The English NHS reforms amount to a car crash, according to a government adviser. Germans give into special interests and constitutionally are incapable of serious reform. The Spanish and Italians are in hock to the unions. And then there are the Dutch...

Unlike all the rest of Europe, the Dutch are actually managing healthcare reform. The new coalition government has set out a four year programme which it will now follow. Expect the proportion of the secondary market where the statutory insurers can negotiate the price to rise from 35% to 90%. Meanwhile, pricing, which at the moment is based partly on length of stay, will move to a pure DRG model.

The government has also confirmed that it will hand the purchasing of care to the insurers. This should allow insurers to build real cooperation between the care and the hospital sectors.

Finally, it will allow external investors to become shareholders in the 100 big Dutch hospitals and to be paid dividends.

Talking to the Dutch you are struck by the way in which they are systematically and rationally constructing a system.  Quality of care, for instance, is being measured and parameters defined. Attention is given to how best to retain and motivate medical and care staff. Academics in the UK often seem removed from the real issues. In the Netherlands they  worki to a common cause.

Prof Andre Knottnerus admits that sometimes progress is difficult and there are arguments. But the Dutch are good at consensus and good at seeing that the aim of the game is to produce high quality, cost effective care.

There are dissenting voices. Some academics argue that the concept of market transparency is not attainable in healthcare. It is too complicated to measure stuff, they say. And there is still a debate about what sort of private shareholders the Dutch want in their hospitals. Not nasty Anglo-American private equity, rather solid Dutch pension funds. Knottnerus says that the arbiter of that should be the impact on care quality. (Other sources question how the Dutch authorities can get round EU law and prohibit private equity).

And there are blips. As we recently pointed out, independent clinics who deliver high quality low cost care have seen their budgets capped at 2009 levels.

Of course, it helps immeasurably that there is now a track record of success.  Bas Leerink, director at insurer Menzis, can show that the cost of healthcare procedures in the negotiated sector of the market has actually fallen in real terms since 2006.

The Netherlands feels like a country which has reached a rational, Enlightment era, say around the 1770s, when it comes to healthcare. The rest of Europe is at about 1450 - a world of Medieval guilds, special interests and regional fragmentation.