The survival and organization of the tertiary health care institutions, which integrates a range of specialist and subspecialist activities, becomes a real challenge during the COVID 19 pandemic due to the weakening economic power of the state and the potential loss of standard sources of funding under voluntary and supplementary health insurance. Aim of the research: To show the most optimal modality of providing services of a tertiary health care institution, which, in addition to tertiary and secondary B health care, expands its activity to secondary A health care, with the evaluation of parameters such as number of hospital days based on discharged patients and daily records, evaluations of groups of operations and number of diagnostic procedures Results: The tertiary level health institution in the period of the COVID 19 pandemic provides tertiary and secondary B health care, with the expansion of services to the secondary A health care, to optimize services and relieve the burden of institutions that provide this type of service. The number of services provided at the tertiary and secondary health care, in terms of the number of b.o. days, operations, examinations, and diagnostic procedures, shows a decrease in comparison with the previous two years,but also continuity despite working conditions in crisi
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