Is safety safe in the market's hands?

There is no doubt that the proposal to establish market-based control mechanisms for patient safety is both interesting and intriguing. However, I am not optimistic that Coiera and Braithwaite’s (C&B’s) proposal (see page 99 ) will see the light of day 1. My objections are based on three fundamental flaws that I see in the foundation for this proposal: first, as an economist, I question whether “safety” can be considered a public good in the same way that the environment might; second, I am not convinced that emissions trading has worked sufficiently well to justify basing a safety strategy on such an approach; and, finally, I propose that our healthcare systems have not been particularly effective in managing resources or priority setting, and I make an economist’s attempt at addressing opportunities that still exist in this domain.