CHICAGO — Moody’s Investors Service downgraded as many nonprofit health care providers as it upgraded during the first quarter of the year, and its analysts expect the sector’s negative conditions to spark more downgrades in the coming months, analysts said in their quarterly report on the sector.

Moody’s issued 11 upgrades and 11 downgrades to providers during the first quarter, though the amount of upgraded debt, $2.75 billion, was nearly double the $1.44 billion downgraded. That’s largely because smaller, stand-alone hospitals are suffering more in the current economy than larger ones, continuing a long-standing industry trend, Moody’s said.

Some upgrades were due to consolidations or mergers. Three of the 11 downgraded hospitals are located in Rhode Island, which is struggling with joblessness and budget deficits, Moody’s said.

The 22 rating actions during the first three months of 2012 compares to 11 during the first quarter of last year, which indicates some turbulence in the sector, analysts said. Moody’s affirmed ratings on 65 providers but maintains a negative outlook on the sector.

“We expect to see continued pressure on revenues from multiple sources that will persist due to the continued slow economic recovery, increasing pressure on state budgets and a larger and growing federal deficit,” analysts said.

The agency currently has four ratings under review for downgrade compared to one on review for possible upgrade.

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