Access to care [9,10]. Nevertheless, it hasbeen a long, difficult procedure, and also the outcomes are controversial [11,12]. In spite from the important increase in public health expenditure from 3 to 6.six 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 beneath the subsidized regime [15] that covers a range of services (POS-S) considerably inferior to that supplied by the contributory a single [16,17]. Around 17 of well being expenditure is devoted to administrative charges [18], of which greater than 50 is spent on supporting every day operations (economic, personnel, and information management) and enrollment processes [19]. Moreover, a number of research seem to indicate a reduce in realized access to solutions [20,21], and point to significant barriers related to traits of population, such PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20433742 as insurance enrolment [22-28], earnings [22,25,26,28], education [22-27,29] and, characteristics of solutions, which include geographic accessibility and top quality of care [26,30]. In 2005, the maternal mortality price, an indicator that is sensitive for the general healthcare system, was 130/100.000 in Colombia, in comparison to 30/ 100.000 in Costa Rica, although per capita 2004 well being expenditure had been equivalent (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 Well being Services Analysis 2010, 10:297 http://www.biomedcentral.com/1472-6963/10/Page three ofIn addition, obtainable proof points to failures in the condition sine qua non for the profitable implementation of managed competitors, in line with its supporters [1]: the existence of an effective regulatory system. These studies [32-35] reveal deficiencies in Fumarate hydratase-IN-2 (sodium salt) chemical information regulation authorities in their ability to control an awesome number of institutions related to insufficient monetary resources, lack of handle mechanisms and excessive, and occasionally contradictory, regulation norms. Most studies of the determinants of use of care in Colombia concentrate on individual variables and initial contact with solutions, and ignore contextual variables wellness policy and characteristics of healthcare services. Insurance coverage, measured only by enrolment rate, is often viewed as an independent variable, even though in managed competitors models, insurers directly influence the provider networks and conditions of access to healthcare [36]. Also, tiny study has evaluated access in the point of view of your social actors [26,37-39], regardless of the restricted capacity of quantitative models in explaining determinants of use of care, as a result of methodological troubles in including contextual variables [40,41]. The objective of this article would be to contribute to the improvement of our understanding of the aspects influencing access to the continuum of healthcare solutions within the Colombian managed competitors model, in the point of view of social actors.Solutions There were two Locations of Study: a single urban (Ciudad Bol ar, Bogot? D.C.) and a single rural (La Cumbre, Division of Valle del Cauca) with 628.672 [42] and 11.122 inhabitants [43] respectively. Within the former, a wide array of insurers are present, though within the latter only one particular subsidized insurance firm, together with the majority of the contributory insurance coverage enrollees becoming affiliated in two insurance organizations. In both places most of the population live in poverty [42]. In the urban location, the coverage from the subsidized regime is slightly less than within the rural a.