Access to care [9,10]. However, it hasbeen a extended, complicated process, and the benefits are controversial [11,12]. In spite in the significant enhance in public wellness expenditure from 3 to 6.6 of GDP, over the 1993 to 2007 period [13], around 15.3 to 19.three from the population remains uninsured [14,15]; and 38.7 are insured under the subsidized regime [15] that covers a variety of solutions (POS-S) tremendously inferior to that supplied by the contributory one particular [16,17]. Roughly 17 of overall health expenditure is devoted to administrative expenses [18], of which greater than 50 is spent on supporting daily operations (monetary, personnel, and info management) and enrollment processes [19]. Furthermore, several studies seem to indicate a lower in realized access to services [20,21], and point to considerable barriers connected to qualities 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, characteristics of solutions, for instance geographic accessibility and high-quality of care [26,30]. In 2005, the maternal mortality rate, an indicator that may be sensitive towards the all round healthcare method, was 130/100.000 in Colombia, in comparison with 30/ one hundred.000 in Costa Rica, while per capita 2004 overall health expenditure had been comparable (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 Research 2010, 10:297 http://www.biomedcentral.com/1472-6963/10/Page three ofIn CT99021 trihydrochloride web addition, accessible evidence points to failures within the condition sine qua non for the productive implementation of managed competition, in line with its supporters [1]: the existence of an effective regulatory technique. These research [32-35] reveal deficiencies in regulation authorities in their capacity to control an incredible quantity of institutions associated to insufficient monetary sources, lack of manage mechanisms and excessive, and at times contradictory, regulation norms. Most studies of your determinants of use of care in Colombia focus on private variables and initial contact with services, and ignore contextual variables health policy and traits of healthcare services. Insurance coverage, measured only by enrolment price, is typically viewed as an independent variable, though in managed competition models, insurers straight influence the provider networks and circumstances of access to healthcare [36]. In addition, small investigation has evaluated access from the point of view of the social actors [26,37-39], despite the limited capacity of quantitative models in explaining determinants of use of care, on account of methodological troubles in including contextual variables [40,41]. The objective of this article is always to contribute to the improvement of our understanding of your factors influencing access towards the continuum of healthcare solutions in the Colombian managed competition model, in the viewpoint of social actors.Procedures There have 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, while within the latter only 1 subsidized insurance coverage corporation, together with the majority on the contributory insurance enrollees becoming affiliated in two insurance providers. In each places most of the population reside in poverty [42]. Inside the urban location, the coverage of the subsidized regime is slightly much less than inside the rural a.