In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of
Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-
2016). It included different interventions to: increase population coverage of basic health insurance, increase quality
of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP)
payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs)
of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and
different professional feedback. The official monitoring program shows general public satisfaction. However, there are
some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the
financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers’ concerns (as
powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences
on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial
equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should
be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is
not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of
healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes)
should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting
interests) must be responded through clarification and providing transparent information. The requirements of
HSEP and especially the key element of progressive tax should be considered properly in the coming sixth national
development plan (2016-2021