Access to care [9,10]. Having said that, it hasbeen a long, complicated method, and the benefits are controversial [11,12]. In spite from the significant increase in public overall health expenditure from 3 to 6.six of GDP, more than the 1993 to 2007 period [13], around 15.3 to 19.3 from the population remains uninsured [14,15]; and 38.7 are insured under the subsidized regime [15] that covers a range of solutions (POS-S) greatly inferior to that provided by the contributory one particular [16,17]. About 17 of well being expenditure is devoted to administrative fees [18], of which greater than 50 is spent on supporting everyday operations (economic, personnel, and details management) and enrollment processes [19]. Additionally, a number of studies seem to indicate a decrease in realized access to services [20,21], and point to substantial barriers related 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, qualities of solutions, which include geographic Biotin-NHS site accessibility and high quality of care [26,30]. In 2005, the maternal mortality rate, an indicator that is definitely sensitive for the all round healthcare method, was 130/100.000 in Colombia, when compared with 30/ one hundred.000 in Costa Rica, though per capita 2004 well being expenditure had been related (USD 549 and USD 598, respectively) but a GNP per capita lower inside the former (USD 6130 and USD 9220) [31].Vargas et al. BMC Wellness Services Study 2010, 10:297 http://www.biomedcentral.com/1472-6963/10/Page three ofIn addition, accessible evidence points to failures in the situation sine qua non for the effective implementation of managed competition, based on its supporters [1]: the existence of an effective regulatory method. These studies [32-35] reveal deficiencies in regulation authorities in their potential to manage an awesome quantity of institutions associated to insufficient financial sources, lack of manage mechanisms and excessive, and at times contradictory, regulation norms. Most research with the determinants of use of care in Colombia concentrate on individual variables and initial contact with solutions, and ignore contextual variables wellness policy and qualities of healthcare services. Insurance coverage, measured only by enrolment rate, is usually viewed as an independent variable, although in managed competition models, insurers straight influence the provider networks and circumstances of access to healthcare [36]. Furthermore, small analysis has evaluated access in the point of view of the social actors [26,37-39], regardless of the restricted capacity of quantitative models in explaining determinants of use of care, due to methodological difficulties in including contextual variables [40,41]. The objective of this article is usually to contribute for the improvement of our understanding of the elements influencing access towards the continuum of healthcare services inside the Colombian managed competition model, in the point of view of social actors.Techniques There were two Regions 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. Inside the former, a wide array of insurers are present, when within the latter only 1 subsidized insurance coverage company, using the majority in the contributory insurance coverage enrollees getting affiliated in two insurance coverage firms. In both locations most of the population reside in poverty [42]. Within the urban region, the coverage of the subsidized regime is slightly much less than inside the rural a.