Access to care [9,10]. Even so, it hasbeen a long, complex approach, as well as the benefits are controversial [11,12]. In spite of the substantial boost in public wellness expenditure from three to 6.6 of GDP, more than the 1993 to 2007 period [13], about 15.3 to 19.3 with the population remains uninsured [14,15]; and 38.7 are insured beneath the subsidized regime [15] that covers a variety of services (POS-S) significantly inferior to that provided by the contributory 1 [16,17]. Roughly 17 of health expenditure is devoted to administrative costs [18], of which more than 50 is spent on supporting day-to-day operations (financial, personnel, and information management) and enrollment processes [19]. Moreover, a number of studies seem to indicate a reduce in realized access to services [20,21], and point to important barriers connected 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, traits of services, including geographic accessibility and excellent of care [26,30]. In 2005, the maternal mortality rate, an indicator which is sensitive to the overall healthcare program, was 130/100.000 in Colombia, when compared with 30/ 100.000 in Costa Rica, even trans-ACPD though per capita 2004 overall health expenditure had been similar (USD 549 and USD 598, respectively) but a GNP per capita reduce within the former (USD 6130 and USD 9220) [31].Vargas et al. BMC Well being Services Research 2010, ten:297 http://www.biomedcentral.com/1472-6963/10/Page 3 ofIn addition, out there proof points to failures inside the situation sine qua non for the thriving implementation of managed competition, in accordance with its supporters [1]: the existence of an effective regulatory technique. These research [32-35] reveal deficiencies in regulation authorities in their ability to manage a great variety of institutions related to insufficient monetary sources, lack of control mechanisms and excessive, and occasionally contradictory, regulation norms. Most studies with the determinants of use of care in Colombia focus on individual variables and initial make contact with with solutions, and ignore contextual variables well being policy and characteristics of healthcare services. Insurance coverage coverage, measured only by enrolment rate, is frequently viewed as an independent variable, though in managed competitors models, insurers straight influence the provider networks and circumstances of access to healthcare [36]. Also, small research has evaluated access in the point of view with the social actors [26,37-39], regardless of the restricted capacity of quantitative models in explaining determinants of use of care, resulting from methodological issues in like contextual variables [40,41]. The objective of this article will be to contribute towards the improvement of our understanding in the factors influencing access for the continuum of healthcare services within the Colombian managed competitors model, from the viewpoint of social actors.Strategies There had been 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 in the latter only a single subsidized insurance business, with the majority in the contributory insurance enrollees getting affiliated in two insurance businesses. In both places most of the population live in poverty [42]. In the urban location, the coverage of the subsidized regime is slightly much less than within the rural a.
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