DAYTON — One year into an entrenched recession, some local hospitals are seeing a smaller percentage of their most profitable patients — those covered by private insurance.

At Children's Medical Center of Dayton, the percentage of patients covered by private insurance averaged 47.5 percent from July to October. That's down from 51 percent in the previous 12 months, said David Miller, Children's chief financial officer.

Miller can't recall a short-term slump of comparable severity in the past 20 years, and said the decline seems sharper than that at Ohio's other children's hospitals.

At Miami Valley and Good Samaritan hospitals in Dayton and Atrium Medical Center in Warren County, all part of Premier Health Partners, the percentage of patients covered by private insurance has fallen from 37.8 percent in 2007 to 36.6 percent so far this year.

"We have seen slow erosion in the past, but this is a more pronounced drop in a one-year period," said Mark Shaw, Premier's vice president of managed care/decision support.

Shaw wouldn't be surprised if a 1 percent decline in Premier's privately insured patients costs the network $10 million in revenue or more.

Over the course of a year, the shift of just 1 percent of patients from private health care coverage to Medicaid costs Children's $1.2 million, Miller said.

Hospital executives don't expect conditions to improve soon, given the closing of General Motors' plant in Moraine on Dec. 23.

And DHL's U.S. freight hub at Wilmington is slated to lose thousands of jobs next year as work there transfers to the United Parcel Service hub at Louisville, Ky., potentially leaving more people out of work and without insurance.

Other local companies have had smaller layoffs.

Frank Perez, president and chief executive officer of Kettering Medical Center Network, said the amount of bad debt incurred from patients for the first nine months of this year was $48.1 million, up nearly 30 percent from $37.1 million for the same period in 2007.

More unemployment and fewer small companies offering health insurance were two primary reasons, he said.

Higher premiums also add to the ranks of the self-insured, uninsured or those covered by Medicaid or Medicare.

The shift in hospitals' "patient mix" from employer-paid insurance to government-subsidized and self-paid health care is significant to hospitals' bottom lines.

"The way the health care system's set up, the payer mix is critical for hospitals to survive," said Bryan Bucklew, president/chief executive officer of the Greater Dayton Area Hospital Association.

Even a small decline in coverage by third-party health plan providers such as Anthem Blue Cross and Blue Shield, UnitedHealthcare or Medical Mutual of Ohio can hobble a hospital's ability to invest in the community, new technology and equipment, he said.

For every dollar Premier hospitals receive from commercial payers for the health care they provide, Medicaid pays 30 cents, Shaw said.

Children's, meanwhile, collects about 39 percent of total charges from Medicaid, and is reimbursed 75 percent to 80 percent of what it actually costs the hospital to care for Medicaid-covered patients, Miller said.