More than 400 hospital employees in the District lost their jobs yesterday, victims of a debt-ridden health care system overflowing with patients who have no insurance when they're sick or no place to go when they're well.

Howard University Hospital announced it had released 281 people, 10 percent of its work force, and George Washington University Hospital cut 150 employees, or 6 percent. Both hospitals said the cuts are primarily in such areas as housekeeping and food service, not in direct medical service, and will not harm patient care.

"My supervisor called me in and gave me the paper," a housekeeping employee at George Washington said. "There are six supervisors in my section, and five of them were let go. People are pretty shocked."

Additional cost-cutting measures are expected. Russell Miller, Howard's vice president for health affairs, said Howard will limit the number of charity patients admitted to the hospital and treated in its emergency room and clinics. He said the hospital will not turn away patients with truly emergency needs.

The dual announcements of job cuts, officials said, were a sign of the times. Hospitals have warned of such actions for months, but the moves were the first of what experts predicted would be several large layoffs in Washington health care.

In fact, Nancy Reller, a spokeswoman for Capitol Hill Hospital, said yesterday that "there's a very good chance" the facility will lay off about 45 workers, or 6 percent of its staff, "within the next few weeks."

"Today you have two hospitals. In the next few weeks there could be a few more," said Howard Jessamy, president of the D.C. Hospital Association, a trade association. "And if things continue as they are, at some point some of our hospitals will be closing."

About one in six D.C. residents -- about 114,000 people -- has no medical insurance. About 200,000 residents are covered by Medicaid or Medicare, but the District has not increased Medicaid payment rates in three years, and the federal government has paid Medicare claims since 1983 by a set formula instead of according to the actual cost of care.

These problems, not unusual among hospitals across the country, particularly in large cities, are worsened here because of the District's epidemic of drug use. Hospitals are caring for increasing numbers of "boarder patients," children and elderly patients who are ready to leave but have no home.

Other pressures, hospital officials said, include shrinkage of services at the city's public hospital, D.C. General, and a decline in public health services in general.

"The public health system in the District of Columbia has been allowed to erode to such a level that people don't get preventive care and basic primary care," said L. Thompson Bowles, vice president for medical affairs at George Washington.

Hospitals in the city provide a total of $176 million in indigent care a year. That deficit has grown $41 million in four years.

The fiscal problems are worse at Howard than at George Washington, officials said.

Howard faces a deficit of $12 million this year on a budget of $168.5 million and projects a deficit of at least $25 million next year on a budget of $156.4 million. The hospital says it gave away $6.5 million in care for boarder babies, usually children of drug-addicted mothers, and $28 million providing long-term care for adult patients.

The hospital previously cut back on hiring, purchases and renovations, then began a forced furlough in which each employee was required to take a week off without pay.

The dismissals will save Howard about $10.8 million a year. Officials said the hospital will still need a $15 million increase in its federal subsidy to avoid a deficit next year.

In the long term, Howard officials said, they will need to change the hospital's image to beat its fiscal problems. "We are a teaching hospital, not a charity hospital," Miller said. "But when you take care of as many poor patients, sometimes you're perceived as the second city hospital or the first city hospital, and that perception becomes reality.

"The historical attitude has been to give any person the care they need," Miller said. "I just don't know how much longer we can keep that up. We can't -- unless we change the patient mix. We're not going to turn away anybody who needs emergency care, but we're going to stop providing routine care in the emergency room to anyone who can't pay. This is the first step."

George Washington will run a deficit of more than $10 million this year, Bowles said. Last year it gave away about $30 million in care, he said. For months it has not filled vacancies when possible.

Both hospitals said they looked carefully for jobs that could be eliminated in nonmedical areas, giving employees with seniority priority if possible. Both hospitals said no staff physicians were cut. Howard cut a few nonlicensed nurses and some administrative nurses.

At George Washington, Bowles said, "We invited in an outside consulting firm, which told us we were overstaffed in the areas of housekeeping, food service, linen, plant maintenance. We had a lot of fat."

Both hospitals announced measures to soften the blow: 30 days' pay at Howard, and at George Washington two weeks' pay plus one week for each year of employment. Both hospitals offered counseling to help employees find other jobs.

Kenneth F. Greene, executive director of Council 20 of the American Federation of State, County and Municipal Employees, which represents about half the Howard employees, said, "This was handled in an outrageous, insensitive manner. One woman with 23 years of seniority was told she had one hour to get out. We intend to see that employee rights are protected."

Howard spokesman Alan L. Hermesch said, "It's unlikely that someone was told that."

Staff writers Rene Sanchez and Stephen Buckley contributed to this report.