OBJECTIVES: To explore health decision-makers’ perceptions on governance on decision-making process within the región de Los Ríosintegrated healthcare delivery network. METHODS: A descriptive and exploratory qualitative study base on in-depth interviews with health decision-makers from región de Los Ríosfrom June 2013 to December 2014 was conducted. A convenience sample of 11 health decision-makers was selected. A health decision-maker was defined as a health professional with a formal policy or managerial status whose primary responsibility would be formal leadership on decision-making (i.e. Health Service Director, and Hospitals Directors). The interviews were performed, recorded -previous signing of the informed consent- and transcript literally. The interviews’ analysis was performed through the content analysis technique in its conventional approach, using ATLAS.ti qualitative software. RESULTS: For the health decision-makers, a meaning of governance applied to health systems and services is not conceived in a technical approach. Moreover, governance is neither perceived as a concept related to health nor universal health coverage. Politics was perceived as a key issue at designing and implementing health decision-making processes among the Chilean health systems. From a governance perspective, politics of health policy is perceived as a strong root for health decision-making in Chile. CONCLUSIONS: the Chilean case highlights is the paradox that establishing good enough governance to implement central initiatives with effective integrity might involve accountability measures that interfere with good administration.