Cathy Lizak
Contributing writer
last updated 10/29/2020

Levels Of Health Care In the Medical System

How Medical Flights Handle Primary Care, Secondary Care, Tertiary Care, and Quaternary Care


You may have heard your doctor or case manager talk about you or your patient's level of care. The level of care is related to how complex the patient's medical situation is, and the skills and specializations of their health care providers. Doctors usually refer to four different levels of care: primary care, secondary care, tertiary care, and quaternary care.

Knowing the meaning of these terms and the type of care they represent can empower you as a patient or family member. It can help you understand what level of care you're receiving and clarify the medical referral system.

Primary Care: Level One

Many of us are familiar with the term "primary care physician" or "primary care provider." Your family doctor or public health clinic are good examples of what is referred to as primary care. In most cases, primary care is our first stop when we have minor medical issues, like a cold or a rash.

Primary care may be provided by doctors, nurse practitioners, and sometimes by specialists such as pediatricians or OBGYNs. Usually these providers are responsible for organizing care among specialists at higher levels of care as well.

Secondary Care: Level Two

If your primary care doctor finds that you may require specialized care, they will refer you to a specialist physician. Specialists provide secondary care, meaning you're receiving care from someone who has specific expertise in the area of your medical needs.

Specialist physicians usually focus on one part of the body, one bodily system, or one disease or disorder. A well-known example of a specialist physician is a cardiologist, who focuses on the heart and blood vessels. You might be referred to a cardiologist for an irregular heart beat or after a heart attack.

Sometimes secondary care and hospital are used interchangeably, but not all secondary care physicians practice in a hospital. For example, psychiatrists and physical therapists are also considered secondary care providers.

In most cases, people with conditions that can't be treated at the primary care level will end up at the secondary care level. However, depending on your insurance, you might need a referral from your primary care physician in order to get coverage.

It can also be helpful to have your primary care physician coordinate your secondary care, especially if you're seeing more than one specialist for different conditions. If your specialists work together with your primary care provider, they'll be able to make sure everyone is on the same page.

Secondary care also includes acute care. Acute care refers to treatment that is necessary for a short time due to a serious illness or injury. This type of care is usually provided by the hospital’s emergency department.

Being in secondary care can make travel more complicated. If you or your patient is receiving secondary care, they may have conditions that make normal commercial transport uncomfortable, or even unsafe. Air ambulance is a safe, reliable option for patients in secondary care. Aeromedically trained flight nurses coordinate with the patient’s primary care and secondary care doctors to ensure that all of their specific needs are met from bedside to bedside.

Tertiary Care: Level Three

After you or your patient are admitted to the hospital, your specialists might refer you to tertiary care. Tertiary care includes advanced medical treatment that may require sophisticated equipment or extensive specialization.

Treatments within tertiary care are generally very complex. They can include neurosurgery, severe burn care, or renal or hemodialysis.

Not all facilities are able to provide tertiary care to all patients. Usually acute care general hospitals provide tertiary care. Even if a patient is already in a hospital, they may need to be transferred to a different facility that has the equipment and specialists to meet their needs.

There are different options for transporting a patient in tertiary care. If the distance to a suitable facility is short, they may be able to ride in an Advanced Life Support (ALS) ambulance. But if the nearest facility is too far, or if their medical emergency occurred far from home, the best option is an air ambulance flight. Air ambulance planes are reconfigured to have all the capabilities of an intensive care unit, so they are able to transport even critical care patients safely and comfortably.

Quaternary Care: Level Four

Quaternary care is an extension of tertiary care, for cases that require even more specialization. Quaternary is very uncommon, but your patient may be referred to quaternary care in rare circumstances. For example, experimental medicine is considered a type of quaternary care. Another example of quaternary care would be very rare and specialized surgeries, such as fetal surgery.

By definition, quaternary care is extremely specialized and extremely rare. This means patients almost always have to travel to a quaternary care facility.

The best way to transport a patient to receive quaternary care is air ambulance. Even critical patients can qualify for air ambulance transport. The overseeing physician will contact the primary and specialist physicians treating the patient to get a full medical evaluation, and then determine exactly how to meet their specific needs throughout their travel.

A High Standard of Care at Every Level

Most of the time, you’ll only need care at the primary and secondary level. But understanding the different levels of health care can empower you as a patient or family member to make sure you’re getting the care you need. Global Air Ambulance is ready to be your partner for long distance medical transport every step of the way.

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