To the Editor.
—In a recent Editorial, Drs Kane and Garrard,1 commenting on changes in antipsychotic drug use in nursing homes after the OBRA-87 regulations,2 claim that, in general, "sticks may work better than carrots" in improvements of health professional prescribing practices. However, they indicate that strict regulations regarding clinical practices may be enforced only if there are clear and specific data supporting such decisions. The comment by Kane and Garrard fits well with the present situation in Italy, which is characterized by a substantial reform of the health system, particularly regarding reimbursement for certain medications by local governments. The drugs have been divided in three categories: class A, free for all patients; class B, free only for those older than 60 years or younger than 10 years; and class C, not reimbursed for anyone. In class A are included some expensive drugs (or previously overprescribed drugs) that
Rozzini R, Trabucchi M. Legislating Drug Prescribing Practices. JAMA. 1994;272(1):30. doi:10.1001/jama.1994.03520010040022