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Table 4 Examples of quotations regarding "barriers related to insurers"

From: Barriers of access to care in a managed competition model: lessons from Colombia

Category Quotations
Introduction of intermediaries that maximize benefits "Intermediation is harming the provision of services. Health enters the market and that's when all the costs and quality problems start, which modify all of the activities. So the financial event becomes more important than the health one" (Manager, public secondary care provider - urban subsidized network)
Use of managed care mechanisms for cost reduction "the auditors and those responsible for authorizations in the insurance companies, ... their job shouldn't be to try to stop authorizations, as they do now, basically because of costs" (health professional, private secondary care provider-rural subsidized network)
Authorization "(...) they should give us the order, and that's all. You see, they send [me] over to the insurance company, and they'd say no, that I had to bring the others [doctor's orders]. I had to go to where he was hospitalized (...) They have you running all around (...) And run. And it [the money] disappears in a flash, you hear, in bus tickets and everything else. So we don't have all that money to run around...bus tickets and the rest" (user, subsidized regime - rural area)
Capitation payment "(...) the first level is capitated, and that is a very perverse contract mechanism. In a poor system, in a poor country, because you have to sacrifice quality. So health professionals are pressured to do the minimum, the minimum, because the cost is fixed, and if they go beyond the minimum, then the contract is no longer worth it, it's not profitable anymore. So quality is often sacrificed in this contract system" (health professional, private secondary care provider - urban subsidized network)
Conflict in interpretation of health services included in the subsidized benefits package (POS-S) "the insurance company and the municipal health secretariat start throwing the ball back and forth in an incredible way. Both start to create strategies so that the other will have to provide care for the patient...(...) So the poor patient ends up being thrown from one side to the other until finally he dies or he gets added complications" (manager, private secondary care provider - urban subsidized network)
Fragmented contracting "the ARS [previous name for subsidized regime insurance company] owns the patient... So it contracts this hospital for this, the other (hospital) for that... so I do a piece here, another there, another there (...)" (health professional, public secondary care provider - urban subsidized network)
Better access to the continuum of care for the uninsured "(...) I pick up the list and if I need a specific specialty, I look for where it is for "vinculados" [the uninsured], where the waiting time is shorter and I send him there (...) That part lets one play with the windows of waiting list. In the Subsidized regime, you don't have this waiting time, because you're limited to what the insurers have contracted" (manager, primary care provider - urban subsidized network)
  1. POS-S: Subsidized benefit package