The system in Germany is a bit different, anyway. I think it's important for the ambulance trusts to get that lovely "letter"/signature from the hospital/doc in order to receive money from the insurance companies, which means: everyone is keen on taking the punters to A&E. Additionally they are too afraid of making a mistake so every patient is rather taken to hospital no matter how serious their illnesses are because the consequences could be grave if you know what I mean. And yet the A&E departments in Germany aren't as busy as in England. Why? Because of the insurance companies. No NHS = nothing's for free really and at the end of the day the insurance companies only pay a part of the costs (and can decide if they do so). Sometimes you will have to pay the costs yourself first and then claim it back. Really annoying but the prospect of being forced to pay makes people shy, believe me. That's my theory.