Purpose The COVID-19 crisis has brought to the forefront the importance of rural health enterprises (RHEs), the peculiarity, in these terms, of rural areas, and the impact of rurality on health entrepreneurial activities. This paper aims to undertake a literature review regarding RHEs in the EU, identify research gaps and set future research directions. Design/methodology/approach A systematic literature review was conducted and the key aspects coded across four thematic areas – after examining 68 papers. Findings The findings reveal that more intense research should be conducted across four area which emerged; rural health providers vs urban health providers; RHEs and rural development; RHEs and quality of life; and social RHEs. Research limitations/implications Future research avenues were identified and suggestions for further research on RHEs were provided. Practical implications The paper provides insights into how rural areas can attract health enterprises and how health enterprises can operate in rural areas. Originality/value This research expands on the limited existing knowledge of RHEs and sets the foundations for further research.

The main lever for the development and promotion of rural tourism in Greece has been, and continues to be, through specific EU programmes. Rural tourism in Greece began with a long delay compared to other European countries. The development philosophy was (and still is) to increase rural incomes as a complement to agricultural and livestock production, not by degrading them. This theoretical paper presents previous research studies in rural tourism and EU development programmes and it describes how European financial tools intended for rural tourism were implemented in Greece. Furthermore, it describes the challenges faced by rural people involved in the development of rural tourism in seeking European funding through a multi-layer approach on the obstacles in the EU funds absorption capacity. The analysis shows that the legislation, design of the programmes, processes from local governments, bureaucracy and malpractices create constraints in the absorption of EU funds and the results in the rural tourism development are not the expected ones. It concludes that there is a need for reforms in the national institutional framework and structures along with a different philosophy in approaching the EU funding initiatives in rural areas.

Despite the difficulties, entrepreneurship met the socioeconomic challenges by providing solutions to rural areas during the COVID‐19 crisis, while healthcare entrepreneurial activity has been adapted to the changing conditions. The Greek rural areas' healthcare enterprises suffer the consequences of the public policies on COVID‐19 as their activities have been affected, their turnover has decreased, and liquidity problems have arisen. Entrepreneurs believe that the announced state and European support will help them overcome the implications. However, some of the support measures that have a loan rational will bring enterprises with bank loans to a halt. Indeed, entrepreneurship in rural areas faces multiple problems that they are trying to overcome during the COVID‐19 crisis. Uncertainty, insecurity and health scare prevailed. Despite the problems, the enterprises showed resilience and did not cease their operations.

In the field of healthcare innovation, Greece ranks 26th in FREOPP’s World Index of Healthcare Innovation (WIHI) 2021 analysis. Such a standing illustrates low performance in the dimensions of quality, science and technology and fiscal sustainability. This article seeks to shed light on this backwardness and examine the obstacles and weaknesses in the development of innovative projects by Greek health entrepreneurs. Furthermore, this research aims to trace entrepreneurs’ views on innovation issues and assess the existence of innovative plans from four perspectives: at the level of service to citizens, in the functionality of health business structures, at the level of facilities and technology, and in a clinical setting. Qualitative research was conducted with the entrepreneurs of 12 health companies in the form of semi-structured interviews. This study has shown that healthcare entrepreneurs do not reject the development of innovative projects and that those who have implemented innovative practices have had positive results; however, various obstacles negatively impact the implementation of innovative ideas. A primary research contribution will capture the factors that negatively affect the development of innovative projects and represent a crucial element for Greece to remove barriers and improve its performance on innovation issues. The results of the research will provide support for not only innovation decision-making centres but also other health entrepreneurs.