OBJECTIVES:  We aimed to explore the key organizational elements and the degrees of autonomy that is granted to Iranian corportized hospital (trustees  hospitals) affiliated to Iranian ministry of health after the Iranian health system decentralization reform. METHODS: : All 18 Iranian corportized hospitals (that meet our criteria) involved to the study. In all, 27 Hospital Top Managers were interviewed (82% response rate). The semi-structured interview questions were developed using the Preker and Harding organizational reform Model and in-depth interviews. The “framework” method was used for the analysis. RESULTS: Nine themes explain the key organizational elements include: decision right in “strategic”, “human resources”, “financial” and “physical resources” management, “product” and “procurement” market exposure, “residual claimant” and “social functions”. Decision right in “strategic”, “human resources” and “physical resources” management was very limited. The hospitals were permitted to generate revenue (fee-for- services) but weren’t the residual claimant, completely. The hospital was exposed to product market but limited in procurement market (ceiling payment). Hierarchical and financial accountability were the main accountability mechanism. Several insurance programs and governmental budget were used to protect poor people. CONCLUSIONS: We can see a kind of unbalanced and inconsistent autonomy. More decision right in “strategic” and “human resources” management, and procurement market should be granted; and also the hospital needs to be the residual claimant. Government needs a regulatory and accountability mechanism to guarantee hospitals performance and balance the revenue generating and social values objectives