Modest copayments for medications, dental treatment, hospitalization, and other items were introduced in 1982 for members of sickness funds. These payments were further increased by the Health Care Reform Act of 1989 (Gesundheitsreformgesetz--GRG) and again by the Health Care Structural Reform Act (Gesundheitsstrukturgesetz--GSG) of 1993. The GSG also introduced new regulatory instruments to monitor more closely access to medical practice, to reorganize sickness-funds governance, and to control medication costs and prospective hospital payments. In addition, it proposed measures to overcome the separation between ambulatory medical care and hospital care that prevailed in the former FRG.