Reforma a la salud y reconfiguración de la trayectoria de acceso a los servicios de salud desde la experiencia de los usuarios en Medellín, Colombia

the following article is the result of qualitative research carried out between 2005 and 2007 in medellín, colombia. in a context of reform to the healthcare sector, it analyses the trajectories of access to healthcare of insured (subsidized and contributive regime) and non-insured individuals within the general social security health system (sgsss in spanish). the model developed by aday and andersen constitutes an analytical framework for the empirical data. the most significant obstacles faced by individuals seeking adequate health services are: exclusion from insurance, insufficiency in the public services network and financial shortcomings. as users they face refusal or deferral of specialized treatment, incomplete or fragmented treatment and insufficient resources. the sgsss privileges economic return over health needs resulting in the reconfiguration of trajectories of access, generating new healthcare barriers and deepening those that existed before the reforms. this results in acute inequalities in healthcare as the obstacles are greater for non-insured and subsidized regime users, precisely those who have less and receive less. qualitative indicators that may be used in the study of access to services are recommended.