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Traditional e-health systems facilitate EHR sharing among healthcare providers but also introduce significant privacy risks, such as unauthorized access and data breaches. Blockchain, when integrated with privacy-preserving techniques, enhances transparency, integrity, and availability in EHR management. Smart contracts further strengthen security by enabling automated authentication and access control. This paper provides a comprehensive survey of blockchain-based access control frameworks in healthcare, categorizing them into permissioned and permissionless approaches. It also explores cryptographic privacy-preserving techniques designed to mitigate privacy risks. Additionally, blockchain platforms and consensus protocols commonly used in these frameworks are analyzed. The methodology follows a structured paper selection process, leading to the final inclusion of 45 research papers focusing on blockchain-based privacy preservation and access control in healthcare. Furthermore, it presents real-world case studies that illustrate the practical implementation of blockchain-based access control in healthcare settings, highlighting their strengths and challenges. Finally, it identifies privacy-related challenges, open research issues, and future directions to guide further research in this evolving domain.<\/jats:p>","DOI":"10.1007\/s10586-025-05308-x","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T11:48:23Z","timestamp":1755604103000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Blockchain-based access control and privacy preservation in healthcare: a comprehensive survey"],"prefix":"10.1007","volume":"28","author":[{"given":"Ahmed M.","family":"Tawfik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman","family":"Al-Ahwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adly S. 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