BACKGROUND: The reform of hospital payment systems is a top priority for policymakers in many countries, including Iran. As knowledge of the current situation and experience with previous reforms are gained, the next phase will focus on improvement. Therefore, this study aims to identify the challenges to hospital payments in the Iranian health system.

METHODS: This qualitative study used semi-structured interviews and focus group discussion meetings to collect data from 29 informants, including physicians, hospital administrators, faculty members, supervisors, and executive managers with expertise in hospital payment systems. Purposive sampling was used to recruit participants. Data were analyzed using content analysis.

RESULTS: The content analysis resulted in five themes and twenty-two sub-themes. Policy and regulation issues, payment methods, fair payment to providers, infrastructure and systems, and behavior of providers were cited as major challenges and drawbacks of Iran’s hospital payment systems.

CONCLUSIONS: Understanding the barriers to hospital payments is essential for reforming or alleviating the problem. This research has shed light on the current state of the hospital payment system in the Iranian health system. Knowledge of the issues with the current system and the needs of healthcare providers is essential for effective reform.

KEYWORDS: Payment system, hospital, health care providers, qualitative study