“…Mass clientelism flourished via political party structures and mechanisms (Lavdas, 2005;Mitsopoulos and Pelagidis, 2011;Pappas, 2013;Afonso et al, 2015), and throughout the 1990s and 2000s, led to an irrational expansion of the public sector along with inefficiencies and low productivity, unjustified increase of welfare spending, rampant tax evasion and misappropriation of social benefits or public land and normalised nepotism in recruitment practices (Pappas, 2013;Zartaloudis, 2014). Within the ESY, for example, more often than not hospital managers are appointed based on political party affiliation rather than qualifications (Liaropoulos et al, Page 5 of 23 2012) and hospital procurement contracts and the outsourcing of services to the private sector are exchanged for political support (Mpourdaras, 2017).…”