After years without enough money to make capital improvements, hospitals say they want to go on a spending spree - building surgery centers, renovating operating rooms, buying the latest medical equipment and even putting in badly needed new computer systems. The big question is how long this can last.

Hospital executives plan to increase their capital spending by an average of 14 percent a year for the next five years, according to a recent survey.

"I think what sits out there is a pent-up demand for capital," said Robert Lux, chief financial officer of the Temple University Health System.

Temple, an inner-city hospital system in Philadelphia, is spending about $75 million on a new ambulatory care center that had been discussed for more than five years though ground was broken for it only last year. Temple has already borrowed $50 million and is in talks with lenders about borrowing the rest.

But consultants say the industry's planned splurge, no matter how long overdue and badly needed, could be short-lived.

The expected rise in interest rates will make borrowing much more expensive, because hospitals, typically run as nonprofit organizations, frequently raise money by issuing tax-exempt bonds. And hospitals that plan to finance the projects with cash from operations could see future revenue squeezed as private insurers balk at paying ever-higher prices for care and the federal government looks for ways to cut the budget.

"Hospitals are going to have to prioritize," said James Callanan, chief executive of the ImPart Group, a Boston consulting firm that advises hospitals. "We're not going to be able to do our wish lists."

hat hospitals are likely to spend money on, consultants say, are the areas that return the favor: moneymakers like operating rooms, surgical suites, and medical and diagnostic equipment. "Everything else will get pushed to the back burner," said Mark Wietecha, a health care consultant with Kurt Salmon Associates in Atlanta.

The deferred items are likely to include some of the computer systems and other information technology that might help finally bring the administration of health care into the 21st century.

Also needed but likely to be delayed are the replacement or renovation of old facilities - aging hospital wings or decrepit elevators in need of makeovers.

"When push comes to shove, what typically happens is infrastructure tends to suffer to medical technology," said Richard L. Clarke, president and chief executive of the Healthcare Financial Management Association, a group of hospital finance executives based in Westchester, Ill., that is studying hospitals' capital needs with GE Healthcare Financial Services, a lender and adviser to the industry.

The spending urge comes as hospitals react to a long period of scant buying and building - a result of lower payments from Medicare that followed the Balanced Budget Act of 1997. Some systems also used their capital for investments like physicians' private practices in hope of gaining patients.

In recent discussions with hospital administrators, the executives indicated that they had delayed making critical capital investments as long as they could, said Randy Fuller, the hospital segment manager for GE Healthcare. Spending, he said, "has become an absolute imperative."

In fact, hospitals have already started. Construction alone reached $15 billion last year, roughly 50 percent more than annual construction spending through much of the 1990's.

Last week, St. David's HealthCare Partnership, a system in Austin, Tex., announced plans to spend $100 million on capital projects, including a new intensive-care unit and outpatient surgery center as well as the purchase of a gamma knife, specialized technology that uses gamma radiation to treat brain tumors.

Hospitals seem to be having no trouble finding money for construction projects, said Robert Levine, an executive specializing in health care clients for Turner Construction. Even for-profit hospitals that do not raise money by selling bonds are picking up the pace, he said. Those hospitals tend to finance the projects from operating revenue.

"There's a lot going forward,'' he said. "But there are some storm clouds."

Some hospitals are struggling to come up with the money for these investments. And analysts and others say that a growing number of hospitals are shut out of the bond market because of heavy losses or debt loads that make them unattractive to investors. A quarter of those surveyed by PricewaterhouseCoopers for the Healthcare Financial Management Association and GE Healthcare also have too much current debt to borrow more. These hospitals, in particular, may suffer if the federal government reduces payments, consultants say, and could end up being acquired by stronger systems.

Some nonprofit hospitals say they plan to find the money by asking for it - persuading people to donate for various projects. But while consultants say that medical research can be a popular area of philanthropy, individual hospitals, particularly those that are not well known, could have difficulty persuading people to make donations for a new operating room or an outpatient clinic.

With the bursting of the stock market bubble and the downturn in the economy in recent years, there tends to be more competition for fewer charitable dollars.

"I think raising philanthropic dollars today is a lot harder than it was five years ago," Mr. Lux of the Temple University Health System said. "I would not want to count on that."

So it remains unclear where some hospitals are going to get the money to do everything they want, particularly in areas like information technology - new computer systems and software that would make them more efficient and could reduce medical errors.

Some consultants argue that such investments are so vital that hospitals will scrape to find the money. But others say spending on information technology could easily be deferred, as it has been in previous years, as hospital executives wait to see how the technology evolves.

"For ages now, hospitals have said they will spend on I.T. and they never do," said Sandy Lutz, the national health care research director for PricewaterhouseCoopers.

What may be different this time is more pressure from the federal government and from employers, some of which have begun paying hospitals more if they have computer systems that could improve patient care. President Bush, who is creating a position in the administration to oversee information technology within health care, has talked about spending $100 million to explore how technology could improve care.

Hospitals may be persuaded to make these investments, Ms. Lutz said, adding, "It really depends on government policy and how much they push it."