Table 2 Difficulties in access to healthcare by type of barrier, insurance regime and area
From: Barriers of access to care in a managed competition model: lessons from Colombia
Subsidized Regime | Contributory Regime | |||
|---|---|---|---|---|
Urban area | Rural area | Urban area | Rural area | |
Insurance design | POS-S low coverage of specialized care | POS-S low coverage of specialized care | Norms limiting access to medical care | Norms limiting access to medical care |
Classification of services by level of care | Classification of services by level of care | |||
Co-payments for non-POS-S services | Co-payments for non-POS-S services (chronic and high-cost illnesses) | |||
Out-of-pocket (basic specialized care) | Out-of-pocket (basic specialized care) | |||
Insurance companies | Maximization of benefits | |||
Managed care mechanisms | Managed care mechanisms | Managed care mechanisms | Managed care mechanisms | |
- authorizations | - authorization requirements | - limits to clinical practice | - limits to clinical practice | |
- capitation payment | - authorization requirements | |||
Conflict in the interpretation of services included in the POS-S | ||||
Purchase of services | ||||
- fragmented contracting | ||||
- change in contracted providers | ||||
Network of healthcare providers | Public healthcare providers' search for economic profit | Public healthcare providers' search for economic profit | ||
Shortage of basic and high technology specialized care | Shortage of basic and high technology specialized care | Shortage of basic specialized care and primary care | ||
Distance to primary and specialized care | Distance to primary and specialized care | Distance to specialized care | ||
Waiting time for specialized care | Waiting time for specialized care | Waiting time for specialized care | Waiting time for specialized care | |
In-person and restricted appointment requirements | In-person and restricted appointment requirements | |||
Poor quality of care | Poor quality of care | |||
Population characteristics | Low income level | Low income level | Low income level | Low income level |
Lack of family support | Lack of family support | Lack of family support | ||