Narayana Hrudayalaya, a complex of health centers based in southern India, offers low-cost, high-quality specialty care in a largely poor country of 1.2 billion people. By thinking differently about everything from the unusually high number of patients it treats to the millions for whom it provides insurance, the hospital group is able to continually reduce costs. Narayana Hrudayalaya's operations include the world's largest and most productive cardiac   hospital, where the average open-heart surgery runs less than $2,000, a third or less what it costs elsewhere in India. Narayana Hrudayalaya's origins date back to 2001, when it built its massive cardiac center on the outskirts  of Bangalore. But it has expanded since then into what founder Dr. Devi Shetty calls a "health city," a series of centers specializing in eye, trauma, and cancer care. Narayana Hrudayalaya now manages or owns hospitals in 14 other Indian cities. Expanding access is paired with a ongoing focus on efficiency. Typically, says Shetty, private hospitals in India focus on patients who can easily afford treatment. "We did it the other way around," he says. "This hospital is for poor people, but we also treat some rich people. We don't look at people who are sgabbily dressed and have trouble paying as outsiders. "  Narayana Hrudayalaya's flagship hospital has 3,000 beds and negotiates for better prices and buys directly from manufacturers, cutting out distributors. In addition to cost-cutting, Narayana Hrudayalaya finds creative ways to make the economics work. The company started a micro-insurance program backed by the government that enables 3 million farmers to have coverage for as little as 22 cents a month in premiums . Patients who pay discounted rates are in effect compensated by those who pay full price Doing something--doing more, actually--is the point. By 2017, Shetty, 58, plans to expand from 5,000 beds throughout India to 30,000. Before becoming one of India's best-known health-care entrepreneurs, Shetty was its best-known heart surgeon. He was interrupted in surgery one day during the 1990s by a request to make a house call. "I said, 'I don't make home visits,' " Shetty says, "and the caller said, 'If you see this patient, the experience may transform your life.' " The request was from Mother Teresa. Inspired by the her work with the poor, he then set out to create a hospital to deliver care based on need, not wealth.  "One lesson she taught me," he says, quoting a saying he keeps framed in his office, "is ' .' " Why did Shetty build the massive cardiac center in 2001?
He wanted to build a health city. He was motivated and decided to help more people. He intended to develop his career in different areas. He meant to help more poor people get free treatment.