How the 4 Levels of Medical Care Differ (2022)

In medicine, levels of care refer to the complexity of the medical cases doctors treat and the skills and specialties of the providers.Levels are divided into four categories.

Primary care is when you consult with your primary care provider. Secondary care is when you see a specialist such as an oncologist or endocrinologist. Tertiary care refers to specialized care in a hospital setting such as dialysis or heart surgery. Quaternary care is an advanced level of specialized care.

As a patient, you might sometimes hear these terms. So knowing their definitions can help you better understand what your doctor is talking about and help you recognize the level of care you're receiving.

This article explains the levels of care, what type of provider is involved in each level, and what situations may require different levels of care.

How the 4 Levels of Medical Care Differ (1)

Primary Care: Essentials

Most people are very familiar with primary care. This office is your first stop for most of your symptoms and medical concerns. You might seek primary care for the following:

  • Illness: You may see your primary care doctor when you notice a new symptom or when you come down with a cold, the flu, or some other infection.
  • Injury: You may also seek primary care for a broken bone, a sore muscle, a skin rash, or any other acute medical problem.
  • Referral: Also, primary care is typically responsible for coordinating your care among specialists and other levels of care.

In addition, you'll probably see a primary care provider (PCP) for regular screenings, general checkups, and wellness visits.

Primary care providers may be:

  • Doctors
  • Nurse practitioners
  • Physician assistants

There are some primary care specialties as well. For instance, OB-GYNs, geriatricians, and pediatricians are all primary care doctors. But they also happen to specialize in caring for a particular group of people.

Studies have shown that primary care providers benefit the healthcare system by:

  • Enhancing access to healthcare services
  • Providing better health outcomes
  • Decreasing hospitalization and use of emergency department visits

Most health insurance policies require you to designate a primary care provider. In most cases, you can choose a family practice physician, internist, OB-GYN, geriatrician, or pediatrician for this role.

Secondary Care: Specialists

Secondary care is when your primary care provider refers you to a specialist. Secondary care means your doctor has transferred your care to someone who has more specific expertise in whatever health issue you are experiencing.

Specialists focus either on a specific system of the body or a particular disease or condition. Examples of specialists include:

  • Cardiologists focus on the heart and blood vessels.
  • Endocrinologists focus on hormone systems, including diseases like diabetes and thyroid disease.
  • Oncologists specialize in treating cancers, and many focus on a specific type of cancer.

Your insurance company may require that you receive a referral from your PCP rather than going directly to a specialist.

(Video) Levels of Disease Prevention (Primary, Secondary, Tertiary)

Sometimes problems arise in secondary care. These may include:

  • Wrong specialist: Sometimes, doctors refer people to the wrong kind of specialist. That can happen because symptoms often overlap between a variety of health conditions. So, your symptoms may suggest one problem when, in reality, it is another condition that requires a different specialist.
  • Lack of coordination of care: You may also experience problems if you're seeing more than one specialist and each is treating a different condition. Sometimes in these cases, doctors might not fully coordinate your care. Ideally, specialists should work with your primary care health team to ensure everyone knows what the others are recommending.

How Referrals Work With Your Health Insurance

Tertiary Care and Hospitalization

If you are hospitalized and require a higher level of specialty care, your doctor may refer you to tertiary care. Tertiary care requires highly specialized equipment and expertise.

At this level, you will find procedures such as:

  • Coronary artery bypass surgery
  • Dialysis
  • Plastic surgeries
  • Neurosurgeries
  • Severe burn treatments
  • Complex treatments or procedures

A small, local hospital may not be able to provide these services. So, if you require more advanced care, they may need to transfer you to a medical center that provides highly specialized tertiary level services.

Studies have shown that when you are in tertiary care for certain chronic conditions such as diabetes and chronic kidney disease, your PCP must remain involved. That's because your PCP can help you establish and maintain a management plan for the long term.

Quaternary Care

Quaternary care is considered an extension of tertiary care. However, it is even more specialized and highly unusual.

Because it is so specific, not every hospital or medical center offers quaternary care. Some may only provide quaternary care for particular medical conditions or systems of the body.

The types of quaternary care include:

  • Experimental medicine and procedures
  • Uncommon and specialized surgeries


Levels of care refer to the complexity of medical cases, the types of conditions a physician treats, and their specialties.

Primary care involves your primary healthcare provider. You see them for things like acute illnesses, injuries, screenings, or to coordinate care among specialists.

