Healthcare Fundamentals

Healthcare systems deliver medical services through organized networks of providers, facilities, payers, and regulators. While specific structures vary by country, core concepts—levels of care, provider roles, care settings, and quality measurement—apply broadly. Understanding these fundamentals enables meaningful assistance with healthcare-related tasks regardless of jurisdiction.

Levels of Care

Healthcare delivery organizes around three levels based on complexity and specialization.

Primary care is the first point of contact and the foundation of health systems. Primary care providers (PCPs) handle routine health maintenance, preventive services, chronic disease management, and initial assessment of new symptoms. PCPs coordinate referrals to specialists and maintain longitudinal relationships with patients. Studies consistently show patients with established primary care relationships have better outcomes and lower overall costs because changes in health status are identified and managed early.

Secondary care involves specialist evaluation and treatment for conditions beyond primary care scope. Patients typically reach secondary care through referral. Examples include cardiology consultations, orthopedic surgery, or oncology treatment. Secondary care may be outpatient (patient goes home same day) or inpatient (overnight hospital stay).

Tertiary care provides highly specialized services for complex conditions, often at academic medical centers or specialized facilities. Organ transplantation, advanced cancer treatment, severe burn care, and complex cardiac surgery represent tertiary care. These services require specialized equipment, multidisciplinary teams, and high patient volumes to maintain expertise.

Quaternary care is sometimes distinguished as experimental or highly specialized medicine not widely available—cutting-edge treatments, rare disease expertise, or research protocols.

Provider Types

Healthcare providers fall into several categories based on training, scope of practice, and autonomy.

Physicians hold MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) degrees. After medical school, physicians complete residency training (3-7 years depending on specialty) and may pursue additional fellowship training for subspecialization. Physicians diagnose conditions, prescribe medications, perform procedures, and admit patients to hospitals.

Advanced practice providers (APPs) include nurse practitioners (NPs) and physician assistants (PAs). NPs complete graduate nursing education and may practice independently in some jurisdictions. PAs complete graduate training and typically practice under physician supervision, though supervision requirements vary. Both can diagnose, prescribe, and manage many conditions independently.

Nurses provide direct patient care across settings. Registered nurses (RNs) complete nursing degree programs and handle assessment, medication administration, care coordination, and patient education. Licensed practical nurses (LPNs) or licensed vocational nurses (LVNs) have shorter training and work under RN or physician supervision.

Allied health professionals include pharmacists, physical therapists, occupational therapists, respiratory therapists, radiologic technologists, laboratory technicians, and many others. Each has specialized training and defined scope of practice.

Support staff (medical assistants, nursing aides, patient care technicians) provide assistance under licensed provider supervision.

Care Settings

Healthcare delivery occurs across diverse settings matched to patient needs and acuity.

Ambulatory/outpatient settings serve patients who don't require overnight stays. This includes physician offices, urgent care centers, ambulatory surgery centers, imaging centers, dialysis clinics, and infusion centers. Most healthcare encounters occur in ambulatory settings.

Emergency departments provide 24/7 access for acute conditions requiring immediate evaluation. EDs stabilize emergencies and either discharge patients or admit them for further care.

Inpatient/hospital settings provide overnight care for patients requiring close monitoring, complex procedures, or intensive treatment. Within hospitals, units specialize by acuity level: general medical-surgical floors, step-down/intermediate care, intensive care units (ICU), and specialty units (cardiac, neurological, burn).

Post-acute care bridges hospital discharge and full recovery. Skilled nursing facilities (SNFs) provide short-term rehabilitation and nursing care. Long-term acute care hospitals (LTACHs) serve patients needing extended hospitalization. Inpatient rehabilitation facilities offer intensive therapy programs.

Home health delivers nursing, therapy, and aide services in patients' homes for those who can live independently with support.

Long-term care provides ongoing assistance for chronic conditions or disabilities. Nursing homes offer 24-hour nursing care for those unable to live independently. Assisted living facilities provide housing with supportive services for more independent residents.

Hospice provides comfort-focused care for patients with terminal illness, emphasizing quality of life over curative treatment.

Healthcare Quality

Quality in healthcare encompasses multiple dimensions: safety (avoiding harm), effectiveness (providing evidence-based care), patient-centeredness (respecting preferences), timeliness (reducing delays), efficiency (avoiding waste), and equity (providing consistent care regardless of patient characteristics).

Process measures assess whether recommended care was delivered—was the diabetic patient's A1C tested? Did the heart attack patient receive aspirin? Process measures assume that following evidence-based protocols leads to better outcomes.

Outcome measures assess actual health results—mortality rates, infection rates, readmission rates, functional status. Outcomes matter most but can be influenced by factors beyond provider control (patient severity, social determinants).

Structure measures assess organizational characteristics—staffing ratios, equipment availability, accreditation status. Structure enables but doesn't guarantee quality.

Patient experience measures capture how patients perceive their care—communication quality, responsiveness, respect. Experience correlates with clinical outcomes and drives patient choices.

Quality measurement requires risk adjustment when comparing providers, since patient populations differ in severity and complexity. Raw mortality rates, for example, would unfairly penalize hospitals treating sicker patients.

Clinical Documentation

Healthcare relies on systematic documentation for communication, continuity, legal protection, and billing.

Medical records contain patient history, examination findings, diagnoses, treatment plans, test results, and progress notes. Records follow patients across encounters and enable care coordination among providers.

Clinical notes have standard structures. History and physical (H&P) documents initial evaluation. Progress notes track daily status. Procedure notes detail interventions. Discharge summaries synthesize hospitalization events and follow-up plans.

Problem lists track active diagnoses. Medication lists document current prescriptions. Allergy documentation prevents adverse reactions.

Electronic health records (EHRs) have largely replaced paper documentation, enabling data sharing, clinical decision support, and population health analytics—though interoperability between systems remains imperfect.

Terminology Notes

Episode of care refers to all services related to treating a specific condition, from initial diagnosis through resolution. A hip replacement episode includes pre-operative evaluation, surgery, hospitalization, and rehabilitation.

Continuity of care means maintaining consistent, coordinated care across time, settings, and providers. Gaps in continuity lead to medication errors, duplicated tests, and missed follow-up.

Care coordination involves deliberately organizing patient care activities and sharing information among all participants to achieve safer, more effective care.

Clinical pathway or care protocol is a standardized, evidence-based approach to managing a specific condition—defining expected interventions, timing, and goals.

Acuity describes how sick or unstable a patient is. Higher acuity requires more intensive monitoring and intervention.

Common Misconceptions

"Hospital" and "health system" are distinct. A hospital is a facility; a health system is an organization that may own multiple hospitals, physician practices, and other entities.

"Doctor's orders" aren't absolute commands—patients have the right to refuse any treatment. Informed consent requires that patients understand risks, benefits, and alternatives before agreeing to procedures.

Not all providers can prescribe all medications. Controlled substance prescribing has additional requirements, and some medications require specialist authorization.

"Admitted to the hospital" has specific meaning—it's a formal status change with different rules than "observation status," even though the patient may occupy the same bed.

Jurisdiction Matters

Specific rules about provider licensing, scope of practice, insurance requirements, and regulatory compliance vary significantly by country, state, or region. This primer covers universal concepts; jurisdiction-specific details require separate reference.

For US healthcare specifics (Medicare/Medicaid, HIPAA, billing codes), see US Healthcare Primer.