Vargas-Lorenzo Ingrid, Vázquez-Navarrete M Luisa, Mogollón-Pérez Amparo S
Grup de Recerca en Polítiques de Salut i Serveis Sanitaris (GRPSS), Barcelona, Spain.
Rev Salud Publica (Bogota). 2010 Oct;12(5):701-12. doi: 10.1590/s0124-00642010000500001.
Contributing towards improving knowledge about access to health services in Colombia following health-sector reform, highlighting the main results and gaps in research.
Original papers were systematically reviewed through a comprehensive search and analysis of original papers published between 1994 and 2009. After selection criteria had been applied, 27 papers were included in the review. Analysis was based on Aday Aday & Andersen and Gold's theoretical frameworks, distinguishing between potential and actual healthcare access and considering the characteristics of the population, health services and insurers influencing service use.
There was little explanatory analysis of service use applying determinant models; this was also partial (limited to geographical areas, diseases or specific groups). Likewise, only a few studies analysed contextual factors influencing service use (health policies and health providers and insures) or social actors' perspectives. The available studies did not seem to indicate increased actual access (except for subsidised system users) but, on the contrary the existence of barriers relating to population (insurance coverage, income and education) and health service factors (geographic and organizational accessibility and quality of care).
This review led to identifying important limitations in the analysis of healthcare access in Colombia and highlighted the need for further research on actual access and the better incorporation of context variables and actors perspectives in understanding the impact of reform on health service use.
助力提升对哥伦比亚卫生部门改革后卫生服务可及性的认识，突出主要研究成果及研究空白。
通过全面检索和分析1994年至2009年间发表的原创论文，对原创论文进行系统综述。在应用选择标准后，27篇论文被纳入综述。分析基于阿代（Aday）、阿代与安德森（Andersen）以及戈尔德（Gold）的理论框架，区分潜在和实际医疗服务可及性，并考虑影响服务利用的人群、卫生服务和保险公司的特征。
运用决定因素模型对服务利用进行的解释性分析很少；这种分析也是局部性的（仅限于地理区域、疾病或特定群体）。同样，只有少数研究分析了影响服务利用的背景因素（卫生政策、卫生服务提供者和保险公司）或社会行为者的观点。现有研究似乎并未表明实际可及性有所提高（补贴系统使用者除外），相反，存在与人群（保险覆盖、收入和教育）以及卫生服务因素（地理和组织可及性以及护理质量）相关的障碍。
本综述发现了哥伦比亚医疗服务可及性分析中的重要局限性，并强调需要进一步研究实际可及性，以及在理解改革对卫生服务利用的影响时更好地纳入背景变量和行为者观点。
