The health decentralization process in Greece: the insiders’ perspective

Athanasios Athanasiadis (Health Economics Observatory, Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Greece) (Foundation for Economic & Industrial Research (IOBE), Athens, Greece)
Nikoleta Ratsika (Department of Social Work, Technological Educational Institute of Crete, Heraklion, Greece)
Constantinos Trompoukis (Department of History of Medicine, School of Medicine, University of Crete, Heraklion, Greece)
Anastas Philalithis (Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Greece)

International Journal of Health Governance

ISSN: 2059-4631

Publication date: 3 December 2018



Greece has legislated health decentralization several times since the 1920s, but none had been implemented until 2001. Even so, the decentralized system was subsequently modified several times, curtailing the powers that were initially delegated to the health regions, while the whole process has been criticized as limited in scope. The purpose of this paper is to explore the reasons that the decentralization process did not fulfil its initial aims.


Elite interviews were conducted with 37 of the 50 directors of health regions who served between 2001 and 2009. Interview transcripts were divided into four themes and analyzed using thematic analysis.


The participants agreed that health decentralization in Greece was only administrative rather than political and did not include fiscal decentralization. They described problematic and competitive relations with party officials and civil servants. They blamed their short tenure for the inability to fulfil their plans. Findings indicate that decentralization in Greece did not achieve its objectives because of the dominant mentality of centralized control, the lack of political support, the discontinuity in health policies and opposition from vested interests.


The value of the present study lies in the fact that it examines in depth the issue of health decentralization drawing on the experiences of the former directors of the Greek health regions, i.e. the persons who were called on to put into practice the process of regional decentralization.



Athanasiadis, A., Ratsika, N., Trompoukis, C. and Philalithis, A. (2018), "The health decentralization process in Greece: the insiders’ perspective", International Journal of Health Governance, Vol. 23 No. 4, pp. 316-329.

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