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This article analyzes the long process of health‐system reform in Colombia, using the advocacy coalition framework. Since its inception in 1993, the basic organizing principles and structures of the Colombian health system have remained highly contested, yet the system brought into effect by Law 100 has proven resilient to decisive reform. This article employs the advocacy coalition framework to explain this ongoing contestation and deadlock. It argues that the highly contested nature of the health system and policy stasis are the result of the power dynamics between three identifiable advocacy coalitions. The analysis of the legislative proposals submitted to the Congress of the Republic of Colombia between 1993 and 2014, reveals how the dominant coalition exploited mechanisms of the lawmaking process to impede Congress from passing successful new legislation. For the advocacy coalition framework, these mechanisms are Relatively Stable Parameters that constitute long‐term constraints and opportunities for subsystem actors. The article shows how Relatively Stable Parameters in the Colombian legislative system shaped the health‐system reform process.

This chapter examines how evidence is used in major policy health policy initiatives in a highly contested political context. Through a case study of legislation proposed in the context of Colombia's ongoing health systems reformed process, it explores how such use is affected by the specific role played by the legislature within a highly fragmented polity. It draws on an analysis of evidence cited in the drafting of relevant laws in the process of health systems reform. Reflecting the role of the legislature in Colombia's contested political system, evidence cited in legislative debates was unable to forge consensus amongst relevant policy actors over health system reforms. While scientific research was available and at the disposal of legislators, it was unable to provide the common ground on which to overcome embedded policy positions and form the basis of compromise over the direction of health systems reforms.

The existence of the tutela mechanism and the endemic weaknesses of the legislative and executive branches of the Colombian state have led to a de facto judicialization of health policymaking. The objective of evidence‐informed policy is to identify effective policy approaches and legitimize policy decisions. Questions arise about the basis on which judges take decisions with significant policy and budgetary consequences, and the forms of evidence they use to inform these. This article focuses on the extent to which courts take account of research evidence in judgements and assesses the implications for health policy in Colombia. We place these discussions in the context of a broader analysis of the ongoing reforms to the Colombian health system and the most recent literature on evidence‐informed policymaking. The judicialization of health policymaking offers a suboptimal means to achieve the objective of evidence‐informed policymaking. The emergence of a range of evidence advisory bodies in recent years is an attempt to address the issue of judicialization alongside the other constitutional and political weaknesses Colombia faces.

The existence of the tutela mechanism and the endemic weaknesses of the legislative and executive branches of the Colombian state have led to a de facto judicialization of health policymaking. The objective of evidence-informed policy is to identify effective policy approaches and legitimize policy decisions. Questions arise about the basis on which judges take decisions with significant policy and budgetary consequences, and the forms of evidence they use to inform these. This article focuses on the extent to which courts take account of research evidence in judgements and assesses the implications for health policy in Colombia. We place these discussions in the context of a broader analysis of the ongoing reforms to the Colombian health system and the most recent literature on evidence-informed policymaking. The judicialization of health policymaking offers a suboptimal means to achieve the objective of evidence-informed policymaking. The emergence of a range of evidence advisory bodies in recent years is an attempt to address the issue of judicialization alongside the other constitutional and political weaknesses Colombia faces.

This article analyzes the long process of health-system reform in Colombia, using the advocacy coalition framework. Since its inception in 1993, the basic organizing principles and structures of the Colombian health system have remained highly contested, yet the system brought into effect by Law 100 has proven resilient to decisive reform. This article employs the advocacy coalition framework to explain this ongoing contestation and deadlock. It argues that the highly contested nature of the health system and policy stasis are the result of the power dynamics between three identifiable advocacy coalitions. The analysis of the legislative proposals submitted to the Congress of the Republic of Colombia between 1993 and 2014, reveals how the dominant coalition exploited mechanisms of the lawmaking process to impede Congress from passing successful new legislation. For the advocacy coalition framework, these mechanisms are Relatively Stable Parameters that constitute long-term constraints and opportunities for subsystem actors. The article shows how Relatively Stable Parameters in the Colombian legislative system shaped the health-system reform process.

Research Highlights and Abstract The article investigates which of two competing accounts of contemporary British policy making better captures the nature of policy making during episodes of major reform of the English NHS. The analysis of the formulation of the English NHS Plan 2000 suggests that the Asymmetric Power Model better describes the reality of NHS policy making under New Labour than the Differentiated Polity Model. Although the process of developing the Plan showed signs of a more open policy process, it was tightly controlled and personally led by the Secretary of State for Health and his close advisers, reflecting an underlying British political tradition that emphasises the idea that the NHS has to be continuously improved with change led from above by central government. However, when compared to the processes underpinning Thatcher's Ministerial Review of the NHS and the 2010 Coalition government's White Paper, if ever NHS policy making in England were to have come close to the Differentiated Polity Model, it would have been during the formulation of the 2000 NHS Plan. Through a case study of the formulation of the English NHS Plan 2000, this article investigates which of two competing models of the British policy process—the Differentiated Polity and Asymmetric Power Models—better describes the reality of major NHS reform policy making under New Labour. The process of developing the Plan showed signs of a more open policy process, seemingly closer to the DPM. There was contestability of policy advice and limited involvement of the medical profession through its representative bodies. However, the process was tightly controlled and personally led by the Secretary of State and his advisers, with the direct involvement of the Prime Minister throughout. Two key moments of interest group involvement—the Modernisation Action Teams and the signing of the Plan by health sector organisations—were marked by power asymmetries. Overall, the APM better describes the reality of major reform policy making under New Labour.