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Despite years of investment and research, the quality of health care in every country is much worse than it should be. Problems range from disrespect of people when they are interacting with the health care system, to preventable mistakes and harm, to high rates of incorrect and ineffective treatment.Among low-and middle-income countries (LMICs) the exact burden of poor quality is difficult to quantify because of a dearth of data, lack of standard metrics, and insufficient research on quality interventions. But new estimates suggest that globally between 5.7 and 8.4 million people die every year from poor-quality care in LMICs. 1 These deaths, plus disabilities from poorquality care, account for lost productivity totaling an estimated $1.4 trillion to $1.6 trillion dollars annually. 1 Wealthier countries have similar experiences in terms of death, disability, and needless cost due to fragmented care, waste, and care organized around facilities instead of patients. One estimate suggests that 15% of all hospital costs in Organisation for Economic Co-operation and Development (OECD) countries can be attributed to patient harms from adverse events. 2 In 2001, the Institute of Medicine published a landmark report on the quality of US health care: Crossing the Quality Chasm: A New Health System for the 21st Century. The report starkly documented major defects in 6 dimensions of quality: safety, effectiveness, patientcenteredness, timeliness, efficiency, and equity. In the nearly 2 decades since, reports have demonstrated that many defects persist and that the "quality chasm" is global.TheNationalAcademiesofSciences,Engineering,and Medicine (NASEM) has issued another report on global health care quality, with an emphasis on low-resource settings: Crossing the Global Quality Chasm: Improving Health CareWorldwide.Thecommitteeincludedscholarsandleadersfromnationsacrossthespectrumofwealth. 1 Thisreport joins 2 recent analyses of problems in global health care quality. 3 Thereportstatesthatwithoutcorrectionofdefects in health care quality, especially in LMICs, universal health coverage, a key component of WHO's Sustainable Development Goals, 4 will give many people access to care that will not help them and may even be harmful.Yet there is reason for hope: momentum and commitment by the global community to achieve universal health coverage offer an opportunity for nations to improve the quality of care while they broaden access. But this will not happen automatically; so far, many nations seem to be focused on expanding access only. Equity and quality of care will arrive together, or not at all.

U.S. global health investment has focused on detection, treatment, and eradication of infectious diseases such as tuberculosis, malaria, and human immunodeficiency virus/acquired immunodeficiency syndrome, with significant results. Although efforts should be maintained and expanded to provide ongoing therapy for chronic infectious disease, there is a pressing need to meet the challenge of noncommunicable diseases, which constitute the highest burden of diseases globally. A Committee of the National Academies of Sciences, Engineering, and Medicine has made 14 recommendations that require ongoing commitments to eradication of infectious disease and increase the emphasis on chronic diseases such as cardiovascular disease. These include improving early detection and treatment, mitigating disease risk factors, shifting global health infrastructure to include management of cardiovascular disease, developing global partners and private-public ventures to meet infrastructure and funding challenges, streamlining medical product development and supply, increasing research and development capacity, and addressing gaps in global political and institutional leadership to meet the shifting challenge.

Background. In response to a longstanding Federal mandate to minimize the role of geography in access to transplant in the United States, we assessed whether patient travel distance was associated with lung transplant outcomes. We focused on the posttransplant time period, when the majority of patient visits to a transplant center occur. Methods. We present a cohort study of lung transplants in the United States between January 1, 2006, and May 31, 2017. Travel distance was measured from the patient’s permanent home zip code to the transplant center using SAS URL access to GoogleMaps. We leveraged data from the US Census, US Department of Agriculture, and the Economic Innovations Group to assess socioeconomic status. Multivariable Cox models were used to assess graft survival. Results. We included 18 128 patients who met the inclusion criteria. Median distance was 69.6 miles. Among patients who traveled >60 miles to reach a transplant center, 41.8% bypassed a closer center and sought care at a more distant center. Patients traveling longer distances sought care at centers with a higher annual transplant volume. In the adjusted Cox Model, patients who traveled >360 miles had a slightly higher risk for posttransplant graft failure than patients traveling ≤60 miles (hazard ratio 1.09; 95% CI, 1.01-1.18), and a higher risk for treated acute rejection (hazard ratio, 1.63; 95% CI, 1.43-1.86). Conclusions Travel distance was significantly associated with post lung transplant survival. However, this effect was relatively modest. Patient travel distance is an important component of access to lung transplant care.