evidence: Cardiac surgeon Dr. Devi Shetty is on a mission to build 5,000-bed "health cities" across India, encouraged by the success at his nine-year-old Narayana Hrudayalaya hospital in Bangalore. He has contained costs by tweaking processes, driving hard bargains and negotiating creative partnership deals, but faces challenges in replicating that model on a bigger scale. Shetty wants to make quality health care accessible and affordable using economies of scale, or the cost advantages businesses obtain due to expansion. His hospital in Bangalore focuses on cardiac medicine but he wants to extend the model to other specialties, in addition to other locations. Shetty believes his success could lead to a new health care model not only for India but perhaps also for the world. "The first heart surgery was done over a hundred years ago but even today only 8% of the world’s population can afford heart operations," Shetty notes. "In India, around 2.5 million people require heart surgeries every year but all of [the country’s doctors] put together perform only 80,000 to 90,000 surgeries a year…. We clearly need to relook and change the way things are being done."