A nationwide survey of 1,400 hospital executives shows that 48 percent of them think reduced Medicare reimbursements may force their hospitals to close in the next five years.

But for the time being, all Utah hospitals are conducting business as usual.Small, rural and government-owned hospitals in Arkansas, Louisiana, Oklahoma and Texas are the most vulnerable, according to the survey conducted and paid for by Touche Ross accounting and management consulting firm.

Most of Utah's rural hospitals are losing money, but an executive of the Utah Hospital Association said none of them are in danger because they are being subsidized by counties or such large hospital corporations as Intermountain Health Care.

Robert D. Burton, association vice president, said health providers are united in the continuing battle to keep the hospitals open.

"The very survival of these rural communities is dependent on the survival of the hospitals - the community's first or second major employer," he said.

Suburban hospitals and hospitals owned by religious organizations also may be much more likely to close than in previous years, the survey showed.

Utah hospitals have felt that potential danger.

St. Mark's Hospital, which was started by the Episcopal Diocese of Utah in a home more than 100 years ago, was sold last December to the for-profit Hospital Corp. of America to enable it to become a "flagship" facility.

Stewart M. Hanson Jr., diocese chancellor, said the hospital had always provided excellent health care. "But it became very apparent within the last year or so, as technology took quantum leaps, that the Episcopal Church couldn't keep a competitive position in a very competitive market. When the opportunity to sell came along, the church took advantage of it."

Holy Cross Hospital, owned by the Sisters of the Holy Cross, is also feeling financial pressure. In March, hospital executives laid off 130 employees "in an attempt to be forward-looking."

"With increasing problems of Medicare and other reimbursements, we felt that we really wanted to choose our destiny in terms of having enough foresight to decrease whatever costs we could while maintaining our quality of health," said Sister Olivia Marie Hutcheson, vice president for mission and medical staff services.

"The action we have taken has really been helpful, and we are going forward with strength."

Hospitals' increased vulnerability to failure is caused by a decrease in revenues under the Medicare Prospective Payment system, a program created in 1983 to standardize the amounts Medicare reimburses hospitals for inpatient care.

Burton said the reductions are a real concern to everyone associated with Utah's hospitals.

"It puts pressure on hospitals' very survival, but I don't foresee any of them closing at this time," he said. "But we are going to have to keep monitoring them. It could jeopardize their future - or at least their ability to provide the quality of care they are providing now."

In its recent survey, Touche Ross sent questionnaires to hospital executives at all 5,678 acute-care hospitals in the country. Almost 70 percent of the hospital executives surveyed said hospital incomes have dropped since the inception of the Medicare Prospective Payment program.

In 1986, hospital executives estimated that 21 percent of their facilities might close. In the recent survey, the chance for closure jumped to 46 percent of local hospitals.