Current debates in Colombian health policy are dominated by the reforms to the health system initiated under the Presidency of Juan Manuel Santos. These debates turn on the issue of health systems financing and the ability of the government to place limits on the package of benefits (POS) available to citizens under the national health insurance scheme. Attempts by government to circumscribe treatment occurs in the context of a constitutionally enshrined right to health services enjoyed by citizens. Consequently, legal avenues exist through which citizens are able to exercise their right to treatments at public expense. The tutela system allows citizens to initiate court proceedings to obtain treatments (including the supply of particular medications) in cases where these have been denied by insurers. This includes instances where patients have been denied treatments included in the POS and the instances in which they demand the provision of other treatments not included in the benefits package. In some circumstances, the cost of treatment for services obtained through the tutela procedure are met not by health insurers (EPS), but by the national government through central funds (FOSYGA), with clear implications for public spending and democratic accountability. The right to health services and the tutela process restricts the ability of governments to place limits on health services included in the POS, and thus control health spending. It has important implications also for the use of research evidence to inform public policy. Policy making involves complex trade-offs between different political priorities (including healthcare), competing for finite resources. The objective of evidence informed policy is to maximise efficiency and efficacy of policy making and policy outcomes, and to provide legitimacy for policy decisions. Given the influence of the Court system over the provision and financing of health services, and thus public spending, questions arise about the basis on which judges take decisions affecting citizens as both service users and taxpayers. Drawing on a series of semi-structured interviews with health policy stakeholders and recent court judgements, this paper focuses on the extent to which the Courts takes account of research evidence in the formulation of its judgements and assesses the implications for public policy in Colombia. In so doing it assesses ways in which evidence may inform judgements in ways in keeping with constitutionally enshrined rights and protections in the context of the constraints of the health budget. We place these discussion in the context of a broader analysis of evidence use by other branches of the Colombian government.
