Causes and Consequences of Lack of Transparency In Iran's Healthcare System: A Qualitative Interview Study

ABSTRACT Lack of transparency in healthcare systems is a critical challenge that undermines accountability, fuels corruption, and erodes public trust. While transparency has been shown to generate multiple positive outcomes, the Iranian healthcare system continues to suffer from significant deficits in this area. To investigate this issue, a qualitative approach was employed, which involved conducting 35 in‐depth interviews with experts and social activists engaged in healthcare system transparency at all levels, recruited through purposive stratified sampling method. This was followed by a thematic analysis aimed at exploring the causes and consequences of the phenomenon. The results indicated that the causes of the lack of transparency in the Iranian healthcare system can be categorized into four main domains: sociopolitical, psychological and behavioral, organizational, and ethical and legal factors. Additionally, the consequences of the lack of transparency can be classified into three primary categories: ethical, organizational, and social factors. The findings of this study provide needed data to enhance transparency and cultivate a culture of openness and accountability in the Iranian healthcare system and other similar contexts.