Egbert Schadé professor of general practice at the Academic Medical Centre a 1000-bed hospital outside Amsterdam said: Patients are asking to be

Egbert Schadé, professor of general practice at the Academic Medical Centre, a 1,000-bed hospital outside Amsterdam, said: "Patients are asking to be referred It is the same all over the world. With newly powerful patient movements, they are asking, Why should I go to the GP when I could go straight to a medical specialist?"Some private insurance packages cover only hospital care, excluding GP services, increasing the incentive for direct access to specialists. The fee for a private GP consultation is 37 guilders and a home visit is charged at 74 guilders. These charges are doubled at night and weekends.None of the hospitals is run to make a profit. Most are owned by private foundations, with the exception of the six university hospitals, but are controlled by the government. Hospital specialists may be salaried or paid on a fee-for-service basis, with maximum fees set by the government's tariff authority.

An average GP earns 150,000 to 170,000 guilders a year (£44,000 to £50,000), a hospital specialist 250,000 to 300,000.The Netherlands is an egalitarian society with a narrower gap between rich and poor than in many countries, which helps to explain the wide acceptance of its heavily regulated health system. Professor Schadé said: "The Dutch mentality is a consensus mentality We are merchants and traders We don't have so many poor, nor so many rich as in the UK. We are more community-oriented."The danger with a tightly regulated system is inefficiency, and efforts have been made to loosen controls and encourage competition. A split premium has been introduced for the sickness funds, the larger part of which is income-related but with a flat rate addition for which the funds can offer different services and compete for patients. A change in the law shifting responsibility for making sickness payments from the social security system to employers has given them a new interest in quick, good-quality health care for their workers.This has increased pressure to reduce waiting lists - a new phenomenon in the Netherlands, although they would inspire envy in the UK. They vary from a few weeks to three months, depending on the hospital and speciality, with the worst stretching to six months. New targets have been set of a maximum three-week wait for a first outpatient appointment in university hospitals, with other targets for specific conditions such as hernia surgery.The Netherlands has fewer hospital beds than the average and low consumption of drugs, at 4.5bn guilders out of a total health budget of 65bn guilders.

Paul van Dyk, a former GP and medical adviser to ZRO, the largest Amsterdam sickness fund, said: "GPs have a very restrictive policy on prescribing drugs. We were taught that if you can do it without drugs you should do it without drugs. That is a big difference from Germany and France."Although the government has no direct control over the health budget, it publishes indicative figures for growth, set last year at 2.4 per cent, with specific amounts allocated to cut waiting lists and pay for expensive new drugs. Despite the strong performance of the economy, concern about rising costs has led the health minister, Borst Eilers, who is a doctor, to propose new restrictions on the cover provided by basic health insurance.

Adult dental treatment, cosmetic surgery and alternative medicine are already excluded and physiotherapy is limited to nine treatments (except for chronic conditions such as arthritis).This has provoked a heated debate in the Netherlands. Dr van Dyk said: "When dental care was insured by the sickness funds it cost 400m guilders a year. Since it was cut and cover provided by private insurers, that figure has risen to 800 million guilders. You can say the collective burden has gone down but the costs have gone up."The Dutch system is equitable and universal, and provides a good standard of care. It has a high level of private investment but is not distorted by the pressures of the market. It provides an intriguing model for other countries seeking a larger injection of private cash.Verdict: Less choice than in some other countries, but the efficiency and equity make system of particular interest to UK..

Ozone therapy is on offer at the surgery of Dr Joachim Taenzer, a family physician practising in a middle-class suburb of Cologne. For 800 marks (£270) patients get 10 treatments over three weeks which involve taking 150ml of their blood - a small cupful - mixing it with ozone gas and then reinfusing it. Ozone therapy is on offer at the surgery of Dr Joachim Taenzer, a family physician practising in a middle-class suburb of Cologne. For 800 marks (£270) patients get 10 treatments over three weeks which involve taking 150ml of their blood - a small cupful - mixing it with ozone gas and then reinfusing it. "Old people get more fitness and it is also good for people with blocked arteries," said Dr Taenzer jovially as he took me on a tour of his seven treatment rooms.The Germans take a serious interest in their health. They visit the doctor twice as often as patients in Britain do and consume twice the value of prescription and over-the-counter medicines, as well as quantities of complementary medicines. Injections and infusions are especially popular - they believe they are more powerful than oral drugs.Cultural differences in medicine abound.