Access to care [9,10]. Nonetheless, it hasbeen a lengthy, complex process, plus the benefits are controversial [11,12]. In spite of your important enhance in public overall health expenditure from three to 6.six of GDP, more than the 1993 to 2007 period [13], around 15.three to 19.three with the population remains uninsured [14,15]; and 38.7 are insured under the subsidized regime [15] that covers a variety of services (POS-S) significantly inferior to that provided by the contributory one particular [16,17]. Approximately 17 of health expenditure is devoted to administrative charges [18], of which more than 50 is spent on supporting every day operations (economic, personnel, and information and facts management) and enrollment processes [19]. In addition, various studies appear to indicate a reduce in realized access to services [20,21], and point to considerable barriers related 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, qualities of solutions, for instance geographic accessibility and high quality of care [26,30]. In 2005, the maternal mortality rate, an indicator that is certainly sensitive to the general healthcare program, was 130/100.000 in Colombia, in comparison to 30/ one hundred.000 in Costa Rica, while per capita 2004 health expenditure had been equivalent (USD 549 and USD 598, respectively) but a GNP per capita reduced in the former (USD 6130 and USD 9220) [31].Vargas et al. BMC Overall health Services Analysis 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 effective implementation of managed competition, based on its supporters [1]: the existence of an effective regulatory system. These research [32-35] reveal deficiencies in regulation authorities in their ability to manage a great variety of institutions related to insufficient MedChemExpress PIM inhibitor 1 (phosphate) financial resources, lack of control mechanisms and excessive, and often contradictory, regulation norms. Most studies with the determinants of use of care in Colombia concentrate on individual variables and initial contact with solutions, and ignore contextual variables well being policy and characteristics of healthcare services. Insurance coverage coverage, measured only by enrolment rate, is frequently viewed as an independent variable, although in managed competitors models, insurers directly influence the provider networks and situations of access to healthcare [36]. Also, little investigation has evaluated access from the point of view of your social actors [26,37-39], despite the restricted capacity of quantitative models in explaining determinants of use of care, because of methodological difficulties in including contextual variables [40,41]. The objective of this article is always to contribute for the improvement of our understanding from the components influencing access for the continuum of healthcare solutions in the Colombian managed competition model, from the point of view of social actors.Procedures There were two Areas of Study: one 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, when in the latter only one particular subsidized insurance coverage organization, with all the majority on the contributory insurance coverage enrollees becoming affiliated in two insurance businesses. In both regions most of the population live in poverty [42]. Within the urban region, the coverage on the subsidized regime is slightly much less than inside the rural a.