Access to care [9,10]. However, it hasbeen a long, complex process, as well as the results are controversial [11,12]. In spite on the important improve in public overall health expenditure from 3 to six.6 of GDP, over the 1993 to 2007 period [13], around 15.3 to 19.3 in the population remains uninsured [14,15]; and 38.7 are insured below the subsidized regime [15] that covers a variety of solutions (POS-S) significantly inferior to that supplied by the contributory 1 [16,17]. Around 17 of health expenditure is devoted to administrative charges [18], of which greater than 50 is spent on supporting everyday operations (financial, personnel, and info management) and enrollment processes [19]. In addition, various research seem to indicate a decrease in realized access to services [20,21], and point to significant barriers related to qualities of population, such PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20433742 as insurance enrolment [22-28], income [22,25,26,28], education [22-27,29] and, traits of services, such as geographic accessibility and high quality of care [26,30]. In 2005, the maternal mortality rate, an indicator that’s sensitive to the general healthcare system, was 130/100.000 in Colombia, in comparison with 30/ one hundred.000 in Costa Rica, whilst per capita 2004 health expenditure had been similar (USD 549 and USD 598, respectively) but a GNP per capita lower within the former (USD 6130 and USD 9220) [31].Vargas et al. BMC Wellness Services Research 2010, ten:297 http://www.biomedcentral.com/1472-6963/10/Page three ofIn addition, obtainable proof points to failures inside the condition sine qua non for the prosperous implementation of managed competition, as outlined by its supporters [1]: the existence of an effective regulatory method. These studies [32-35] reveal deficiencies in regulation authorities in their ability to control a fantastic quantity of institutions connected to insufficient monetary sources, lack of handle mechanisms and excessive, and from time to time contradictory, regulation norms. Most research from the determinants of use of care in Colombia concentrate on private variables and initial make contact with with solutions, and ignore contextual variables well being policy and qualities of healthcare solutions. Insurance coverage coverage, measured only by enrolment rate, is typically viewed as an independent variable, while in managed competition models, insurers straight influence the provider networks and circumstances of access to healthcare [36]. Furthermore, small study has evaluated access in the point of view from the social actors [26,37-39], despite the limited capacity of quantitative models in explaining determinants of use of care, resulting from methodological issues in including contextual variables [40,41]. The objective of this article is always to contribute towards the improvement of our understanding from the components influencing access towards the continuum of healthcare solutions within the Colombian managed competitors model, from the point of view of social actors.Approaches There had been two Places of Study: one particular urban (Ciudad Bol ar, Bogot? D.C.) and a single rural (La Cumbre, Division of Valle del Cauca) with 628.672 [42] and 11.122 inhabitants [43] respectively. In the former, a wide array of insurers are present, while within the latter only one particular subsidized insurance EED226 organization, with the majority in the contributory insurance enrollees being affiliated in two insurance coverage firms. In both locations the majority of the population reside in poverty [42]. In the urban region, the coverage of your subsidized regime is slightly less than in the rural a.