force reductions do not involve workers who provide direct medical care to patients.

Officials at George Washington -- who operate a hospital with an occupancy rate that has been running at or above 90 percent -- say that they will run a deficit of more than $10 million this year. At Howard, officials say they are facing a $12 million shortfall this year and are projecting a $25 million deficit for next year.

Such alternatives as a reductions in care for those least able to afford it are unacceptable. And a local solution to the problem is unlikely. The D.C. government, given its growing fiscal problems, will not soon find a way to dramatically increase its share of the cost by expanding services at either its public hospital or its health clinics. A broader solution is required. The hospitals, meanwhile, are running out of money ... and time.