Congenital heart defects (CHDs) affect approximately 240,000 newborns annually in India, where lifesaving surgical interventions are inaccessible and unaffordable for rural populations. The objective of this project was to identify opportunities for improving congenital cardiac care delivery in low- and middle-income countries via comparative analysis of the costs and health care outcomes of pediatric cardiac surgery in India between two health care systems: one that provides care free of charge to patients under a philanthropy model and one private institute that charges for services. The authors utilized time-driven activity-based costing (which assigns costs to activities based on productive time) and they quantified the costs incurred during hospital-based care. Data on direct costs were collected from two hospitals specializing in pediatric cardiac care: the charitable Sanjeevani Hospitals (SH) and the private Amrita Institute of Medical Sciences (AIMS). The authors examined the surgeries for tetralogy of Fallot (TOF) and ventricular septal defect (VSD) and they assessed health care outcomes to evaluate the value of care, using the Risk Adjustment for Congenital Heart Surgery score to evaluate comparable cases. The authors found that, for the period between January 1, 2022, and December 31, 2023, the average costs of CHD surgery were US$2132 for TOF and US$2038 for VSD at SH versus US$4645 for each of the two procedures at AIMS. The average mortality rate of 2.96% for 846 surgeries at SH was comparable to a 1.91% mortality rate for 629 surgeries at AIMS (P=0.2). Several drivers of lower-cost care were identified at SH, such as the inclusion of patients’ families in the care continuum and lower administrative costs. These and other findings suggest that scalable, cost-effective models for pediatric cardiac surgery are available in India. By addressing financial challenges in care delivery, health care systems in global health contexts can improve access to lifesaving surgery, contributing to greater health equity and improved clinical and socioeconomic outcomes.