Patients’ and citizens’ perspectives and their active engagement are critical to make health systems safer and people-centred, and are key for co-designing health services and co-producing good health with healthcare professionals, and building trust in health systems. Patients, families, caregivers and citizens can contribute towards improving patient safety at all levels from clinical, local, institutional (e.g. hospital , nursing home), community (e.g. primary care, home care) and national levels of healthcare systems. This report, the sixth in the series on the Economics of Patient Safety, covers: (i) the economic impact of patient engagement for patient safety; (ii) the results of a pilot data collection to measure patient-reported experiences of safety and; (iii) the status of initiatives on patient engagement for patient safety taken in 21 countries, which responded to a snapshot survey. It also provides recommendations for countries to enhance patient engagement for patient safety.