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OBJECTIVE: Patient safety practices have primarily focused on providers, such as hospitals and ambulatory or long-term care. Based on the premise that most medical errors and patient safety problems arise from system issues, and that managed care constitutes the largest, most integrated system in health care, the authors examine the role of managed care in making patient care safer. STUDY DESIGN: Review of the literature and analysis of the role of managed care in patient safety. RESULTS: Authors find that although much has been written regarding managed care and quality, there is little research on managed care's relationship to patient safety. Research shows that managed care is not significantly different from indemnity insurance in terms of quality of care. However, managed care contracting, reimbursement, and management practices result in health care utilization changes that could pose potential risks for patient safety. Although managed care may pose possible risks to patient safety, practices can be monitored and adjusted to maintain quality and safety. At the same time, managed care provides opportunities for promoting patient safety at an integrated system level. Managed care organizations are in a unique position to influence patient safety by using safety strategies in selective contracting, financial incentives for performance, quality improvement programs, consumer education, and management and integration of care delivery. Our literature review reveals that health plans are starting to implement some of these strategies, but the practice is not widespread. CONCLUSIONS: Authors conclude with a framework and recommendations for patient safety.