Qual Saf Health Care 18:99-103 doi:10.1136/qshc.2007.025833
  • Organisational matters

Market-based control mechanisms for patient safety

Open Access
  1. E Coiera1,
  2. J Braithwaite2
  1. 1
    Centre for Health Informatics, Institute of Health Innovation, University of New South Wales, Australia
  2. 2
    Centre for Clinical Governance Research, Institute of Health Innovation, University of New South Wales, Australia
  1. Professor E Coiera, Centre for Health Informatics, University of New South Wales, 2052, NSW, Australia; e.coiera{at}
  • Accepted 25 August 2008


A new model is proposed for enhancing patient safety using market-based control (MBC), inspired by successful approaches to environmental governance. Emissions trading, enshrined in the Kyoto protocol, set a carbon price and created a carbon market—is it possible to set a patient safety price and let the marketplace find ways of reducing clinically adverse events? To “cap and trade,” a regulator would need to establish system-wide and organisation-specific targets, based on the cost of adverse events, create a safety market for trading safety credits and then police the market. Organisations are given a clear policy signal to reduce adverse event rates, are told by how much, but are free to find mechanisms best suited to their local needs. The market would inevitably generate novel ways of creating safety credits, and accountability becomes hard to evade when adverse events are explicitly measured and accounted for in an organisation’s bottom line.


  • Competing interests: None.

  • Funding: This research is supported by a grant from the Australian Research Council (LP0775532), and NHMRC Program Grant 568612.

  • EC declares that he originated the safety market concept, participated in the developing the concept and the writing of the paper. JB declares that he participated in developing the safety market concept and the writing of the paper.

  • See Editorial, p 83 and Commentaries, p 86–91