Levels of Health-care

Primary, Secondary and Tertiary Healthcare/Medical Care

What is Health-care/Medical Care?

Health care, or healthcare, is the process of preserving or improving one's health by preventing, diagnosing, treating, ameliorating, or curing disease, illness, injury, and other physical and mental impairments in humans. Health care is provided by health professionals and other members of the allied health professions. Health care encompasses the fields of medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, and athletic training, among others. It encompasses work in primary care, secondary care, tertiary care, and public health.

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Access to health care varies across countries, groups, and individuals, and is determined by socioeconomic and health policy factors. Health care services are defined as "the timely utilisation of personal health care services in order to achieve the greatest potential health results." Consider financial constraints (such as insurance coverage), geographic restrictions (such as additional commuting costs, the possibility of taking paid time off work to use such services), and personal constraints when it comes to health care access (lack of ability to communicate with health care providers, poor health literacy, low income). Restriction of health care services has a detrimental effect on the utilisation of medical services, the efficacy of treatments, and the overall outcome (well-being, mortality rates).


Health care systems are organisations formed to address the health care needs of specific populations. The World Health Organization (WHO) states that a well-functioning health care system requires a financing mechanism, a well-trained and adequately compensated workforce, reliable data on which to base decisions and policies, and well-maintained health facilities capable of delivering quality medicines and technologies.

A well-functioning health care system may significantly contribute to a country's economy, development, and industrialization. Health care is often viewed as a critical factor in promoting people's overall physical and emotional health and well-being. A case in point is the WHO-declared worldwide eradication of smallpox in 1980, the first illness in human history to be eradicated through purposeful health care treatments.


Levels of Health-care/Medical Care

There are three levels of healthcare that are mentioned in the following:

Primary Healthcare

Primary healthcare denotes the first level of contact between individuals and families with the health system. According to the Alma Atta Declaration of 1978, Primary Health care was to serve the community it did; it included care for mother and child, which included family planning, immunisation, prevention of locally endemic diseases, treatment of common diseases or injuries, provision of essential facilities, health education, provision of food and nutrition and adequate supply of safe drinking water.


Primary care refers to the work of health professionals who act as the first point of consultation for all patients within the health care system. Such a professional would usually be a primary care physician, such as a general practitioner or family physician. Another professional would be a licensed independent practitioner such as a physiotherapist or a non-physician primary care provider such as a physician assistant or nurse practitioner. Depending on the locality of the health system organisation, the patient may see another health care professional first, such as a pharmacist or nurse. Depending on the nature of the health condition, patients may be referred for secondary or tertiary care.

Primary health care mainly focuses on health equity, producing social policy beyond the traditional healthcare system. Its main aim is to provide local care to a patient because primary care professionals are normal generalists dealing with a broad range of psychological, physical and social problems, etc., rather than specialists in any particular disease area. Primary care services rapidly increase in developed and developing countries depending on the increasing number of adults at greater risk of chronic non-communicable diseases like diabetes, asthma, back pain, hypertension, anxiety, depression etc.


Read More: Health and Public Health

5 Key Elements of Primary Health Care

"The ultimate goal of primary health care is better health for all. WHO has identified five key elements to achieving that goal: 
a) reducing exclusion and social disparities in health (universal coverage reforms); 
b) organizing health services around people's needs and expectations (service delivery reforms); 
c) integrating health into all sectors (public policy reforms); 
d) pursuing collaborative models of policy dialogue (leadership reforms); and 
e) increasing stakeholder participation."


Secondary Healthcare

Secondary care includes acute care: necessary treatment for a short period for a brief but severe illness, injury, or other health condition. This care is often found in a hospital emergency department. Secondary care includes skilled attendance during childbirth, intensive care, and medical imaging services.

"Secondary care" is sometimes used synonymously with "hospital care." However, many secondary care providers, such as psychiatrists, clinical psychologists, occupational therapists, and most dental specialities or physiotherapists, do not necessarily work in hospitals. Some primary care services are delivered within hospitals. Depending on the organisation and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care. Physiotherapists are primary and secondary care providers who do not require a referral.


This healthcare is provided by the medical specialists and other health problems who do not have direct contact with a patient like urologists, dermatologists, cardiologists etc. According to National health system policy, the patient requires primary care professional's referral to proceed further for secondary care. Depending on the country, the patient cannot directly take secondary care because sometimes the health system restricts patient referral in terms of payment.

The systems that come under this category are the District Health System and County Health system.

a) The District Health system mainly focuses on child health and maternity care. People population of this system is about 25000 to 50000 and includes various healthcare centres and district hospitals. Healthcare centres receive referrals from multiple primary health care and remain open for 24 hours every day. District hospitals include emergency services, neonatal care, comprehensive emergency obstetrics etc. and stay open for 24 hours every day.

b) County Health System: Hospitals receive referrals from the District & community health systems into this system. The county hospital provides gynecologic services, general medicine, obstetrics, general surgery etc. and remains open for 24 hours every day.


Tertiary Healthcare

Tertiary care is specialised consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility with personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital. Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions.

This type of healthcare is specialised consultative healthcare, usually for inpatients and primary and secondary healthcare referrals for advanced medical investigation and treatment. Following examples of tertiary care services are plastic surgery, burn medicine, cardiac surgery, cancer management, neurosurgery, complex medical and surgical interventions etc.


The leading provider of tertiary care is the national Health system consisting of regional and national hospitals. Regional hospitals receive a reference from various county hospitals and serve as training sites complementary to the National referral hospital. It also provides additional care services and remains open 24 hours every day.

Difference between Primary, Secondary and Tertiary Medical Care/Health Care


Primary Healthcare Services

a) As the name implies, primary care focuses on the most basic healthcare treatments that address an individual's health concerns. The treatment does not necessitate a specialist and can be handled by a general practitioner.

b) Primary care is expanding rapidly in both developed and developing cities worldwide.

c) According to WHO guidelines, the goal is to make general health solutions available to everyone.

d) Primary care anticipates growing participation from general healthcare actors and the induction of excellent healthcare, practises at the fundamental level and satisfying the needs of healthcare recipients.


Secondary health-care Services

a) Cardiologists, dermatologists, urologists, and other specialists are included in secondary healthcare.

b) Individuals seek secondary medical care providers after being referred by leading healthcare doctors.

c) Individuals in a few nations cannot consult specialists without first receiving a recommendation from a primary care physician.

d) Secondary healthcare professionals serve as a link between the patient and sophisticated medical treatment.


Healthcare at the tertiary level

a) This type of care is provided to individuals due to a referral from their primary care physician or other healthcare practitioners.

b) For conditions such as cancer and neurological impairments, the individuals may require complex medical operations such as major surgeries, transplants, replacements, and long-term medical care management.

c) The highest kind of healthcare is specialised consultative medical care, which performs all major medical procedures.

d) Tertiary medical care includes advanced diagnostic centres, specialised intensive care units, and contemporary medical facilities.

e) The practices that provide tertiary medical care could be government-run or a mix of the public and private sectors. The latter is exemplified by India's healthcare system.

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