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Access to care [9,10]. However, it hasbeen a long, complex process, as well as the outcomes are controversial [11,12]. In spite of the considerable raise in public overall health expenditure from three to six.six of GDP, more than the 1993 to 2007 period [13], about 15.3 to 19.three on the population remains uninsured [14,15]; and 38.7 are insured beneath the subsidized regime [15] that covers a variety of solutions (POS-S) drastically inferior to that provided by the contributory a single [16,17]. Roughly 17 of health expenditure is devoted to administrative fees [18], of which greater than 50 is spent on supporting daily operations (economic, personnel, and facts management) and enrollment processes [19]. Furthermore, a number of research look to indicate a lower in realized access to services [20,21], and point to important barriers associated to traits of population, such PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20433742 as insurance coverage enrolment [22-28], earnings [22,25,26,28], education [22-27,29] and, qualities of solutions, for instance geographic accessibility and high quality of care [26,30]. In 2005, the ABT-494 web maternal mortality price, an indicator that may be sensitive for the overall healthcare system, was 130/100.000 in Colombia, in comparison with 30/ one hundred.000 in Costa Rica, although per capita 2004 well being expenditure were comparable (USD 549 and USD 598, respectively) but a GNP per capita decrease in the former (USD 6130 and USD 9220) [31].Vargas et al. BMC Well being Services Study 2010, ten:297 http://www.biomedcentral.com/1472-6963/10/Page three ofIn addition, accessible evidence points to failures inside the condition sine qua non for the productive implementation of managed competitors, in accordance with its supporters [1]: the existence of an effective regulatory system. These studies [32-35] reveal deficiencies in regulation authorities in their ability to control an incredible variety of institutions connected to insufficient monetary sources, lack of handle mechanisms and excessive, and sometimes contradictory, regulation norms. Most studies from the determinants of use of care in Colombia concentrate on individual variables and initial speak to with solutions, and ignore contextual variables well being policy and characteristics of healthcare services. Insurance coverage coverage, measured only by enrolment rate, is often viewed as an independent variable, though in managed competition models, insurers directly influence the provider networks and conditions of access to healthcare [36]. Moreover, tiny study has evaluated access from the point of view with the social actors [26,37-39], despite the restricted capacity of quantitative models in explaining determinants of use of care, because of methodological troubles in including contextual variables [40,41]. The objective of this short article is to contribute to the improvement of our understanding of the aspects influencing access to the continuum of healthcare solutions in the Colombian managed competition model, in the viewpoint of social actors.Procedures There were two Locations of Study: a single 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 a single subsidized insurance organization, together with the majority of your contributory insurance coverage enrollees becoming affiliated in two insurance businesses. In both locations most of the population live in poverty [42]. In the urban region, the coverage of the subsidized regime is slightly less than within the rural a.