Differences Between Primary, Secondary, Tertiary, and Quaternary Care

Levels of Care

In medicine, levels of care refer to the complexity of the medical cases that healthcare providers treat and the skills and specialties of the providers. Levels are divided into four categories, beginning with primary care when you consult with your primary care provider.

Secondary care is when you see a specialist such as an oncologist (cancer expert) or endocrinologist (often for metabolic disorders like diabetes). Tertiary care refers to specialized care in a hospital setting such as renal dialysis or heart surgery. Quaternary care is an advanced level of specialized care.

This article explains these terms. Knowing their definitions can help you better understand what your provider is talking about and help you recognize the level of care you're receiving.

An illustration with differences between primary, secondary, and tertiary care

Illustration by Michela Buttignol for Verywell Health

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 provider 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: 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 health screenings, general checkups, and wellness visits.

Primary care providers may be:

There are some primary care specialties as well. For instance, obstetrics and gynecology (OB-GYN) specialists, geriatricians who treat older people, and pediatricians are all primary care providers. 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.

Secondary Care: Specialists

Secondary care occurs 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. They remain in contact with the specialist.

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

  • Cardiologists, who focus on the heart and blood vessels
  • Endocrinologists, who focus on hormone systems, including diseases like diabetes and thyroid disease
  • Oncologists, who 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.

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.

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 refers to highly specialized equipment and expertise with the goal of treating specific, complex health conditions.

At this level, you will find procedures such as:

Other specialized procedures, like dialysis, a coronary artery bypass graft (CABG), or burn treatment, are provided at a tertiary care facility. A small, local hospital may not be able to provide advanced care, so you may be transferred to a tertiary medical facility.

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

Summary

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.

Frequently Asked Questions

  • 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).

7 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.
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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.