Efforts to improve patient safety have taken many forms, including accreditation, information technology, legislation, litigation, safety training, and systems change. Pay for performance (P4P) initiatives have also captured national attention as a mechanism to tie financial incentives to delivering high quality and safe care. This commentary expands on all of the drivers for change in the context of market forces, drawing on analogies from other industries. The authors discuss the design of a patient safety "market," measuring and putting a price on safety and establishing a safety baseline with targets. While pointing out the challenges and barriers involved, the authors describe how market forces can be an efficient and powerful driver of change in health care delivery.