OBJECTIVES: Healthcare systems are designed to improve accessibility, equity, service quality, and efficiency indicators, within their limited resources. This study was aimed to provide a comprehensive overview of four years-achievements and challenges of Iran’s Health Transformation Plan (HTP), began in 2014.

METHODS: "Thematic analysis" following interviews with health experts was carried out to identify positive and negative consequences. Subsequently, "Content analysis" was applied on published official reports; finally, results were aggregated and analyzed through "Triangulation" method.

RESULTS: Positive outcomes of Iran’s HTP, identified in this study, include reducing inpatients’ out of pocket expenditure in public sector, protecting vulnerable patients, promoting natural childbirth delivery, improving public health sector’s tangible assets, and improving access to specialized services in remote areas. In contrast, negative consequences of this plan are increasing induced demand, increase in total health expenditures, higher number of referrals in public sector services, increase in share of health expenditure in household budget, supply chain weakening, and intensification of medical personnel complaints due to salary inequity. Additionally, lack of feasibility studies before starting the plan, lack of sustainable resources to maintain services providing, conflicts with macro policies and conflict of interest in policymaking, prioritizing treatment over prevention, inappropriate human resource management, and inefficient policies are identified as main drivers of HTP challenges.

CONCLUSIONS: Despite some achievements, HTP has suffered from lack of holistic approach and acceptable economic measures which had led to diminishing some positive outcomes at the expense of public budget. It is concluded that a major revision of HTP based on sound health economics measures is of necessity.