Under the efficiency savings challenge set by NHS England chief executive Sir David Nicholson, the health service has been ordered to find £20bn savings by 2015.
Just 11% of finance directors from CCGs and NHS trusts who took part in a King's Fund think tank survey said their organisation would be in deficit by the end of 2013/14.
But 56% said there was a high or very high risk that the national savings target would be missed.
A further third (32%) said there was a 50/50 chance it would be missed, and just one in 10 believed there was a better than 50/50 chance the target would be met.
The King's Fund's latest quarterly monitoring report, published on Wednesday, found that 31% of NHS finance leaders believed patient care had worsened in their area in the past year. Just 14% said it had improved, and 55% said it had stayed the same.
A total of 72% were pessimistic about the prospects for their local health economy over the coming 12 months.
Professor John Appleby, chief economist at The King’s Fund said: ‘The findings from our survey of finance directors have become significantly more pessimistic over the past 12 months, reflecting the growing pressures on the NHS.
'Now just over half way through the so-called Nicholson Challenge, it is clear the NHS will struggle to meet its £20 billion productivity target, with potentially serious consequences for patient care. The reality for many hospitals is that they face an uncomfortable choice between whether to prioritise the quality of services for patients or allow performance in some areas to slip in order to balance the books.’