Background: The Relative Value Unit (RVU) is a value scale and plays a key role in the physician reimbursement system. The health sector has faced challenges such as providers’ dissatisfaction, income disparities, and reduced service quality which is said to be due to improper RVUs. Always there are debates about it. This study aims to identify the challenges of the RVU experience in Iran from the perspective of the service providers, payers and, policymakers.

Methods: This qualitative study was conducted in 2020. Data were collected from November 2019 to February 2020. Thirty experts participated in the study and were categorized into four groups: insurance organizations’ managers, surgeons, health economists, and health policymakers. Focus Group Discussions and semi-structured interviews were held to collect data. Content analysis was conducted to analyze data.

Results: According to the expert, the challenges of RVU in Iran are classified into five scopes. Financial, payment, macro-organization, regulation, and persuasion scope. Each scope’s result was categorized into main themes and relevant sub-themes.

Conclusions: The RVU has an important impact on the health system, provider behavior, and even patients. Paying attention to required infrastructures, decision- makers’ conflict of interests, decrease the Ministry of Health and Medical Education’s authority, and expanding the active role of involved organizations to increase their commitment to the successful implantation of RVU is necessary.

Keywords: Relative Value Unit, Challenge, Expert opinion, Qualitative study, Iran