Why is Greece besieged by a challenging capacity to reform even after the arrival of the Troika into the very core of governmentaldecision-making? Despite Troika pressure, Greece is not reforming due to the presence of informal procedures in decision-making that have become institutionalized in practice. Using a blend of Historical and Discursive Institutionalism (HI and DI) to examine the impact of formal and informal institutions on decision-making, this paper takes stock of reform on health policy and e-prescription. It argues that Greek decision-makers attempt to break path dependent practices of syncopated reform and stakeholder reaction by the bailout agreement requirement for eprescription in particular. Accepting a Historical Institutionalist view of actor-driven and process-driven developments on the policy outcome, the paper explores the fundamental position of Discursive Institutionalism on the role of ideas as drivers of change or inaction. Based on evidence from 10 elite interviews, findings demonstrate that in the case of Troika negotiations, the greater the distance between formally negotiated and embedded informal ways of national policy-making, the lower the likelihood is for national actors to initiate the points of reform.
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