It’s not near death, but the L.A.-area hospital industry is in need of acute care.

That’s the conclusion of the latest study of the 180-hospital market, which has found more than a quarter of the hospitals have limited access to capital because of poor financial results, while even the best performing facilities are overleveraged.

“Greater Los Angeles is fortunate to have some of the best health care organizations in the nation, but its health care system is sitting on a fault line and the pressure is increasing,” said Patrick Powers, a senior analyst for HealthLeaders-InterStudy Inc., which conducted the study with PricewaterhouseCoopers.

The study found that even the best hospitals had debt-to-equity ratios topping 40 percent, compared with 27 percent nationally. This raises the cost of debt and makes it harder to borrow just as hospitals are attempting to meet new state seismic standards and expand clinical services.

Already, the Los Angeles region has seen more closures than any other area of the country over the past decade. That has weeded out underperforming facilities, the study noted, but also put significant pressure on remaining emergency rooms and trauma centers.

Among the factors squeezing hospitals are the nation’s largest population of uninsured and Medicaid patients; the lowest state reimbursement for Medicaid; tough state mandates; and a decentralized mix of hospitals, health systems and physicians and medical groups competing for market share.