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Objectives: Contributing towards improving knowledge about access to health services in Colombia following health-sector reform, highlighting the main results and gaps in research., Methods: 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., Results: 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)., Conclusions: 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.

This paper analyzes the main advances in health coverage and health services demand in Colombia using the 1997 and 2003 living standards surveys. The study showed an increase in health coverage associated with expansion of the subsidized care system, although a large proportion of the population is still not entitled to health care. The type of entitlement also directly affects the demand for services. There was an increase in preventive medical consultations in 2003 and a decrease in the use medical care for acute illness, due mainly to lack of money. Access to medicines increased from 1997 to 2003, as reflected by a decrease in out-of-pocket expenditure on medicines.

Background: The burden of illness of cervical cancer has not decreased enough in developing countries. For that reason is important to improve coverage, access and effectiveness of cervical cancer screening programs. The objective of this paper is to analyze women's access to the cervical cytology programme of the Secretary of Health of Medellín (Colombia)., Methods: An analysis was made of 1,519 records of women from a cross-sectional study conducted in an urban area of Medellin (Colombia). Descriptive analysis was conducted and a Logit model was estimated for analysing recent cervical cytology (cytology performed less than 36 months prior to the survey)., Results: 68.7% of women had a recent cytology, 17.2% did not have recent cytology and 14.2% of women attended for the first time to the service. The probability of having a recent cytology increased with age, women with family history of cervical cancer, women with personal history of sexually transmitted infections, women with some education and women who are (or were) married or in a stable union., Conclusions: The demand for cytology appears to be concentrated; a limited number of women assist frequently while others don't practice it or stop assisting.