CHICAGO — Moody's Investors Service said Tuesday that it downgraded $20 billion of non-profit health care debt in 2012 — a 213% increase over 2011 and a record-high amount since the ratings agency began tracking the figure in 1995.

There were 40 downgrades in 2012 compared to 34 in 2011 and 44 in 2010. Three large systems accounted for more than $13 billion of the downgraded debt.

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