The present study examines the key drivers and uncertainties affecting the development of future scenarios for Iran’s health tourism industry, with consideration of sustainable development. Data were collected using a qualitative method through semi structured interviews with 12 experts in the fields of tourism and healthcare, based on the principle of theoretical saturation, and were analyzed using the grounded theory approach (Strauss and Corbin) and three stage coding in MAXQDA software.The findings indicate that the sustainable development of health tourism in Iran is influenced by a set of interconnected factors, including environmental issues, political and managerial outcomes, technological factors, human resource training, economic conditions, infrastructural and facility related components, service quality, and international and regional competitiveness. These were organized into 18 axial categories and 9 main dimensions.The study underscores the need for coordinated action across all these dimensions and shows that single dimensional policies are insufficient. Ultimately, it emphasizes a systemic approach as the primary pathway for achieving sustainable development scenarios in the health tourism sector.