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Access to care [9,10]. On the other hand, it hasbeen a extended, complex method, as well as the results are controversial [11,12]. In spite on the substantial enhance in public overall health expenditure from three to six.6 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 solutions (POS-S) considerably inferior to that provided by the contributory one particular [16,17]. About 17 of wellness expenditure is devoted to administrative expenses [18], of which greater than 50 is spent on supporting every day operations (monetary, personnel, and facts management) and enrollment processes [19]. Moreover, various research appear to indicate a decrease 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, qualities of services, including geographic accessibility and top quality of care [26,30]. In 2005, the maternal mortality price, an indicator that is certainly sensitive for the general healthcare method, was 130/100.000 in Colombia, in comparison with 30/ one hundred.000 in Costa Rica, even though per capita 2004 health expenditure had been related (USD 549 and USD 598, respectively) but a GNP per capita reduce within the former (USD 6130 and USD 9220) [31].Vargas et al. BMC Wellness Services Investigation 2010, 10:297 http://www.biomedcentral.com/1472-6963/10/Page 3 ofIn addition, available evidence points to failures inside the situation sine qua non for the thriving implementation of managed competition, in line with its supporters [1]: the existence of an efficient regulatory system. These studies [32-35] reveal deficiencies in regulation authorities in their ability to handle a fantastic variety of institutions associated to insufficient financial sources, lack of handle 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 speak to with services, and ignore contextual variables overall health policy and traits of healthcare services. Insurance coverage coverage, measured only by enrolment price, is often viewed as an independent variable, despite the fact that in managed competition models, insurers straight influence the provider networks and Mirin situations of access to healthcare [36]. Furthermore, tiny research has evaluated access from the point of view in the social actors [26,37-39], despite the restricted capacity of quantitative models in explaining determinants of use of care, due to methodological issues in such as contextual variables [40,41]. The objective of this article is usually to contribute for the improvement of our understanding from the variables influencing access towards the continuum of healthcare solutions in the Colombian managed competitors model, in the viewpoint of social actors.Techniques There had been two Places of Study: one particular 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. Within the former, a wide array of insurers are present, although within the latter only 1 subsidized insurance coverage company, with the majority with the contributory insurance enrollees being affiliated in two insurance organizations. In both locations the majority of the population live in poverty [42]. Inside the urban region, the coverage from the subsidized regime is slightly less than inside the rural a.