The numbers, released Thursday, show the kind of burden placed on hospitals dealing with rising numbers of uninsured Americans - 45 million across the nation and an estimated 200,000 to 300,000 in the Tristate.

Hospitals are the last resort for the uninsured, who often must be treated in emergency rooms, said Lynn Olman, president of the Greater Cincinnati Health Council, which surveyed costs from 25 hospitals in the Tristate.

Uncompensated care drives down profit margins at hospitals, hurting their ability to reinvest revenues in new facilities and in new technology, Olman said. Ultimately, hospitals try to make up for these losses by seeking higher reimbursements from private health insurance companies.

"Without major changes to our health care system, I don't see this trend reversing. There's no magic bullet on the horizon," said Steve Schwalbe, vice president of strategy, communications and public affairs at TriHealth, the hospital system that includes Good Samaritan and Bethesda North.

TriHealth provides about 17 percent of uncompensated care in Hamilton County, compared with about 50 percent from University Hospital, Schwalbe said.

The Health Council has been surveying hospitals about their uncompensated-care costs since the early 1990s. The figure represents both "charity care," in which patients have no way of paying, and "bad debt," where patients make agreements with hospitals to pay at a later date but don't.

The $120 million figure for 2003 is also above and beyond the uncompensated care that is reimbursed to hospitals by Hamilton County's indigent care levy, which defrays some of the costs of serving the poor and uninsured.

The latest levy, approved in 2001, sends 80 percent of the proceeds - about $34 million a year - to University Hospital. The rest goes to Cincinnati Children's Hospital Medical Center and a handful of county-supported specialty health services.

Some hospitals in Greater Cincinnati and across the country have recently come under attack for the way they handle charity care cases.

A federal class-action lawsuit, filed in July accuses 320 U.S. hospitals of inflating how much charity care they provide and of using strong-arm tactics to collect money from uninsured patients.

Included in the lawsuit was Catholic Healthcare Partners, a not-for-profit system that includes 29 hospitals, 14 nursing homes and other services in Ohio, Indiana, Kentucky, Tennessee and Pennsylvania. Catholic Healthcare Partners has defended its policies.

E-mail mleingang@enquirer.com