Access to care [9,10]. On the other hand, it hasbeen a long, complicated approach, as well as the outcomes are controversial [11,12]. In spite from the important improve in public overall health expenditure from three to six.6 of GDP, more than the 1993 to 2007 period [13], about 15.3 to 19.three with the population remains uninsured [14,15]; and 38.7 are insured below the subsidized regime [15] that covers a range of services (POS-S) significantly inferior to that offered by the contributory one particular [16,17]. Approximately 17 of wellness expenditure is devoted to administrative costs [18], of which greater than 50 is spent on supporting daily operations (monetary, personnel, and facts management) and enrollment processes [19]. Moreover, numerous studies look to indicate a reduce in realized access to services [20,21], and point to considerable barriers connected 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 quality of care [26,30]. In 2005, the maternal mortality rate, an indicator that is certainly sensitive to the all round healthcare system, was 130/100.000 in Colombia, when compared with 30/ one hundred.000 in Costa Rica, whilst per capita 2004 well being expenditure were 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 Wellness Solutions Analysis 2010, 10:297 http://www.biomedcentral.com/1472-6963/10/Page three ofIn addition, available proof points to failures within the situation sine qua non for the prosperous implementation of managed competitors, in line with its supporters [1]: the existence of an effective regulatory program. These studies [32-35] reveal deficiencies in regulation authorities in their potential to handle a terrific number of institutions connected to insufficient economic sources, lack of control mechanisms and excessive, and from time to time contradictory, regulation norms. Most research on the determinants of use of care in Colombia concentrate on private variables and initial contact with services, and ignore contextual variables overall health policy and traits of healthcare solutions. Insurance coverage, measured only by enrolment price, is often viewed as an independent variable, while in managed competitors models, insurers straight influence the provider networks and situations of access to healthcare [36]. Also, small investigation has evaluated access from the point of view in the order Diosmetin social actors [26,37-39], despite the restricted capacity of quantitative models in explaining determinants of use of care, on account of methodological troubles in such as contextual variables [40,41]. The objective of this article is usually to contribute for the improvement of our understanding on the factors influencing access towards the continuum of healthcare solutions in the Colombian managed competitors model, from the perspective of social actors.Solutions There were two Areas of Study: one urban (Ciudad Bol ar, Bogot? D.C.) and one 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 within the latter only a single subsidized insurance coverage enterprise, with the majority of the contributory insurance coverage enrollees becoming affiliated in two insurance coverage firms. In both regions the majority of the population live in poverty [42]. Inside the urban location, the coverage from the subsidized regime is slightly much less than inside the rural a.
