I agree with Quinn that the introduction of managed-cost insurance plans into the American health care system has resulted in a number of benefits, such as more careful scrutiny of children's vaccination records. However, some of the benefits that Quinn credits to managed-cost plans were well under way long before these insurance plans came on the scene. For example, lengths of stay in the hospital, eg, for acute myocardial infarction or after childbirth, have fallen dramatically during the last 30 years. These declines in length of hospitalization began to occur long before managed-cost insurance appeared on the horizon. Length of stay for acute myocardial infarction was 3 weeks in the 1960s, 10 to 14 days in the 1970s, and 7 days or less during the 1980s, long before the impact of managed cost. No doubt, managed cost has resulted in further declines in hospitalization time, but the trend toward shorter hospital stays was well under way long before this form of reimbursement developed.
Alpert JS. Rebuttal to Editorial. Arch Intern Med. 1998;158(18):2068. doi: