Perhaps surprisingly to some, Colombia has come much further along the path towards universal coverage than many developed countries in the world, including the US. Most of this progress happened precipitously starting in the early 1990’s: while in 1993 fewer than 5% of people in the lowest income quintile had access to any health care that was not paid for entirely out-of-pocket, by 2011 over 85% were covered by a social security system that provides access to a basic package of health benefits. Although there are persisting problems in terms of the effectiveness of coverage, many of us would argue the progress has been real and frankly impressive. But none in Colombia would deny that there is still much room for improvement, and that the government has inexcusably failed to take advantage of numerous opportunities over the past two decades to make those improvements.
These failures led to a landmark decision on the part of the Constitutional Court in 2008, which through its jurisprudence in the T/760 decision of 2008 adjudged the right to health to be a fundamental constitutional right, thereby permitting that specific demands by citizens be submitted for constitutional judicial review through the tutela protection writ (the Colombian version of the amparo). The decision has been seen by many as a trail-blazing approach to protecting the fundamental rights of the most vulnerable individuals in Colombia from the effects of persistent negligence on the part of the Government.