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At the time, there were too many hospitals ehsaas program providing acute stroke care in London to allow any to amass a high volume. Neurologists at Royal Free began practicing at University College, and a Royal Free neurologist was appointed as the overall leader of the stroke program.  UCL Partners later moved all emergency vascular surgery and complex aortic surgery to Royal Free. Numerous studies confirm that volume in a particular medical condition matters for value. Providers with significant experience in treating a given condition have better outcomes, and costs improve as well. Patients, then, are often much better off traveling longer distance to obtain care at locations where there are teams with deep experience in their condition. Further, Karachi is an overly-populated city with the worst traffic situation, all this makes it more difficult to travel. Legacy delivery approaches and payment structures, which have remained largely unchanged for decades, have reinf...