CHICAGO - Following a sharp spike in downgrades among not-for-profit hospitals over the last two months, Moody's Investors Service warned that the sector is increasingly struggling with a number of internal and market-related pressures.

The warning, prompted by the unusual number of downgrades during October and November, comes less than a month after the ratings agency revised its outlook to negative from stable on the sector. Since October, Moody's has downgraded 18 hospitals while only upgrading one. In contrast, most recent quarters have seen an equal number of upgrades to downgrades.

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