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Most of us are aware of the three levels of medical care: primary, secondary and tertiary. These levels represent the severity of the health challenges encountered and the complexity of care rendered.

Given below is a brief overview of the different healthcare models. Knowing this is important as it will help us make the right healthcare decisions and recognize when higher levels of care are needed.

Primary care is typically our first stop for any medical issue encountered. We consult primary care providers when:

• We are down with a cold or flu
• We are experiencing some kind of aches and pains
• We are injured
• We need help managing chronic conditions like diabetes, hypertension, etc.

Primary care providers also help with referrals to more specialized care when needed.

People are referred to secondary care by a primary care provider when treatment is needed for a specific condition.

• Referral to a cardiologist, oncologist, nephrologist, etc. falls under secondary care.
• Sometimes, more than one secondary care provider can be involved.
• The secondary care providers keep in contact with the primary care provider about the patient’s condition to enable co-ordination of care and to make sure all the healthcare providers understand the whole picture.

When the health condition is complex, typically requiring hospitalization and access to highly specialized skill and technology that is not available with secondary care, people are referred to tertiary care. Here too, patients remain connected to primary care providers to ensure care co-ordination and best outcomes.

Some examples of tertiary care include:

• Neurosurgery
• Organ transplant
• High-dose chemotherapy
• Dialysis centres
• Trauma centres
• Severe burns treatment
• Plastic surgery centres

When care beyond tertiary is required, patients are referred to quaternary care hospitals.

What Is Quaternary Care?

Quaternary care centres offer highly specialized care for complicated conditions; this kind of care is typically not widely available. These centres are staffed with highly skilled and experienced medical professionals who have access to cutting-edge technology to handle rare and complex conditions.

The Need for Quaternary Care

• Quaternary care has gained prominence due to the global increase in non-communicable conditions. The increase in the incidence of cancers, cardiovascular conditions, neurological diseases and autoimmune disorders has led to a scenario where specialized interventions, advanced diagnostics and long-term care are essential.
• Further, with increased lifespan, people often have multiple health conditions concurrently which require specialized care for management.
• Unlike in the past where treatments followed a generalized protocol, we are now in an era where personalized precision medicine delivers superior patient outcomes for difficult conditions. A quaternary care centre is equipped with advanced laboratory features and interdisciplinary teams that make personalized precision care possible.
• Many quaternary care centers also function as research centres, which means patients have access to experimental trials that are not otherwise accessible to the general public.

In effect, we can say that quaternary care hospitals offer patients with rare and difficult conditions solutions that cannot be obtained at other medical care centres.

Dwelling Further into Quaternary Care

That quaternary care hospitals have both pros and cons is a fact that has to be acknowledged.

The Pros:

• Patients get access to super specialists who are leaders in their field with experience in handling rare and challenging conditions.
• Having quaternary care hospitals locally means that people do not have to travel overseas for treatment.
• As quaternary centres handle difficult and unusual cases, they generate useful information that can aid in research and further experimentation. As a result, they help push the boundaries of innovation further and help refine treatments.

The Cons:

• Some quaternary care institutions struggle with staffing as highly skilled staff is required. While these institutions are equipped with cutting-edge technology and equipment, the staff to utilize the equipment is hard to find. Shortage of trained staff negates the benefits the advanced technology offers.

• The complexity of health conditions encountered in quaternary care inherently makes the care expensive. These conditions require highly skilled and experienced specialists, sophisticated infrastructure and specialized treatment (in some cases long-term) which increase the cost.

• Studies show that unnecessary referrals to quaternary care do happen. This results in not just increased cost for the patients but also overcrowding of the hospital, and more importantly, delayed care for the patients who actually need the specialized care.

Focusing on the Whole Healthcare Spectrum

To overcome some of the issues that quaternary care faces, we need to strengthen our primary and secondary levels of care – well-equipped local hospitals, trained staff, dependable diagnostics and efficient referral pathways will help ensure early detection of health conditions and proper escalation of care.

When lower levels function efficiently, it not only saves patients from unnecessary expenditure but also leaves the higher levels of care free to focus on patients who need it the most.

Thus, the government and independent healthcare providers, while establishing quaternary care centres at strategic locations, also need to focus on the foundational layers of healthcare to establish a healthcare ecosystem that would be most beneficial to the public.

Kauvery Hospital’s Quaternary Care Facility at Vadapalani

On March 20^th 2024, Kauvery Hospital launched its quaternary care hospital at Vadapalani, Chennai. This 250-bedded hospital is equipped with a 75-bedded critical care unit, a 24-bedded transplant ICU and 6 modular operation theatres. With 9 focused Centres of Excellence, Kauvery Hospital stands committed to bringing world-class healthcare to the people of our country.

While that remains true, Kauvery remains equally committed to its mission of world-class affordable healthcare for all - something it achieves through lean management and a focus on what is strictly necessary. Further, transparency about treatment and costs, along with a focus on empathetic care, has helped Kauvery win the trust of the public, and the hospital is firm in its resolve to honour the trust that the people have placed in it.

Frequently Asked Questions

1. What is a quaternary care hospital?

A quaternary care hospital provides highly specialized medical care for rare, complex, or advanced conditions that cannot be treated at primary, secondary, or tertiary care centres.

2. How is quaternary care different from tertiary care?

Tertiary care handles complex conditions requiring hospitalization, while quaternary care goes a step further by offering cutting-edge treatments, experimental therapies, advanced diagnostics, and super-specialist expertise.

3. When does a patient need quaternary care?

Patients are referred to quaternary care when their condition is rare, life-threatening, treatment-resistant, or requires advanced technology such as organ transplantation, precision medicine, or specialized ICUs.

4. What services are typically available in quaternary care hospitals?

Quaternary care hospitals offer services like organ transplants, advanced cancer care, complex neurosurgery, genetic medicine, advanced critical care, and access to clinical trials.

5. Are quaternary care hospitals expensive?

Yes, quaternary care is generally more expensive due to specialized doctors, advanced infrastructure, and complex treatments. However, these centres provide solutions that are not available elsewhere.

6. Do patients need a referral for quaternary care?

In most cases, yes. Patients are usually referred by primary, secondary, or tertiary care doctors to ensure appropriate use of highly specialized resources.