Summary

Patients move through primary, secondary, and tertiary levels in the healthcare system throughout their lifetimes. Most patients spend most of their lives seeing practitioners at the primary level. At this level, basic preventive and curative care is provided, patients receive regular screening, immunizations, wellness care, and sick care. When a patient needs a higher level of skill, knowledge, or diagnostic capability than what a primary care physician can provide, they move to the secondary health care level. Secondary health care occurs in hospitals, specialty clinics, and therapeutic facilities and is provided by medical, mental health, and allied healthcare professionals who have specialized education beyond the scope of the primary practitioner. When patients have traumatic injuries, require extensive surgeries or treatments, have rare conditions, or are critically ill, they move to tertiary care. Most tertiary care is performed in large hospitals designed to treat and manage severe and unusual conditions and injuries. Some care is performed in smaller specialty clinics such as dialysis or substance abuse treatment centers.

Healthcare systems can be arranged and understood in a variety of ways. First, healthcare systems can be described through economics and critical need, in terms of for-profit, NFP, and state/local hospitals. Second, they can be defined based on how they are managed and what their responsibilities include: public versus private health care. Finally, they can be illustrated through the relationships they have with other facilities, physicians, and agencies as systems that provide integrated health care.

There are many barriers to a patient’s ability to access health care. No matter where a patient lives or who they are, at some point in their lives, they may have difficulty with access to varying levels. It is incumbent on the healthcare community to be aware of and work toward taking down these barriers. Geography, time, transportation, and availability of providers all impact patients in ways out of their control. Healthcare costs can be a substantial burden for all people, even those with insurance, but they affect the uninsured most profoundly. There are also disparities related to knowledge, education, racial background, and mistrust of medicine and medical providers that are barriers preventing patients from receiving the care they need.

Health care has its own culture that has moved from being organized by discipline to being focused on collaboration. Further, it has shifted from being focused on diseases and conditions to being patient centered and holistic. These changes do not happen automatically and are generally due to systemic decisions that encourage improved communication, relationships, and engagement between disciplines and patients. Alongside the movement for PCC has been an increased focus on safety and a shift from a model of blame to a model of planning, management, learning, and continual quality improvement.