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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
  1. POS-S: Subsidized Regimen Benefit Package
  2. Source: authors