This policy-oriented study examines the role of blockchain technology in Iran’s healthcare system and identifies the key opportunities and challenges associated with its adoption within the broader context of innovation policymaking in digital government. The research employs a qualitative–explanatory design aimed at developing a contextualized theoretical framework and proposing policy strategies for the effective use of blockchain in health governance. A systematic review of national and international literature and content analysis of academic sources were conducted to identify influential components. Qualitative data were then collected through semi-structured interviews with experts in healthcare, information technology, and public administration, and analyzed using MaxQDA software. In the final stage, the identified components were validated and prioritized using the Fuzzy Delphi method.The findings indicate that implementing blockchain in Iran’s healthcare sector is a complex and multidimensional policy issue. Key challenges include weak technological infrastructure, the absence of legal and regulatory frameworks, institutional resistance to emerging technologies, and inadequate coordination among relevant bodies. Conversely, major opportunities include enhanced transparency, improved data security, reduced pharmaceutical fraud, and increased patient participation in managing health information. Based on innovation diffusion theory and institutional capacity perspectives, the study concludes that successful blockchain adoption depends on innovative policymaking, stronger executive institutions, and digital infrastructure development. Finally, four categories of policy strategies—regulation, institutional capacity building, infrastructure development, and digital culture promotion—are proposed to support gradual and effective implementation