Healthcare: Primary, Secondary and Tertiary [Brief Description]

Health care Definition:

Health care is an organised way of medical care concerned with the maintenance of the health
of the whole body. It is delivered by the healthcare providers or professionals in various fields
includes a pharmacy, nursing, medicine, dentistry, psychology, physicians etc. Day by day
healthcare facilities got improved into various corners of the world and meets the gaming
technology. Healthcare is mainly influenced by the social, economic conditions & health
policies of the place and varies across different countries, individuals, groups etc.

In few countries to meet the health needs of the people, various healthcare systems are
established. According to World Health Organization, health care system requires a well-
trained and adequately paid workforce, deliver quality medicines and technologies etc.

Types of Healthcare:
Every individual has required different care depending upon their health problem like some
require normal care and some require extra special care. So on the basis of patient condition
healthcare divides into various types. Following types of healthcare are explained below:

(i) Primary Healthcare:

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
professionals related to primary care are normal generalists, deals with a broad range of
psychological, physical and social problems etc rather than specialists in any particular disease
area. Primary care services rapidly increasing in both the developed and developing countries
depending upon the increasing number of adults at greater risk of chronic noncommunicable
disease like diabetes, asthma, back pain, hypertension, anxiety, depression etc.

To achieve the ultimate goals of primary health care., WHO has described five elements to
achieve this goal. Following are:

 Stakeholder participation increased.

 Integrate health into all sectors.
 According to people need & expectation organizing healthy services.
 Pursuing collaborative models of policy dialogue.

(ii) Secondary Healthcare:

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 required primary care professionals referral to proceed
further for secondary care. Depends on countries to countries, the patient cannot directly take
secondary care because sometimes health system imposed a restriction of referral on a patient in
terms of payment.

The systems come under this category is known as District Health system and County Health
system.

(a) District Health system : This system mainly focus 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 various primary health care and is
remain open for 24 hours every day. District hospitals include emergency services, neonatal care,
comprehensive emergency obstetric etc and is remain open for 24 hours every day.

(b) County Health system: Into this system, hospitals receive referrals from the District &
community health systems. County hospital provides gynecologic services, general medicine,
obstetrics, general surgery etc and is remain open for 24 hours every day.

(iii) Tertiary Healthcare:

This type of healthcare is known as specialized consultative healthcare usually for inpatients and
on referral from primary and secondary healthcare for advanced medical investigation and
treatment. following examples of tertiary care services are plastic surgery, burn treatment,
cardiac surgery, cancer management, neurosurgery, complex medical and surgical interventions
etc.

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

Types of healthcare delivery services

Outpatient Care
Outpatient Care is provided in a medical treatment facility (hospital, clinic, etc.) for a condition
or course of treatment, which does not require admission to a hospital (in other words, for a
treatment which would require an overnight stay). Outpatient care can be provided by primary
care physicians and various types of medical specialists.

A person seeking medical care (a patient or sick person) usually first sees what is often referred
to as a “primary care physician” – this person is also often referred to as a “general
practitioner”, “family doctor”, “pediatrician”, etc. and he/she could be a dentist, gynecologist,
etc. For care from a primary care physician, it is usually necessary for the person seeking care to
have previously registered (been enrolled) with that physician.

A doctor may refuse to accept a patient for treatment in any of the following situations:

 If the doctor already has a full roster of registered persons – such that the doctor would
not have the ability to properly care for their existing registered persons if additional
persons were registered.
 If the doctor’s office is located too far away from the to-be-registered person’s place of
residence – i.e. the doctor would be too far away from the person’s home should a home
visit be necessary.
 If the patient is not insured by a health insurance company with which the provider of
medical services has a contract; this does not apply to persons with insurance who are
insured in another Member State of the European Union, a state that is part of the
European Economic Area or the Swiss Confederation, or persons from a country with
which the Czech Republic has entered into a social security agreement, which includes
within its scope a substantive right to healthcare.

Should a primary care physician refuse to register (or accept) an individual as a patient, the
refused person is entitled to have the refusal provided to them in writing. In the case of an
emergency (i.e. an accident or sudden acute illness), no doctor can refuse to see a patient;
however, once the emergency has been dealt with, the attending doctor can transfer the patient
into the care of a primary care physician with whom the person is (or should otherwise have
been) registered.

Individuals always have the right to visit a specialist without first seeing their primary care
physician. They do not need what is often referred to as a “referral”.

