Access to care [9,10]. However, it hasbeen a long, complex procedure, and also the results are controversial [11,12]. In spite on the significant enhance in HMN-154 public wellness expenditure from 3 to 6.six 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 range of services (POS-S) tremendously inferior to that offered by the contributory one [16,17]. Around 17 of overall health expenditure is devoted to administrative fees [18], of which greater than 50 is spent on supporting every day operations (monetary, personnel, and details management) and enrollment processes [19]. Moreover, a number of research appear to indicate a lower in realized access to solutions [20,21], and point to important barriers connected to qualities 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, traits of solutions, which include geographic accessibility and quality of care [26,30]. In 2005, the maternal mortality rate, an indicator that is sensitive for the all round healthcare program, was 130/100.000 in Colombia, in comparison with 30/ 100.000 in Costa Rica, whilst per capita 2004 health expenditure had been equivalent (USD 549 and USD 598, respectively) but a GNP per capita reduced 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 addition, obtainable evidence points to failures within the situation sine qua non for the profitable implementation of managed competition, as outlined by its supporters [1]: the existence of an effective regulatory system. These research [32-35] reveal deficiencies in regulation authorities in their capacity to manage an awesome variety of institutions associated to insufficient economic sources, lack of manage mechanisms and excessive, and often contradictory, regulation norms. Most studies of the determinants of use of care in Colombia focus on personal variables and initial get in touch with with solutions, 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, despite the fact that in managed competition models, insurers straight influence the provider networks and situations of access to healthcare [36]. Additionally, small research has evaluated access from the point of view of 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 including contextual variables [40,41]. The objective of this article is usually to contribute towards the improvement of our understanding of your elements influencing access towards the continuum of healthcare services within the Colombian managed competition model, from the point of view of social actors.Solutions There have been two Regions of Study: one particular 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. Inside the former, a wide array of insurers are present, whilst within the latter only 1 subsidized insurance coverage enterprise, together with the majority with the contributory insurance enrollees becoming affiliated in two insurance companies. In each regions most of the population reside in poverty [42]. Inside the urban area, the coverage from the subsidized regime is slightly significantly less than inside the rural a.