Access to care [9,10]. On the other hand, it hasbeen a lengthy, complex process, along with the benefits are controversial [11,12]. In spite with the significant increase in public well being expenditure from three to 6.6 of GDP, over the 1993 to 2007 period [13], around 15.three to 19.three in the population remains uninsured [14,15]; and 38.7 are insured under the subsidized regime [15] that covers a range of solutions (POS-S) drastically inferior to that provided by the contributory 1 [16,17]. About 17 of well being expenditure is devoted to administrative expenses [18], of which greater than 50 is spent on supporting every day operations (economic, personnel, and information management) and enrollment processes [19]. Furthermore, several studies appear to indicate a lower in realized access to solutions [20,21], and point to considerable barriers connected to qualities of population, such PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20433742 as insurance enrolment [22-28], income [22,25,26,28], education [22-27,29] and, characteristics of services, including get MP-A08 geographic accessibility and excellent 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/ 100.000 in Costa Rica, although per capita 2004 well being expenditure have been similar (USD 549 and USD 598, respectively) but a GNP per capita reduced inside the former (USD 6130 and USD 9220) [31].Vargas et al. BMC Health Services Analysis 2010, 10:297 http://www.biomedcentral.com/1472-6963/10/Page three ofIn addition, available proof points to failures inside the condition sine qua non for the thriving implementation of managed competition, according to its supporters [1]: the existence of an effective regulatory system. These research [32-35] reveal deficiencies in regulation authorities in their ability to manage a terrific quantity of institutions connected to insufficient economic resources, lack of manage mechanisms and excessive, and at times contradictory, regulation norms. Most research of the determinants of use of care in Colombia focus on individual variables and initial make contact with with services, and ignore contextual variables well being policy and qualities of healthcare solutions. Insurance coverage coverage, measured only by enrolment rate, is frequently viewed as an independent variable, although in managed competition models, insurers directly influence the provider networks and situations of access to healthcare [36]. In addition, little analysis 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, because of methodological difficulties in which includes contextual variables [40,41]. The objective of this article will be to contribute towards the improvement of our understanding from the factors influencing access towards the continuum of healthcare services in the Colombian managed competition model, in the perspective of social actors.Techniques There were two Areas 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 organization, using the majority from the contributory insurance enrollees becoming affiliated in two insurance corporations. In each places the majority of the population reside in poverty [42]. Inside the urban area, the coverage in the subsidized regime is slightly significantly less than inside the rural a.