The following types of outpatient care are provided:

a) Primary Outpatient Care. This includes visits (usually to a doctor’s office) for
the following types of care: preventive, diagnostic, therapeutic and assessment. It also
includes the coordination of the continuity of healthcare services being provided by
other providers (specialists, medical facilities). Primary outpatient care also includes
any necessary home visits to a patient.

b) Specialized Outpatient Care. This is care that requires the services of a medical
specialist (for example, an internist, surgeon, cardiologist, etc.).

c) Stationary Care. This care is provided to patients whose medical condition

requires repeated daily outpatient type treatments.

Inpatient Care
If, and as required by the nature of an illness, a primary care doctor or outpatient specialist can
‘recommend’ that a patient receive treatment in a hospital (a medical facility of the inpatient care
provider), or the doctor can ‘directly arrange’ for the patient’s admission to a hospital. There are
the following types of inpatient health care facilities: acute standard, acute intensive, follow-up
and long-term.

The Health Services Act defines “inpatient care” as healthcare, which cannot be provided on an
outpatient basis and which requires the patient to be hospitalized in order to provide the patient
with the necessary course or type of treatment. Inpatient care must be provided in a medical
facility of a healthcare provider with 24-hour operating hours.

In the Czech Republic there are four types of inpatient care:

a) Acute Standard Inpatient Care. This is intended for any of the following:

 Patients with a sudden illness or the sudden deterioration of a chronic condition, which
seriously threatens their health, but does not lead directly to a failure of vital bodily
functions.
 The performance of a medical procedure that cannot be done on the outpatient basis.
 To give an early start to some type of medical rehabilitation program.

b) Acute Intensive Inpatient Care. This level of care is provided to patients in

situations in which there is a sudden bodily malfunction or a sudden threat to basic
bodily functions or situations in which such a malfunction can be reasonably expected
to occur.

c) Follow-Up Inpatient Care. This level of care is provided to the following:

 Patients who were given a baseline diagnosis and whose health condition has been
stabilized.
 Patients who are dealing with a sudden illness or a sudden worsening of a chronic
condition.
 Patients whose medical condition requires follow-up care or some type of therapeutic
rehabilitative care.
 Patients who are partially or totally dependent on some type of care for the support of
vital bodily functions.

d) Long-Term Inpatient Care. This level of care is provided to patients whose

medical condition cannot be significantly improved by medical treatment or
intervention. It is also provided to patients requiring the ongoing provision of some type
of nursing care to prevent their condition from worsening. This level of care is also
provided to patients with some type of impaired basic bodily function.

Medical Rescue Service and Emergency Service

The Medical Rescue Service is a healthcare service, which is contacted using the below-listed
emergency phone number. It is primarily designed to provide pre-hospitalization emergency care
to an individual with a severe health impairment or to someone facing a life-threatening
situation. It is used in the case of a sudden severe illness or injury, when the patient cannot be
expected to get to the hospital by themselves. This service is also used in the event of an
accident, when someone needs to receive immediate care. It is also used when someone needs to
be taken to a hospital (a medical facility for the providing of inpatient care) for emergency
medical care in order to prevent the further deterioration or a health condition or when there is a
threat to someone’s life.

The following phone numbers are to be used in an emergency situation:

155 A nationwide emergency number in the Czech Republic to receive aid in the
case of a medical emergency. (Medical Rescue Service)

112 The pan-European (common) emergency number to call for help in the
event of a situation involving large numbers of injured persons – this number is used to
activate a response from the integrated rescue services system (this includes the Police
of the Czech Republic, the providers of emergency medical services, fire brigades and
fire protection units).

An Emergency Service (paid for by the health insurance provider) is also available for use by
those with a less severe sudden illness (including injury, a dental problem outside of normal
business hours and in the absence of an attending physician). Based on the arrangements made in
different local areas and with different medical facilities, doctors either cover for one other (in
their own offices) or the care is provided in special offices of the emergency medical services or
dental emergency services.

These emergency services are usually provided by inpatient medical care service providers (i.e.
hospitals).

More information can be obtained from the Department of Health or from the offices of the local
Regional Authorities on the manner in which emergency medical services are dispatched and
provided.

