Health-care services declined in nearly all areas in the fourth quarter of 2008, a sign that the recession is hitting Iowa’s hospitals, according to data collected by the Iowa Hospital Association.

Home health visits were down 5.2 percent and inpatient surgeries were down 2.2 percent compared with the prior year.

Meanwhile, charity care and bad debt rose 13.3 percent, which means Iowa provided more care to patients who were unable to pay for their care. Hospitals totaled nearly $72 million in charity care and bad debt, a quarterly record.

As a result, hospitals’ operating margins were reduced to 0.8 percent in 2008 compared with 2.8 percent in the year-earlier period. When hospital reserve investment losses are added, margins fell to -9.6 percent at the end of last year from 5.5 percent a year earlier.

Forty-five percent of Iowa hospitals lost money on operations and 45 percent lost money on total revenues.