Operating margins, the difference between revenues and expenses, have dropped sharply under cost-cutting pressure from Medicare and private health insurers.

Professor Coffee worries that in-house regulators would be vulnerable to cost-cutting pressures.

Hospitals, for their part, are under cost-cutting pressures from managed care and Government payers.

Under cost-cutting pressures from employers and insurers, including the Government's own Medicare program, many hospitals have hired executives with business credentials.

Hospital managers said they needed the concessions to cope with budgetary strains created by Federal and state cutbacks in aid and the cost-cutting pressures from health-maintenance organizations.

Those, too, are buffeted by cost-cutting pressures from taxpayers and questions from state legislators about diluted academic standards.

But entrenched bureaucracies and cost-cutting pressure do not easily produce elegance.

At the same time, severe economic problems in both countries in recent years added to cost-cutting pressures by reducing traffic and revenues.

There was also talk that the company would be laying off dozens - if not hundreds - of workers because of cost-cutting pressure by Paramount Communications, which owns the publishing house.

Consequences: More breakdowns of the equipment, higher costs and cost-cutting pressure.