Secure operation of hospitals during and right after earthquake is essential. Past lessons from earthquake damages have shown that most of the injured and the death occurred within 30 minutes after earthquake and the portion of nonstructural damage has become significant. However, hospital buildings in Korea have not prepared fully to address such rising issues. This paper is to study what type of damage patterns are related to hospital buildings and how to develop a preparedness plan to keep hospitals operational at all earthquakes if possible. This paper first reviews on past earthquake damages reported as critical to hospital buildings while classifying them into four groups: (1) structural element; (2) architectural-nostructural element; (3) medical equipments and contents; and (4) utility facility. Upon such classification, some detailed concerns can be specified under each group explicitly. Then a hierarchy for hospital building is also developed for the classified groups, which enables us to identify required things for the enhancement of seismic performance of hospital building that consists of heterogeneous elements. To upgrade the level of seismic performance for existing hospital buildings, the concept of performance-based approach can be adopted to address the heterogeneous problems in a systematic and stepwise manner. Finally a conceptual framework for the seismic risk assessment for hospital building is proposed toward the seismic enhancement of hospital buildings using performance-based approach.