The paper presents a hierarchical framework for production control of hospitals which deals with the balance between service and efficiency, at all levels of planning and control. The framework is based on an analysis of the design requirements for hospital production control systems. These design requirements are translated into the control functions at different levels of planning required for hospital production control. The framework consists of five levels of planning and control: patient planning and control, patient group planning and control, resources planning and control, patient volumes planning and control and strategic planning, though this last level does not make part of production control as such. Each of the levels of the framework is further elaborated in terms of the decisions made regarding patient flows and resources, and the co-ordination of the different planning levels. Implications of the framework are discussed by describing some points where current practice deviates from assumptions made in our approach. Recommendations for future research and development of the planning framework are formulated.