Background: Many patients are being denied access to health services and medicines in Latin America; therefore, judges have to intervene. This trend of judicialization has accelerated during the past decade. In a similar vein, existing literature on the justiciability and judicialization of the right to health is concerned with the question of whether judges should intervene or not in the protection of the right to health. Objective: To evaluate the challenges arising from the litigation of the Right to Health in Colombia, Argentina, Brazil, and Mexico. Methodology: Qualitative, descriptive, and comparative analytical and methodological framework. It includes a literature review and 37 semi-structured interviews with judges, academics, and government officials. In addition, a jurisprudential analysis of the latest jurisprudence in the four countries was carried out through content analysis. Results: A Moderate-Downstream approach to litigation, concerned with the consequences of the judicialization process, is persistent in the four countries studied. This entails, first, the incorporation of some limits and conditions in the recognition of the right to health by courts and, second, in general terms, that judgments are not considering the structural causes affecting litigiousness. Structural causes such as corruption, pharmaceuticalization, institutional arrangements, and privatization are triggering the judicialization process. In terms of consequences, countries have also introduced new strategies, including tests, laws, policies, institutions, mechanisms, and practices. Conclusions: Courts should move towards intentional equilibrium in the recognition, remedies, monitoring, and evaluation of judgments. This entails being more reflexive and strategic rather than reactive and passive. In other words, the more immature the health system is, and the more structural causes are perceived, the more reflexive and strategic courts should be, and the more recognition, protection, monitoring, and evaluation should be promoted. States should also adopt strong measures against the structural causes and must operationalize a more practical rights-based approach to health.