In early 1993, the Health Care Structural Reform Act (Gesundheitsstrukturgesetz--GSG) came into effect, marking the end of a more than a century-long period in which benefits and services under statutory public health insurance had been extended to ever larger segments of the population. Rising health expenditures may prompt policy makers to impose further restrictions on providers and consumers of health care. These high expenditures have been caused by a rapidly aging population (retirees' costs rose by 962 percent between 1972 and 1992), the intensive and costly use of advanced-technology medical procedures, and other economic and budgetary pressures. As of mid-1995, the drafting of new reform proposals was under way.