Access to care [9,10]. Nonetheless, it hasbeen a lengthy, complex process, plus the final results are controversial [11,12]. In spite on the significant improve in public wellness expenditure from three to six.6 of GDP, over the 1993 to 2007 period [13], around 15.3 to 19.3 of your population remains uninsured [14,15]; and 38.7 are insured under the subsidized regime [15] that covers a range of solutions (POS-S) greatly inferior to that provided by the contributory 1 [16,17]. Approximately 17 of health expenditure is devoted to administrative costs [18], of which greater than 50 is spent on supporting daily operations (economic, personnel, and data management) and enrollment processes [19]. Moreover, several studies seem to indicate a decrease in realized access to services [20,21], and point to considerable barriers related to characteristics 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, traits of solutions, which include geographic accessibility and top quality of care [26,30]. In 2005, the maternal mortality price, an indicator which is sensitive for the overall healthcare method, was 130/100.000 in Colombia, in comparison to 30/ 100.000 in Costa Rica, while per capita 2004 well being expenditure had been related (USD 549 and USD 598, respectively) but a GNP per capita reduced inside the former (USD 6130 and USD 9220) [31].Vargas et al. BMC Overall health Solutions Investigation 2010, 10:297 http://www.biomedcentral.com/1472-6963/10/Page 3 ofIn addition, readily available proof points to failures inside the condition sine qua non for the successful implementation of managed competitors, as outlined by its supporters [1]: the existence of an efficient regulatory program. These studies [32-35] reveal deficiencies in regulation authorities in their ability to handle a terrific quantity of institutions associated to insufficient monetary sources, lack of control mechanisms and excessive, and sometimes contradictory, regulation norms. Most studies of your determinants of use of care in Colombia concentrate on personal variables and initial get in touch with with services, and ignore contextual variables wellness policy and traits of healthcare solutions. Insurance coverage, measured only by enrolment rate, is generally viewed as an independent variable, despite the fact that in managed competition models, insurers straight influence the provider networks and circumstances of access to healthcare [36]. Furthermore, tiny investigation has evaluated access in the point of view on the social actors [26,37-39], despite the limited capacity of quantitative models in explaining determinants of use of care, on account of methodological difficulties in including contextual variables [40,41]. The objective of this short article is to contribute towards the improvement of our understanding from the elements influencing access for the continuum of healthcare solutions within the Colombian managed competition model, in the point of view of social actors.Methods There had been two Areas of Study: one urban (Ciudad Bol ar, Bogot? D.C.) and one rural (La Cumbre, Department of Valle del Cauca) with 628.672 [42] and 11.122 inhabitants [43] buy Acumapimod respectively. Within the former, a wide array of insurers are present, even though in the latter only one subsidized insurance organization, using the majority of your contributory insurance enrollees becoming affiliated in two insurance coverage organizations. In both areas the majority of the population reside in poverty [42]. Inside the urban location, the coverage of your subsidized regime is slightly much less than within the rural a.