Median ratios for U.S. not-for-profit health care systems and stand-alone hospitals were stable in fiscal 2011, Standard & Poor's Rating Services said Monday in two reports.

The median trends highlight management's continued focus on improving the balance sheet and, to the extent possible, the income statement, to increase their flexibility in preparation for expected changes in health care delivery and financing in the next few years. However, the ratios may have peaked and could decline slightly in 2012 and in 2013 as industry pressures grow, according to Standard & Poor's.

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