Background & objectives: In today's world, health has wider prospect and special attention has been paid to non-medical expectations. The health care reform plan aims to improve community health, reduce treatment costs and increase the satisfaction of patients. The aim of this paper was to identify the factors influencing the development of health system in Ardabil province. Methods: This mixed-methods study was performed in two stages. In the first stage, comprehensive literature review was carried out and important factors in establishment of health system reform in the world were discovered. In the second stage and using the first stage findings, the questionnaires were completed by 185 experts and administrators of health development plan in Ardabil province who were selected by non-random purposeful sampling and local factors affecting the establishment of the plan in the province hospitals were obtained. Lisrel software was used for factor analysis . Results: The most important indicators of development of health care system were as follows: political support, providing and promoting community participation, management and resource assurance, satisfaction guarantee for paramedics, commitment of senior executives, commitment of interested physicians, continuous monitoring and evaluating and providing the feedback to project executives, existence of infrastructure and project steering committee. The results of structural equation modeling showed the relationship between independent and dependent variables. Conclusion: The study modeling indicators showed that, the proposed model is in good agreement. It seems that paying attention to regional indicators and variables is very important in the formulation and implementation of strategic plans and has a decisive role in achieving the goals.