Access to care [9,10]. Nonetheless, it hasbeen a extended, complicated method, and also the results are controversial [11,12]. In spite with the important raise in public overall health expenditure from 3 to six.six of GDP, more than the 1993 to 2007 period [13], around 15.three to 19.three of your population remains uninsured [14,15]; and 38.7 are insured beneath the subsidized regime [15] that covers a variety of solutions (POS-S) significantly inferior to that supplied by the contributory 1 [16,17]. Approximately 17 of overall health expenditure is devoted to administrative charges [18], of which more than 50 is spent on supporting day-to-day operations (economic, personnel, and information management) and enrollment processes [19]. Moreover, various research look to indicate a reduce in ARA290 site realized access to services [20,21], and point to substantial barriers associated to qualities of population, such PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20433742 as insurance coverage enrolment [22-28], revenue [22,25,26,28], education [22-27,29] and, traits of solutions, like geographic accessibility and excellent of care [26,30]. In 2005, the maternal mortality price, an indicator that may be sensitive to the overall healthcare program, was 130/100.000 in Colombia, compared to 30/ 100.000 in Costa Rica, whilst per capita 2004 health expenditure had been related (USD 549 and USD 598, respectively) but a GNP per capita lower within the former (USD 6130 and USD 9220) [31].Vargas et al. BMC Well being Services Investigation 2010, ten:297 http://www.biomedcentral.com/1472-6963/10/Page 3 ofIn addition, obtainable evidence points to failures within the situation sine qua non for the prosperous implementation of managed competition, according to its supporters [1]: the existence of an effective regulatory method. These studies [32-35] reveal deficiencies in regulation authorities in their capability to handle an awesome number of institutions associated to insufficient economic sources, lack of control mechanisms and excessive, and occasionally contradictory, regulation norms. Most studies of the determinants of use of care in Colombia focus on private variables and initial speak to with services, and ignore contextual variables health policy and characteristics of healthcare solutions. Insurance coverage, measured only by enrolment rate, is usually viewed as an independent variable, even though in managed competition models, insurers directly influence the provider networks and situations of access to healthcare [36]. Also, little study has evaluated access in the point of view from the social actors [26,37-39], regardless of the limited capacity of quantitative models in explaining determinants of use of care, resulting from methodological difficulties in which includes contextual variables [40,41]. The objective of this article would be to contribute to the improvement of our understanding on the elements influencing access towards the continuum of healthcare services within the Colombian managed competitors model, in the point of view of social actors.Methods There had been two Places of Study: a single urban (Ciudad Bol ar, Bogot? D.C.) and one particular 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, when inside the latter only 1 subsidized insurance corporation, together with the majority with the contributory insurance enrollees being affiliated in two insurance businesses. In both areas most of the population live in poverty [42]. Inside the urban area, the coverage from the subsidized regime is slightly much less than in the rural a.