NEW YORK » The feverish patient had spent hours in a crowded emergency room. When she opened her eyes in her Manhattan hospital room last winter, she recalled later, she wondered if she could be hallucinating: "This is like the Four Seasons — where am I?"

The bed linens were by Frette, Italian purveyors of high-thread-count sheets to popes and princes. The bathroom gleamed with polished marble. Huge windows displayed panoramic East River views. And in the hush of her $2,400 suite, a man in a black vest and tie proffered an elaborate menu and told her, "I’ll be your butler."

It was Greenberg 14 South, the elite wing on the new penthouse floor of NewYork-Presbyterian/Weill Cornell hospital. Pampering and decor to rival a grand hotel, if not a Downton Abbey, have long been the hallmark of such "amenities units," often hidden behind closed doors at New York’s premier hospitals. But the phenomenon is escalating here and around the country, health care design specialists say, part of an international competition for wealthy patients willing to pay extra, even as the federal government cuts back hospital reimbursement in pursuit of a more universal and affordable U.S. medical system.

"It’s not just competing on medical grounds and specialties, but competing for customers who can go just about anywhere," said Helen K. Cohen, a specialist in health facilities at the international architectural firm HOK, which recently designed luxury hospital floors in Singapore and London and renovated NewYork-Presbyterian’s elite offerings in the McKeen Pavilion in Washington Heights. "These kinds of patients, they’re paying cash — they’re the best kind of patient to have," she added. "Theoretically, it trickles down."

A waterfall, a grand piano and the image of a giant orchid grace the soaring ninth floor atrium of McKeen, leading to refurbished rooms that, like those in the hospital’s East 68th Street penthouse, cost patients $1,000 to $1,500 a day, and can be combined. That fee is on top of whatever base rate insurance pays to the hospital, or the roughly $4,500 a day that foreigners are charged, according to the hospital’s international services department.

But in the age of Occupy Wall Street, catering to the rich can be trickier than ever, noted Avani Parikh, who worked for NewYork-Presbyterian as in-house project leader when the 14th floor was undertaken. She pointed to the recent ruckus at Lenox Hill Hospital, where parents with newborns in the intensive care unit complained that security guards had restricted their movements and papered over hospital security cameras in their zeal to please Jay-Z (real name Shawn Carter) and Beyonce Knowles, whose daughter was born Jan. 7 in a new "executive suite."

Many U.S. hospitals offer a VIP amenities floor with a dedicated chef and lavish services, from Johns Hopkins Hospital in Baltimore to Cedars-Sinai Medical Center in Los Angeles, which promises "the ultimate in pampering" in its $3,784 maternity suites. The rise of medical tourism to glittering hospitals in places like Singapore and Thailand have turned coddling and elegance into marketing necessities, designers say.

The spotlight on luxury accommodations comes at an awkward time for many urban hospitals, now lobbying against cuts in Washington and highlighting their role as nonprofit teaching institutions that serve the poor. Indeed, NewYork-Presbyterian, which once opposed amenities units, would not answer questions about its shift, and declined a reporter’s request for a tour.

In Greenberg, where the visitors’ lounge seems to hang over the East River in a glass prow and Ciao Bella gelato is available on demand, the patient who likened her suite to the Four Seasons was not paying for it. She did not want to be identified because her wealthy boss, who picked up the tab, would not want publicity.

During unofficial visits to both units this month, however, some people enjoying the perks voiced uneasiness about those priced out. In space-starved New York, many regular hospital rooms are still double-occupancy, though singles are now the national standard for infection control and quicker recovery.

NewYork-Presbyterian said in a statement: "NewYork-Presbyterian is dedicated to providing a single standard of high quality care to all of our patients." At Mount Sinai Medical Center, where the aesthetic of the Eleven West wing is antique mahogany rather than contemporary sleek, and the best room costs $1,600, William Duffy, the hospital’s director of hospitality, noted that his favorite entree is Colorado rack of lamb, adding, "We pride ourselves on getting anything the patient wants. If they have a craving for lobster tails and we don’t have them on the menu, we’ll go out and get them."

The 19-room unit, which opened 18 years ago but received a recent facelift, takes in $3.5 million a year, Duffy said, estimating that 30 percent of its clientele comes from abroad. If the ER is backed up, a regular patient may be upgraded, he added: "Bump ’em up to Business, as we say."

Wayne Keathley, Mount Sinai’s president, minimized the unit’s role in the 1,171-bed hospital, on Fifth Avenue at 101st Street. "It is not nearly as large or elaborate as some others," Keathley said. He called the money it brought in "a rounding error in my budget," and said that patients came for the clinical care, not amenities.

In Eleven West’s library on a recent Friday, Nancy Hemenway, a senior financial services executive, was reading the paper in a spa-style bathrobe. "I was supposed to be in Buenos Aires last week taking tango lessons, but unfortunately I hurt my back, so I’m here with my concierge," she said.

Increasingly, hospitals serving the merely well-off are joining the amenities race. Beth Israel Medical Center near Union Square added a "deluxe unit" in 2008, catering mainly to patients after elective orthopedic surgery. The green-carpeted lobby may be more Radisson than Ritz, but its 12 single rooms starting at $450 feature Bose stereos, flat-screen TVs and mini-refrigerators, and chef-prepared kosher food is served on blue china.

"A very insignificant portion of our beds are identified as deluxe accommodations," said Gail Donovan, the chief operating officer of Continuum Partners, which includes Beth Israel and St. Luke’s – Roosevelt Hospital. "Our mission is really to be the safety net hospitals of our communities."

The conflicts echo those of a century ago, in another era of growing income inequality and financial crisis, said David Rosner, a professor of public health and history at Columbia University. Hospitals, founded as free, charitable institutions to rehabilitate the poor, began seeking paying patients for the first time in the 1890s, he said, restyling themselves in part as "hotels for rich invalids."

"Every generation of hospitals reflects our attitude about health and disease and wealth and poverty," Rosner said. "Today, they pride themselves on attracting private patients, and on the other hand ask for our tax dollars based upon their older charitable mission. There’s a conflict there at times."

© 2012 The New York Times Company