Access to care [9,10]. Nonetheless, it hasbeen a lengthy, complicated approach, and also the benefits are controversial [11,12]. In spite of your considerable improve in public wellness expenditure from three to 6.six of GDP, more than the 1993 to 2007 period [13], about 15.three to 19.3 from the population remains uninsured [14,15]; and 38.7 are insured beneath the subsidized regime [15] that covers a variety of services (POS-S) drastically inferior to that provided by the contributory a single [16,17]. Approximately 17 of wellness expenditure is devoted to administrative fees [18], of which greater than 50 is spent on supporting everyday operations (monetary, personnel, and facts management) and enrollment processes [19]. In addition, several research look to indicate a decrease in realized access to services [20,21], and point to significant barriers associated to traits of population, such PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20433742 as insurance coverage enrolment [22-28], income [22,25,26,28], education [22-27,29] and, characteristics of solutions, like geographic accessibility and high-quality of care [26,30]. In 2005, the maternal mortality rate, an indicator that is definitely sensitive for the overall MedChemExpress RIP2 kinase inhibitor 1 healthcare method, was 130/100.000 in Colombia, compared to 30/ one hundred.000 in Costa Rica, when per capita 2004 overall health expenditure have been related (USD 549 and USD 598, respectively) but a GNP per capita reduced within the former (USD 6130 and USD 9220) [31].Vargas et al. BMC Wellness Services Analysis 2010, 10:297 http://www.biomedcentral.com/1472-6963/10/Page three ofIn addition, readily available proof points to failures within the condition sine qua non for the prosperous implementation of managed competition, as outlined by its supporters [1]: the existence of an efficient regulatory program. These studies [32-35] reveal deficiencies in regulation authorities in their potential to handle an awesome number of institutions connected to insufficient economic sources, lack of control mechanisms and excessive, and from time to time contradictory, regulation norms. Most studies on the determinants of use of care in Colombia focus on individual variables and initial speak to with services, and ignore contextual variables wellness policy and characteristics of healthcare solutions. Insurance coverage coverage, measured only by enrolment price, is often viewed as an independent variable, while in managed competition models, insurers straight influence the provider networks and conditions of access to healthcare [36]. Furthermore, little analysis has evaluated access in the point of view of your social actors [26,37-39], despite the limited capacity of quantitative models in explaining determinants of use of care, on account of methodological troubles in which includes contextual variables [40,41]. The objective of this article is always to contribute for the improvement of our understanding from the variables influencing access towards the continuum of healthcare services inside the Colombian managed competition model, from the perspective of social actors.Methods There have been two Places of Study: one particular urban (Ciudad Bol ar, Bogot? D.C.) and 1 rural (La Cumbre, Division of Valle del Cauca) with 628.672 [42] and 11.122 inhabitants [43] respectively. Inside the former, a wide array of insurers are present, though in the latter only one subsidized insurance coverage organization, with all the majority on the contributory insurance enrollees getting affiliated in two insurance coverage organizations. In each areas most of the population live in poverty [42]. Inside the urban area, the coverage of your subsidized regime is slightly much less than in the rural a.