Access to care [9,10]. On the other hand, it hasbeen a long, difficult course of action, plus the outcomes are controversial [11,12]. In spite of your substantial boost in public health expenditure from three to 6.6 of GDP, more than the 1993 to 2007 period [13], around 15.3 to 19.3 of the population remains uninsured [14,15]; and 38.7 are insured beneath the subsidized regime [15] that covers a variety of services (POS-S) tremendously inferior to that offered by the contributory one [16,17]. Around 17 of health expenditure is devoted to administrative fees [18], of which more than 50 is spent on supporting every day operations (financial, personnel, and information and facts management) and enrollment processes [19]. Additionally, a number of studies appear to indicate a decrease in realized access to services [20,21], and point to considerable barriers associated to qualities of population, such PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20433742 as Elacestrant (dihydrochloride) chemical information insurance enrolment [22-28], income [22,25,26,28], education [22-27,29] and, traits of solutions, for instance geographic accessibility and high quality of care [26,30]. In 2005, the maternal mortality price, an indicator which is sensitive for the overall healthcare method, was 130/100.000 in Colombia, when compared with 30/ one hundred.000 in Costa Rica, when per capita 2004 well being expenditure were comparable (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 Health Solutions Research 2010, ten:297 http://www.biomedcentral.com/1472-6963/10/Page 3 ofIn addition, out there evidence points to failures in the condition sine qua non for the successful implementation of managed competitors, according to its supporters [1]: the existence of an efficient regulatory method. These studies [32-35] reveal deficiencies in regulation authorities in their ability to manage a fantastic number of institutions associated to insufficient monetary resources, lack of control mechanisms and excessive, and sometimes contradictory, regulation norms. Most research in the determinants of use of care in Colombia focus on personal variables and initial get in touch with with solutions, and ignore contextual variables well being policy and qualities of healthcare services. Insurance coverage coverage, measured only by enrolment rate, is frequently viewed as an independent variable, although in managed competitors models, insurers directly influence the provider networks and situations of access to healthcare [36]. Additionally, tiny investigation has evaluated access in 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, resulting from methodological troubles in including contextual variables [40,41]. The objective of this article is to contribute for the improvement of our understanding of your aspects influencing access for the continuum of healthcare services inside the Colombian managed competitors model, from the viewpoint of social actors.Approaches There had been two Places of Study: 1 urban (Ciudad Bol ar, Bogot? D.C.) and one rural (La Cumbre, Department 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 in the latter only 1 subsidized insurance coverage firm, using the majority of your contributory insurance enrollees being affiliated in two insurance coverage organizations. In both regions most of the population reside in poverty [42]. Inside the urban location, the coverage in the subsidized regime is slightly much less than within the rural a.