Secondary care is the care of a specialist. These specialists may include oncologists, cardiologists, and endocrinologists.

Tertiary care is a higher level of specialized care within a hospital. Similarly, quaternary care is an extension of tertiary care, but it is more specialized and unusual.

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A Word From Verywell

The majority of the time, you'll only receive primary or secondary care. However, when you have a severe injury, condition, or disease, your doctor will move you to higher levels.

Understanding the levels of care will help you navigate the medical system and receive the care you need.

Frequently Asked Questions

  • What are the different levels of health care?

    Health care is described as different levels of care: primary, secondary, tertiary, and quaternary. Primary care is the main doctor that treats your health, usually a general practitioner or internist. Secondary care refers to specialists. Tertiary care refers to highly specialized equipment and care. Quaternary care is an even more specialized extension of tertiary care.

  • Is a hospital considered secondary or tertiary care?

    It depends on the hospital and the services you receive. A secondary care hospital is typically a smaller facility that lacks specialized equipment. If you are at a secondary-care level hospital and need more specialized care, you will be transferred to a tertiary care hospital. Examples of tertiary care include coronary artery bypass surgery, severe burn treatments, neurosurgery, and dialysis.

  • Is tertiary level care the same as Level III care?

    No. Tertiary care and Level III care are different. Care levels discussed in Roman numerals refer to trauma center designations. Care levels discussed in ordinals (primary, secondary, etc.) describe the intensity of care and are commonly used for insurance purposes.

    Care levels are named in ascending order lowest level of care (primary) to highest intensity (quaternary). Trauma care levels descend from the lowest level (Level V trauma center) to the highest level of care (Level I trauma center).

    (Video) What are the differences in trauma levels? - Frankfort Regional Medical Center

2 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Shi L. The impact of primary care: a focused review.Scientifica (Cairo). 2012;2012:432892. doi:10.6064/2012/432892

  2. Lo C, Ilic D, Teede H, et al. Primary and tertiary health professionals' views on the health-care of patients with co-morbid diabetes and chronic kidney disease - a qualitative study.BMC Nephrol. 2016;17(1):50. doi:10.1186/s12882-016-0262-2

By Trisha Torrey
Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system.

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What are the 4 level model of the health care system? ›

In the broadest terms, there are four major healthcare models: the Beveridge model, the Bismarck model, national health insurance, and the out-of-pocket model.

Which 4 factors contribute to quality of care? ›

To understand why, we have to realize that health includes more than just health care.
  • The Social and Economic Environment.
  • Health Behavior.
  • Clinical Care.
  • The Physical Environment.
18 Jul 2018

What are the four types of care? ›

In general, there are four common care environments: Home Health Care, Assisted Living Facilities, Nursing Homes, and Adult Daycare Centers.

What are the four functions of health systems? ›

4, in every health system organizations have to perform four basic functions: financing, provision, stewardship and resource gen- eration (human, physical and knowledge) (56).

What are the 4 levels of health promotion? ›

Four levels of health promotion are identified: environmental, social, organisational and individual.

What are the different levels of medical? ›

Healthcare is divided into four levels; primary, secondary, tertiary, and quaternary. Doctors use these different categories to distinguish between the complexities of medical cases and the level of care they require.

What are the different types of healthcare systems? ›

Let's take a closer look at the four key types of healthcare systems and how they aim to meet the medical needs of populations. They are known as the Beveridge Model, the Bismarck Model, the National Health Insurance Model, and the Out-of-Pocket Model.

What are the 4 primary caregivers? ›

Definition of Primary Caregiver

Primary caregivers may be caring for children, a senior, a spouse with a terminal illness, or any friend or family member who requires assistance with daily activities.

What is the difference between primary and secondary care? ›

Primary care is the first place people go to when they have a health problem and includes a wide range of professionals, e.g., GPs, dentists, pharmacists and opticians. Secondary care simply means being taken care of by someone who has particular expertise in whatever problem a patient is having.

What is the importance of health care system? ›

Providing social health protection and equal access to quality health care has significant positive effects on individual and public health, economic growth and development. The health sector is also a major employment sector, with important potential in job creation.

What makes a good healthcare system? ›

Quality health services should be: effective; safe; people-centred; timely; equitable; integrated; and efficient.

What is the purpose of healthcare system? ›

The fundamental purpose of health care is to enhance quality of life by enhancing health. Commercial businesses focus on creating financial profit to support their valuation and remain viable. Health care must focus on creating social profit to fulfill its promise to society.

