Background: The health transformation plan (HTP) was put into action in Iran, in 2014, with 8 service packages. This plan was not implemented as a pilot and therefore, various problems and barriers have since emerged. Objectives: The aim of this study was to identify the economic challenges of inpatient payment reduction directive in HTP from the perspectives of 2 groups of experts in levels of hospital and university held in 2 time periods. Methods: In this qualitative study, data were collected through semi-structured interviews with 20 participants involved in the healthcare reform in hospitals as well as the executive committee of HTP in universities. Results: Data collection resulted in 36 descriptive codes presenting the economic challenges of the payment reduction directive in thems of insurance / tariffs and financial affairs in the period of 3 months and 1 year since the beginning. Interviewees then suggested their solutions. Conclusions: Challenges trends over times show that some parts of challenges are changing. In addition, challenges interact with each other and could be avoided just by appropriate planning. On the other hand, execution of this directive was extremely costly for the government; it would be better to allocate resources with meticulous planning and designs.
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