The hospital system I use only does major heart surgeries at one facility. That's probably the most economical way to do it.
Same here. Our hospital is a small-town facility, part of a network of five hospitals in the same system. It’s great for non-life threatening surgeries, i.e., knee replacements, prostate surgery, etc., as well as emergency care. For anything major, you get referred to the hospital in Corvallis, OR, about an hour and a half drive from the Coast. If you have a sudden life-threatening condition, you get stabilized here, then ambulanced or air-lifted to Corvallis.