Occupation / Work Related Medical Services

These healthcare services are preventive in nature and their purpose is to assess the influence of
work, the working environment and working conditions on the health of individuals. These
occupation-related medical services include preventative examinations and health condition
assessments, which are used to evaluate the fitness of an individual to perform the tasks required
of them by their respective job. Also included here are consultations on occupational health and
safety issues, occupationally-related diseases and work-related illnesses. As part of these
occupational medical services, the employer pays for employee training in first aid and the
regular supervision of workplaces and working conditions.
Dispensary Care
This type of care is given to patients with chronic or long-term illnesses or with a condition in
which there is an ongoing deterioration in an individual’s health. Through the active and long-
term monitoring of the condition of such patients, it is possible to get a timely diagnosis of when
there is the need for additional therapeutic intervention.

Spa Therapeutic / Rehabilitative Care

Spa treatment can be included as part of therapeutic and rehabilitative care. It is prescribed by
the patient’s attending physician with a review by a supervising physician. The prescription for
this type of care is submitted by an individual’s regular doctor or by the attending physician
while the patient is still hospitalized.

Providing of Medicines and Medical Devices

In the Czech Republic there is an extensive network of pharmaceutical dispensing facilities
(pharmacies), which are used for the distribution of medicinal products (drugs) and medical
devices, both on the basis of a doctor-provided prescription and without it (i.e. an over-the-
counter sale).

Medical prescriptions have the following types of validity:

 1 day (from the issue date if issued by an emergency room)

 5 days (for antibiotics and antimicrobial chemotherapeutics)
 14 days (for other types of prescriptions – unless otherwise specifically noted with a
different validity period by the person issuing the prescription)

Preventative Care
A primary care physician performs preventive examinations and gives vaccinations against
infectious diseases.

Types of Home Health Care Services

What are the different types of home health care services?

The range of home health care services a patient can receive at home is limitless. Depending on
the individual patient's situation, care can range from nursing care to specialized medical
services, such as laboratory workups. You and your doctor will determine your care plan and
services you may need at home. At-home care services may include:

 Doctor care. A doctor may visit a patient at home to diagnose and treat the illness(es). He or
she may also periodically review the home health care needs.
 Nursing care. The most common form of home health care is some type of nursing care
depending on the person's needs. In consultation with the doctor, a registered nurse will set
up a plan of care. Nursing care may include wound dressing, ostomy care, intravenous
therapy, administering medication, monitoring the general health of the patient, pain control,
and other health support.

 Physical, occupational, and/or speech therapy. Some patients may need help relearning
how to perform daily duties or improve their speech after an illness or injury. A physical
therapist can put together a plan of care to help a patient regain or strengthen use of muscles
and joints. An occupational therapist can help a patient with physical, developmental, social,
or emotional disabilities relearn how to perform such daily functions as eating, bathing,
dressing, and more. A speech therapist can help a patient with impaired speech regain the
ability to communicate clearly.

 Medical social services. Medical social workers provide various services to the patient,
including counseling and locating community resources to help the patient in his or her
recovery. Some social workers are also the patient's case manager--if the patient's medical
condition is very complex and requires coordination of many services.

 Care from home health aides. Home health aides can help the patient with his or her basic
personal needs such as getting out of bed, walking, bathing, and dressing. Some aides have
received specialized training to assist with more specialized care under the supervision of a
nurse.

 Homemaker or basic assistance care. While a patient is being medically cared for in the
home, a homemaker or person who helps with chores or tasks can maintain the household
with meal preparation, laundry, grocery shopping, and other housekeeping items.

 Companionship. Some patients who are home alone may require a companion to provide
comfort and supervision. Some companions may also perform household duties.

 Volunteer care. Volunteers from community organizations can provide basic comfort to the
patient through companionship, helping with personal care, providing transportation,
emotional support, and/or helping with paperwork.

 Nutritional support. Dietitians can come to a patient's home to provide dietary assessments
and guidance to support the treatment plan.

 Laboratory and X-ray imaging

Certain laboratory tests, such as blood and urine tests, can be performed in the comfort of the
patient's home. In addition, portable X-ray machines allow lab technicians to perform this
service at home.
 Pharmaceutical services. Medicine and medical equipment can be delivered at home. If the
patient needs it, training can be provided on how to take medicines or use of the equipment,
including intravenous therapy.

 Transportation. There are companies that provide transportation to patients who require
transportation to and from a medical facility for treatment or physical exams.

 Home-delivered meals. Often called Meals-on-Wheels, many communities offer this service
to patients at home who are unable to cook for themselves. Depending on the person's needs,
hot meals can be delivered several times a week.