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utical care is the focus of the further professional development. Today, the delivery of pharmaceutical is often included in the contract between pharmacies and health insurance, but the remuneration is very limited (Mil and Schulz 2006).

Although many pharmaceutical products are manufactured by pharmaceutical industries, about 2-3% of prescription or 13.000 medicines per day needs to be compounded by the pharmacists (Buurma, et al. 2003). Compounding occurred almost for dermatologic products and patients of 12 years or younger. In about 33% of the compounding activities are related to patient issue (patient disabilities, repeat prescription etc) and another 10% is concerned to pharmaceutical care issue. However, the frequency will continue to decline due to several issues like changing in the remuneration system, growing pressure on the rationality of compounded medicine and shortage of personnel.

Remuneration system for Pharmacist

In Netherlands, pharmacist fee is determined by the health care authorities. The fee includes all of services delivered by the pharmacist such as drug dispensing, costumer counseling and medication surveillance. In 2007, community pharmacies generated 874 million for their services. This includes fixed fee for WMG (Wet Marktordening Gezondheidszorg) prescriptions was about 844 million and the margin on medicines that are not covered by the Health Care Market Regulation Act which about 30 million (Kengetallen, 2008). For every drug dispensed on the prescription, pharmacist receives 6,10 per WMG medicine, regardless of the quantity or the price of the drug. The result of this policy is that the tariff for dispending a medicine is same for all pharmacies. The purchase fee, refund paid by the insurers to pharmacies is determined by a reimbursement list so-called taxe of z-index. Taxe is a list of medicine that is registered in Netherlands and published monthly based on the 11 CTG tariff orders.

Pharmacies also receive discount and bonus from the pharmaceutical manufacturers and wholesalers to counterbalance the rising pharmacy practice cost and the reduction of pharmacy budgets. By the end of the 1990s the government fought against discount and bonus received by pharmacies. Since then, pharmacists have been obliged by the government to give some of their refund by a decrease in the reimbursement prices of drugs. This deduction of the reimbursement price is called 'clawback'. A clawback of 6,82% to a maximum 15,00 given to justify the difference between official and real selling prices (Philipsen & Faure, 2002).

Another incentive comes from the sale of non WTG and medical devices which in 1998 takes account of 20-30% of profit margin. Pharmacist also gets incentive from the substitution of branded medicines to generic medicines; this is to support the campaign of using generic medicine. However, price differences between generic and branded drug become smaller under the Drug Prices Act and Drug Reimbursement System on the price level. KNMP wrote a list of interchangeable product for each chemical entity that explains the name of the wholesaler, the manufacturer, the number and the registration date. When two drugs on the list are identical, their regist本论文由英语论文网提供整理，提供论文代写，英语论文代写，代写论文，代写英语论文，代写留学生论文，代写英文论文，留学生论文代写相关核心关键词搜索。