Access to care [9,10]. Even so, it hasbeen a lengthy, difficult approach, and also the final results are controversial [11,12]. In spite of the important raise in public health expenditure from 3 to six.6 of GDP, more than the 1993 to 2007 period [13], around 15.three to 19.3 of your population remains uninsured [14,15]; and 38.7 are insured under the subsidized regime [15] that covers a variety of services (POS-S) greatly inferior to that provided 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 each day MedChemExpress PRT-060318 operations (monetary, personnel, and data management) and enrollment processes [19]. In addition, a number of research appear to indicate a lower in realized access to solutions [20,21], and point to important barriers connected to characteristics 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, characteristics of solutions, for instance geographic accessibility and high quality of care [26,30]. In 2005, the maternal mortality price, an indicator that is definitely sensitive to the overall healthcare program, was 130/100.000 in Colombia, when compared with 30/ 100.000 in Costa Rica, although per capita 2004 overall health 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 Overall health Services Analysis 2010, 10:297 http://www.biomedcentral.com/1472-6963/10/Page three ofIn addition, out there proof points to failures in the situation sine qua non for the effective implementation of managed competitors, according to its supporters [1]: the existence of an effective regulatory system. These studies [32-35] reveal deficiencies in regulation authorities in their capacity to control an excellent number of institutions associated to insufficient economic sources, lack of control mechanisms and excessive, and at times contradictory, regulation norms. Most research of the determinants of use of care in Colombia concentrate on individual variables and initial get in touch with with services, and ignore contextual variables overall health policy and qualities of healthcare solutions. Insurance coverage, measured only by enrolment price, is normally viewed as an independent variable, while in managed competition models, insurers straight influence the provider networks and situations of access to healthcare [36]. In addition, tiny investigation has evaluated access in the point of view from the social actors [26,37-39], in spite of the limited capacity of quantitative models in explaining determinants of use of care, as a result of methodological difficulties in like contextual variables [40,41]. The objective of this article is to contribute for the improvement of our understanding of the aspects influencing access to the continuum of healthcare solutions inside the Colombian managed competitors model, from the viewpoint of social actors.Procedures There were two Places of Study: one urban (Ciudad Bol ar, Bogot? D.C.) and a single rural (La Cumbre, Department 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 inside the latter only one particular subsidized insurance company, with all the majority from the contributory insurance enrollees becoming affiliated in two insurance coverage corporations. In both areas most of the population reside in poverty [42]. Inside the urban area, the coverage with the subsidized regime is slightly much less than within the rural a.
