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Confronted with the continuing cost expansion in the health care sector, policy makers face a dilemma: limiting moral hazard in medical care requires that consumers participate in the cost, yet copayment is strongly resisted by today's socially insured. Thus, the experiences of three private German health insurers will be of interest to physicians, social scientists, and policy makers. Insurer A writes conventional plans with deductibles and coinsurance; B pays back three-monthly premiums as a fixed rebate for no claims; while C runs an experience-rated bonus system starting with a rebate of three-monthly premiums for the first year without a claim, reaching a maximum of five after three years. While both rebates and bonuses are quite popular among insureds, this study shows that bonus options are particularly effective in limiting the demand for ambulatory and even hospital care. But what about adverse effects on health caused by the desire to save one's bonus? On this issue, there is some surprising evidence.

"Halley's Comet has been prominently displayed in many newspapers during the last few months. For the first time in 76 years it appeared this winter, the nocturnal sky. This is an appropriate occasion to clearly visible against point out the fact that Sir Edmund Halley also constructed the world's first life table in 1693, thus creating the scientific foundation of life insurance. Halley's life table and its successors were viewed as deterministic laws, i. e. the number of deaths in any given group and year was considered to be a well defined number that could be calculated by means of a life table. However, in reality this number is random. Thus any mathematical treatment of life insurance will have to rely more and more on probability theory. By sponsoring this monograph the Swiss Association of Actuaries wishes to support the ""modern"" probabilistic view of life contingencies. We are fortu­ nate that Professor Gerber, an internationally renowned expert, has assumed the task of writing the monograph. We thank the Springer-Verlag and hope that this monograph will be the first in a successful series of actuarial texts. Zurich, March 1986 Hans Biihlmann President Swiss Association of Actuaries Preface Two major developments have influenced the environment of actuarial math­ ematics. One is the arrival of powerful and affordable computers; the once important problem of numerical calculation has become almost trivial in many instances."

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