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Access to care [9,10]. Having said that, it hasbeen a extended, complex approach, and the outcomes are controversial [11,12]. In spite of your considerable boost in public health expenditure from 3 to 6.6 of GDP, over the 1993 to 2007 period [13], around 15.three to 19.3 with the population remains uninsured [14,15]; and 38.7 are insured beneath the subsidized regime [15] that covers a variety of services (POS-S) significantly inferior to that supplied by the contributory one [16,17]. Around 17 of overall health expenditure is devoted to administrative charges [18], of which greater than 50 is spent on supporting daily operations (financial, personnel, and data management) and enrollment processes [19]. Furthermore, a number of research look to indicate a decrease in realized access to services [20,21], and point to significant barriers connected to traits of population, such PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20433742 as insurance coverage enrolment [22-28], revenue [22,25,26,28], education [22-27,29] and, traits of solutions, like geographic accessibility and quality of care [26,30]. In 2005, the maternal mortality rate, an indicator that is certainly sensitive to the general MedChemExpress SCH00013 healthcare system, was 130/100.000 in Colombia, in comparison with 30/ one hundred.000 in Costa Rica, though per capita 2004 well being expenditure have been equivalent (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 Health Services Investigation 2010, ten:297 http://www.biomedcentral.com/1472-6963/10/Page three ofIn addition, accessible evidence points to failures inside the situation sine qua non for the productive implementation of managed competitors, as outlined by its supporters [1]: the existence of an effective regulatory technique. These studies [32-35] reveal deficiencies in regulation authorities in their capacity to manage a terrific variety of institutions related to insufficient financial resources, lack of control mechanisms and excessive, and occasionally contradictory, regulation norms. Most studies on the determinants of use of care in Colombia focus on private variables and initial make contact with with services, and ignore contextual variables well being policy and characteristics of healthcare solutions. Insurance coverage, measured only by enrolment price, is normally viewed as an independent variable, though in managed competitors models, insurers straight influence the provider networks and situations of access to healthcare [36]. Furthermore, tiny research has evaluated access from the point of view with the social actors [26,37-39], in spite of the limited capacity of quantitative models in explaining determinants of use of care, on account of methodological difficulties in which includes contextual variables [40,41]. The objective of this article is always to contribute for the improvement of our understanding in the components influencing access towards the continuum of healthcare solutions within the Colombian managed competition model, in the point of view of social actors.Methods There have been two Areas of Study: a single urban (Ciudad Bol ar, Bogot? D.C.) and one particular 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, while within the latter only 1 subsidized insurance company, with all the majority of your contributory insurance enrollees becoming affiliated in two insurance corporations. In each places the majority of the population reside in poverty [42]. Within the urban region, the coverage with the subsidized regime is slightly less than within the rural a.