Background and Objectives: Since 2014, the "health system transformation plan" was designed and implemented in order to solve some of the problems in Iranian health system. One of the goals of this plan is to reduce direct payments by inpatients. This study aimed to compare the direct payments by inpatients, before and after implementing the transformation plan.

Material and Methods: In this analytical-descriptive study, 1351 cases were selected (all cases). Direct costs paid by the inpatients were extracted from medical records and then analyzed using SPSS v.19 software and applying Uman-Whitney test.

Results: The overall level of direct costs paid by inpatients before and after implementing the transformation plan has been decreased from 704 286 to 491815 Rials. A statistical relationship was observed between implementing the plan and the reduction of direct costs; but in detailed costs, there was no change.

Conclusion: Health system transformation plan reduced the direct costs paid by inpatients; but in detailed costs, there was no reduction in some parts. Cooperation between hospitals is necessary to continue the plan.