High-volume medicine: lower costs, and--surprise!--better care.

India is a poor country, but at least one hospital group there is managing to drive down costs in part by driving up volume. And guess what--outcomes are better, too. The Wall Street Journal reported yesterday that cardiac surgeon Dr. Devi Shetty of Bangalore has set up specialized surgical hospitals that allow for similar types of operations to be performed on huge numbers of patients, including the poor. These hospitals appear to be both cheap and safe by Western standards. The fact that doing the same operation over and over again improves patient safety and saves money is something Canada already knows; its Shouldice Hernia Centre, examined by Atul Gawande in his 2002 book Complications, has achieved good results for decades.

To wit: when setting up a clinic or hospital in low-resource settings, there are ways to beat Western-sized budgets, and not by just a little. Smarter expenditure can make all the difference. As Dr. Shetty put it, "What health care needs is process innovation, not product innovation." And it is low-resource practitioners who have perhaps the greatest incentive to make process innovation work.