The effect of health system reform plan on services sector of private section is very important . This study investigated the effect of implementation of third phase of health system reform plan on out of pocket payments and other expenditure related to open surgery of coronary arteries in Shiraz private hospitals. This study done in form of before and after and then by using data from 3 hospitals in which open heart surgery taken places . Sample content was 15 patients and data was collected in summer 2014& summer 2015. These finding show that after health system reform plan after controlling confounding variables , out of pocket payments in private section for open heart surgery of coronary arteries increased significantly . Also Salamat insurance premium ads overall costs of services increased significantly . But no increase in Salamat complementary expenses was seen . These findings show that reform plan couldn’t help the financial protection of patients on open heart surgery and only health system expenses increased .