What are the 4 main factors which affect health and wellbeing? ›

The determinants of health include: the social and economic environment, the physical environment, and. the person's individual characteristics and behaviours.

What are the 4 major factors that affect the health of a community? ›

These include things like housing, financial security, community safety, employment, education and the environment. These are known as the wider determinants of health.

What factors determine quality of care? ›

Factors Influencing the Quality of Healthcare Services
  • Clinical competence of the hospital staff. ...
  • Physical ambience of the hospital. ...
  • Amenities provided by the hospital. ...
  • Expertise of the physicians. ...
  • Behaviour of the staff. ...
  • In-patient experience. ...
  • Patient satisfaction.
11 Jul 2019

What are the different levels of prevention? ›

  • Primary Prevention—intervening before health effects occur, through.
  • Secondary Prevention—screening to identify diseases in the earliest.
  • Tertiary Prevention—managing disease post diagnosis to slow or stop.

Why is primary secondary and tertiary prevention important? ›

Population health

The primary prevention approach focuses on preventing disease before it develops; secondary prevention attempts to detect a disease early and intervene early; and tertiary prevention is directed at managing established disease in someone and avoiding further complications.

What are the four principles of disease prevention and health promotion? ›

Healthy Settings key principles include community participation, partnership, empowerment and equity.

What are the difference of level 1 Level 2 & Level 3 hospitals? ›

From the patient's viewpoint, the main difference between a level III trauma center and a level I/II trauma center, is that these services will be available within 30 minutes rather than 15 minutes.

What is the main difference between primary secondary and tertiary care? ›

Primary care involves patients' primary healthcare providers, secondary care deals with specialists and tertiary care is a higher level of specialised care within a hospital. Knowing these levels of healthcare is important for anyone looking to work in the healthcare industry.

What is primary level of care? ›

Primary Level of Care

Usually the first contact between the community members and other levels of the health facility. Center physicians, public health nurses, rural health midwives, traditional healers.

What is the best healthcare system? ›

According to this index, the ten countries with the best health care are:
  • Denmark.
  • Austria.
  • Japan.
  • Australia.
  • France.
  • Spain.
  • Belgium.
  • United Kingdom.

What is the medical model in health care? ›

The medical model is a diagnostic approach to medicine and is the primary model of healthcare medical assistants and doctoral level physicians assistants use. The medical model focuses on cause and effect, with an emphasis on treating the symptoms as a priority to restore a patient to health as quickly as possible.

What are the 4 types of caregivers for dependent adults? ›

The most common type of caregiver is the family caregiver: someone who takes care of a family member without pay. The other types are professional, independent, private, informal, and volunteer caregivers.

What is the difference between caregiving and caregiver? ›

Caregiver is a noun that means one who supports another person. This support could be physical, as in the case of the elderly or disabled, emotional, or psychological, as in the context of many caring professions. Caregiving is a profession in the field of human services.

Can a dad be a primary caregiver? ›

Conclusions: Fathers describe a wide range of reasons for becoming primary caregivers for their infant, and generally experience themselves as being actively involved in that decision. If fathers are to take an increasing role in child care, societal values and financial pressure may need to be addressed.

What is the difference between primary and acute care? ›

Acute care nurses focus on patients with complex, critical and chronic illnesses. Primary care nurses, on the other hand, emphasize health promotion, disease prevention and treat minor acute and chronic health problems.

What are primary secondary and tertiary health services? ›

Preventive health care is the main responsibility of the primary health care sector while secondary healthcare provides patients with the curative healthcare facilities. Tertiary healthcare, on the other hand, provides patients with more advanced curative healthcare facilities.

What does secondary care include? ›

Secondary care, which is sometimes referred to as 'hospital and community care', can either be planned (elective) care such as a cataract operation, or urgent and emergency care such as treatment for a fracture.

What is the difference between health care and medical care? ›

However, medical care probably constitutes only 10% – 20% of health outcomes. Health care is a much broader idea of which medical care is only a subset and constitutes the remaining 80-90% of health outcomes.

How can we improve healthcare? ›

5 Ways to Improve Health Care for the Future
  1. Surprise Medical Billing. ...
  2. Increasing Competition to Reduce Drug Prices. ...
  3. Expanding Adoption of Health Care Innovations. ...
  4. Transparency for Patients Without the Risk. ...
  5. Protecting Medicare Advantage and Medicaid.
23 Mar 2020

What is the difference between health care and healthcare? ›

Health care are the specific things that people do: see a patient or prescribe a medication. Healthcare is an industry, the system by which people get the health care they need.

