There is a growing consensus that fair priority-setting and the right to health contribute to achieving universal health coverage. The right to health creates legal entitlements to receive care and fair priority-setting promotes efficient and just health systems. However, there can be tension between them, particularly when the right to health is judicially protected. This article analyses three approaches to understanding this tension: the first minimises the conflicts between them to emphasise their synergies; the second admits the tension and considers it positive as rights create and protect substantive entitlements against priority-setting decisions; the third also recognises that this tension exists, but sees these substantive entitlements as obstacles for fair priority-setting. Building on the analysis of these approaches, this article argues that the involvement of courts in allocative decisions can be more comprehensively evaluated by assessing whether they promote or impair fair priority-setting rather than by focusing on the direct beneficiaries of judicial decisions. If this argument is correct, then courts using the right to health to create and enforce substantive entitlements to health treatments becomes very questionable.