HARRISBURG -- When Monsour Medical Center in Westmoreland County and Philipsburg Area Hospital in Centre County closed recently, state Sen. John Wozniak of Johnstown didn't like it.

When Tara Hospital in Brownsville closed, Sen. Richard Kasunic of Fayette County became concerned that residents might lack health care.

Sen. Constance Williams of Montgomery County had similar concerns when a hospital closed in Norristown, near Philadelphia.

Those are four of the 13 general hospitals, also called "acute care" hospitals, that have closed in Pennsylvania since 2000, according to the state Department of Health.

Yesterday, Mr. Kasunic and other members of the Senate Democratic Policy Committee held a hearing on the financial problems of hospitals and what the state could do to keep more hospitals from shutting down.

"Once you have a hospital disappear, it becomes a political issue," said Mr. Wozniak. "People wonder, does anybody care about them?"

"The prospect of small to medium-sized hospitals becoming an endangered species should trouble policy makers and community leaders," said Joe Martin of the Pennsylvania Health Care Cost Containment Council, which monitors hospitals' profits or losses each year.

James M. Redmond, a senior vice president for the Hospital & Healthsystem Association of Pennsylvania, said the state had 201 general hospitals in 1996, but that number had declined to 176 by 2004, the latest year for which figures were available.

Besides Monsour, Philipsburg and Tara, hospital closures in the last five years included St. Francis Medical Center in Pittsburgh, Metro Health Center in Erie and eight in southeastern Pennsylvania.

Those losses have been somewhat offset by a growth in smaller clinics that focus on one procedure, such as psychiatric or rehabilitation services. There are 91 such specialty hospitals now, up from 80 in 1996.

Different hospitals have different reasons for closing, a process that usually follows years of financial declines, Mr. Redmond said.

A closure can result from a decrease in patients, especially in rural or remote areas; relatively low state and federal reimbursements for Medicare and Medicaid patients, which hospitals would like to increase; medical malpractice judgments against a hospital; or poor hospital management. Also, smaller hospitals sometimes merge or are acquired by larger health systems with greater resources.

Cliff Shannon, president of SMC Business Councils in Churchill, agreed that some small hospitals are struggling due in large part to reimbursements from the public health insurance programs. But he also noted that the struggles come as some large systems, such as the University of Pittsburgh Medical Center, are thriving and even talking about adding hospital beds.

"I think it's created some pockets of disruptions for the communities affected by the closings," said Mr. Shannon, who is a board member at the Pennsylvania Health Care Cost Containment Council. "But in terms of overall access to health care services, we have enough hospital beds, and some would say we still have a surplus."

Senate Democrats are limited in their influence because Republicans control the chamber 29 to 21. But the Policy Committee considers ideas that can evolve into legislation, and some proposals mentioned yesterday included:

Enacting a medical malpractice reform law to limit -- perhaps to $250,000 -- the so-called pain and suffering awards, or non-economic damages, in lawsuits against doctors and hospitals.

Increasing state reimbursements to hospitals for lower-income Medicaid patients. Without this, hospitals must shift a greater financial burden to privately paid or employer-paid health insurance or see their uncompensated care costs rise, which endangers their bottom line.

Increasing efforts to recruit and retain doctors and nurses in Pennsylvania hospitals after they receive their education.

Continuing to provide state financial aid for nursing and other health-related education at community colleges and hospital schools.

Continuing to invest in new health-related technology, which can extend medical services to remote rural locations.