How is quality of care measured in healthcare? ›

Structural measures of quality typically include the characteristics of the resources in the health care system, including individual practitioners, groups of practitioners, organizations and systems of care, geographic location, and accessibility of services.

Why is quality of life important in healthcare? ›

Measuring HRQOL can help determine the burden of preventable disease, injuries, and disabilities, and can provide valuable new insights into the relationships between HRQOL and risk factors. Measuring HRQOL will help monitor progress in achieving the nation's health objectives.

What does effective care mean? ›

Effective care is provided when:

People's needs and choices are assessed, with care, treatment and support delivered in line with current legislation, standards and evidence-based guidance.

How does healthcare impact society? ›

Healthcare holds a significant place in the quality of human capital. The increased expenditure in healthcare increases the productivity of human capital, thus making a positive contribution to economic growth (4, 5).

What are the models of health and describe each model? ›

There are two common models of health, the biological, focusing on the physical illness only, and biopsychosocial, which focusses on all aspects of the patient. There are drastic differences between the health of the deprived and the more affluent.

What are the four nursing care delivery models? ›

Traditionally, four dominant methods are mentioned in the literature on the organization of nursing care delivery: functional nursing, individual, team nursing, and primary nursing [4].

What are models of health care delivery? ›

Health care delivery models offer the very first layer of confusion for many consumers. Here, we'll discuss seven common models: HMO, PPO, POS, EPO, PFFS, SNP and ACO and examine the differences between each one.

What are the models of care? ›

Some of the most commonly used models of care are the Health Home Model, the Special Needs Plan Model, and the Chronic Care Model.

Why do we have different models of health? ›

The different models were assumed to depict different, but related, ways of representing health and disease. It is probable that different groups in society, including the different groups in the health service--doctors, nurses and patients--look at health and illness from partly different models.

Why is it important to use a model of health? ›

It is used to explain and predict individual changes in health behaviors. It is one of the most widely used models for understanding health behaviors. Key elements of the Health Belief Model focus on individual beliefs about health conditions, which predict individual health-related behaviors.

Why are models of health important? ›

Theories and models are used in program planning to understand and explain health behavior and to guide the identification, development, and implementation of interventions.

Why is it important to identify how this nursing care is delivered? ›

Depending on the nursing care delivery model utilized in a facility, the skill mix can vary. Effective nursing care delivery models are important to ensure safe and quality patient outcomes, nurse satisfaction and retention 3 and cost-effectiveness for the organization.

What is the difference between primary nursing and total patient care? ›

This is distinguished from the practice of team nursing, functional nursing, or total patient care, in that primary nursing focuses on the therapeutic relationship between a patient and a named nurse who assumes responsibility for a patient's plan of care for their length of stay in a particular area.

What is the most important difference between patient-focused care and team nursing? ›

Terms in this set (14)

What is the most important difference between patient-focused care and team nursing? Patient-focused care uses multi-skilled workers. In which nursing care delivery model does one registered nurse (RN) direct all of the care to a patient in a unit for the patient's entire stay?

How many different types of healthcare systems are found across the world? ›

There are four major models for health care systems: the Beveridge Model, the Bismarck model, the National Health Insurance model, and the out-of-pocket model.

What are the types of universal healthcare? ›

Types of Universal Healthcare Coverage
  • Required health insurance.
  • Single-payer insurance systems.
  • National health care systems.

Who is primarily responsible to provide healthcare to people? ›

Public health is a State subject, the primary responsibility to provide quality health care services to the people including in rural, tribal and hilly areas lies with State/UT Governments.

What is a primary care model? ›

The Direct Primary Care (DPC) model is a practice and payment model where patients/consumers pay their physician or practice directly in the form of periodic payments for a defined set of primary care services.

Why are models of care important in nursing? ›

Nursing models offer the practising nurse a way to decide which activities to use in a particular nursing situation. In short, a nursing model provides the comprehensive framework for the implementation of the nursing process.

What is an example of medical home model of care? ›

Because the medical home can be a physical or a virtual network of providers and services, HIT facilitates communication and information sharing among providers. For example, medical homes use electronic health records, which give providers instant access to patient information regardless of location.


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