Primary to Quaternary – Levels of Healthcare and their Impact

Summary

Healthcare is a vast and deep domain that involves hundreds of stakeholders of different types and levels. To a lay man, this complexity translates into specialized and timely care when and where needed. To achieve this, a lot of effort goes on behind the scenes. New players want to enter this sector all the time, however, they need to pick exactly where they would like to be in this vast landscape. They need to understand the four levels of care offered by the sector. Understanding that will give them, and the layman, an idea on how governments and healthcare sector collaborate to deliver this level of care. In this article, we will learn more.

Introduction

In the 70s and 80s, it was common to find Indians traveling to the US or UK for advanced treatments, as those were not available in India. Post-liberalization in 1991, more and more private-equity investment started pouring into India’s healthcare sector. This led to the creation of state-of-the-art corporate hospitals, with the latest in medical equipment, the best of doctors, and advanced therapies that were now available in India. Since then, India’s healthcare sector has progressed impressively and today, the country is the number-one destination in the world for medical tourism.

Its success has inspired, and continues to inspire, hundreds of pharma companies, doctors, specialists, care providers and medical-equipment manufacturers to enter the sector and enrich it further, day after day. However, given the vastness of the sector, its important for them, and the common-man, to understand how the healthcare sector is organized. It is important to know the four levels of care offered by the sector and their respective impact on patient wellness, and the society at large.

The four levels can be seen as part of a pyramid, where the levels go up one goes up the pyramid.

Primary Care

This is the bottom, and the broad base of the pyramid. This pertains to ‘essential healthcare’. Basically, this is the first level of interaction between the patient or his/her family and the healthcare sector, whenever there is a health issue. As a common-man, you will access Primary Care, in all these situations:

• Illness: Aches, pain, fevers, common infections are routine matter that are addressed here.
• Injury: One could have rashes, burns, fractures, a twisted muscle, sprain, etc. This applies equally to adults and children. In the case of women’s healthcare, this refers to pregnancy and childbirth. When it comes to elders, there are geriatricians who address concerns here.
• Referral: Once a larger problem is diagnosed, the doctor(s) concerned will refer the patient to a specialist or team of specialists. This too happens at this level.

So, who are the stakeholders, or players, at this level? They will be:

• Doctors: These are general physicians, and some specialists like a gynaecologist, paediatrician and geriatrician (elder health specialist)
• Nurse practitioners: Qualified and trained, male or female nurses, working full-time or part-time, in different models
• Physician assistants: These are junior doctors, interns and certain categories of care providers like a mid-wife in rural settings where primary care is hard to come by.

Primary Healthcare is very significant to the common-man who is the patient; to the healthcare sector; to local and central governments, as well as the society at large, because of the benefits it brings. These are:

• Primary care is the doorway to quick cure, and hence better quality of life
• Primary care reduces the prevalence, or minimizes the effect of – chronic conditions that adults and children face
• It helps to reduce the risk of complications that can be prevented and secondary conditions that can develop
• It facilitates ongoing care till the patient has fully recovered
• It helps avoid lengthy hospitalizations, re-admission and hence overall cost of healthcare

Given the importance of Primary Care, both local and central governments invest in creating a network of primary healthcare centres (PHCs) that are well-staffed and funded. The WHO has been emphasizing universal health coverage. In this direction, they have launched the Rehabilitation 2030 Call for Action, that aims at strengthening rehabilitation within the local healthcare system and especially within primary healthcare.

Secondary Care

Secondary care is received when the primary care physician has referred you to a specialist who can do a better job of diagnosing and treating the condition. In many countries, one can meet a specialist only with a referral from a primary care physician, while in other countries, including India, one can meet a specialist directly. These specialists are found in a hospital, a speciality clinic, or sometimes in a community setting. Secondary care will involve more planned operations, specialized equipment, devices and medication.

Secondary care service providers can be broadly classified this way:

• Consultative Specialists: Heart Specialists, Endocrinologists, Oncologists, psychiatrists, clinical psychologists, dermatologists, psychiatrists, orthopaedics, pulmonologists, nephrologists, ENT specialists, dental specialists, gastroenterology surgeons, etc
• Allied Services providers: Childbirth assistants, ICU doctors, medical imaging lab technicians, radiologist, etc
• Rehabilitation Services providers: Physiotherapists, respiratory therapists, speech therapists, occupational therapists, nutritionists and dietitians

Tertiary Care

Sometimes, the consultation and allied services provided under secondary care may not be enough. There may be a higher level of specialists or interventionists, such as surgeons who are required to perform a procedure or provide a therapy, that will resolve the condition, partially or fully. These specialists are referred by a secondary care service provider, of the types listed above.

These higher-order specialists are only available in hospitals or nursing homes and one can rarely meet them directly. They are surgeons or doctors who undertake treatment for severe burns, neurosurgery, plastic surgery, cardiac surgery, advanced neonatology services (in case the newborn has some complications) and palliative care for people suffering from an end-stage disease that cannot be cured. It also includes specialists in interventions such as endoscopy, minimally-invasive surgery, and complex medical or surgical interventions like valve-repair, organ transplantation, etc.

Incidentally, tertiary care services may not be available in villages or Tier-3 cities of India, and one must invariably come to a Tier-1 or Tier-2 city in India for these services. The hospital or nursing home will have modern medical amenities, specialised ICUs and advanced diagnostic capabilities.

Quaternary Care

 This is the apex or the top of the pyramid. As you can guess, these are made up of super specialists. These specialists are again referred by secondary-care or tertiary-care specialists. They are rare and fewer in number. They can only be met by reference and not directly. The specialists are highly reputed and are known in both national and international circles. Such level of specialization may only be available in some centres in the country or abroad. Needless to say, the condition these specialists are treating are also complex. It may require long-drawn hospitalization, multiple therapies and costly drugs.

Outlook

In recent decades, Indian governments have been trying to strengthen the primary care network, across the length and breadth of the country. Indian doctors and hospitals in Tirunelveli, Salem, Hosur, Trichy, Chennai and other metros and beyond have done very well when it comes to tertiary and quaternary levels of healthcare. This has reduced the necessity for Indians to go abroad for complex conditions. They can receive the same level of care in India, at a nearby destination, and at more affordable rates than traveling abroad. It has made the world sit up and acknowledge India as a global healthcare and pharmaceutical hub.

Frequently Asked Questions:

What are the four levels of healthcare?

The four levels are primary care, secondary care, tertiary care, and quaternary care, each providing progressively specialized and intensive medical services.

What is primary care and who are the stakeholders involved?

Primary care is the first point of contact between patients and the healthcare system, addressing common health issues. Stakeholders include general physicians, nurse practitioners, and physician assistants.

How does primary care benefit patients and society?

Primary care offers quick cures, reduces chronic conditions, prevents complications, facilitates ongoing care, and lowers overall healthcare costs, benefiting both patients and society.”

What is secondary care and who provides it?

Secondary care involves specialized medical services received upon referral from primary care physicians. It’s provided by consultative specialists, allied service providers, and rehabilitation professionals.

When is tertiary care required, and what services does it entail?

Tertiary care is necessary for complex conditions requiring advanced interventions like surgery or specialized therapies. Services include neurosurgery, cardiac surgery, organ transplantation, and advanced neonatology.

What is quaternary care, and how is it different from other levels?

Quaternary care offers highly specialized services provided by renowned super specialists for complex and rare conditions, often requiring long hospitalizations and costly treatments, with referrals from tertiary care specialists.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 •  Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801