Definition and Characteristics
Any hospital, including a district hospital, will receive referrals from lower levels of care. Indeed, referral can be defined as any process in which health care providers at lower levels of the health system, who lack the skills, the facilities, or both to manage a given clinical condition, seek the assistance of providers who are better equipped or specially trained to guide them in managing or to take over responsibility for a particular episode of a clinical condition in a patient (Al-Mazrou, Al-Shehri, and Rao 1990). Furthermore, higher-level hospitals in developing countries do not treat only referred patients; tertiary hospitals are frequently the first point of contact with health services for many patients.
Differentiating referral hospitals from district hospitals, therefore, requires consideration of the different resources used by different levels of hospital. Such a differentiation will tend to revolve around three features—the availability of increasingly specialized personnel, of more sophisticated diagnostic technologies, and of more advanced therapeutic technologies—that permit the diagnosis and treatment of increasingly complex conditions.
This volume, including this chapter, uses a standard definition of hospital levels (Mulligan and others 2003). Table 66.1 presents some of the commonly used alternative terminology for different levels of hospitals. Note that this chapter deals only with general—that is, multispecialty—secondary and tertiary hospitals. Specialized hospitals, such as psychiatric, substance abuse, tuberculosis, infectious diseases, and rehabilitation hospitals, clearly have important roles to play in a well-functioning referral system. However, they are attended by specific features and challenges, account for a relatively small share of overall resources, and operate in a significantly different manner than general hospitals do.