<p>Blockchain has gained attention for its potential to verify health insurance records, allow secure data sharing, and protect patient privacy. Despite these benefits, blockchain adoption in Egypt remains limited, and little research has examined its drivers and barriers. This study contributes to the limited research on blockchain adoption in Egyptian public hospitals by extending the TOE model with context-specific factors and examining adoption decisions at the organizational level. The study was conducted in public hospitals operating within the Universal Health Insurance System (UHIS) across six governorates. A quantitative approach was used, with data collected from a stratified random sample of 228 senior management and IT professionals across 53 public hospitals, analyzed using PLS-SEM. The results show that relative advantage, financial capability, and perceived trust positively affect adoption intention, whereas perceived risk and complexity negatively affect it. Security and privacy, as well as government support and regulations, significantly enhance perceived trust but do not directly affect adoption intention. Top management support and hospital readiness also strengthen perceived trust. The model explains 67.1% of the variance in blockchain adoption intention (R² = 0.671) and shows predictive relevance (Q² = 0.662). Perceived trust positively influences adoption intention and mediates selected relationships in the model, particularly for security and privacy, as well as government support and regulations, which indirectly influence adoption through trust. The proposed model provides practical insights for Egyptian public hospitals, blockchain providers, the Ministry of Health, and policymakers in designing strategies that may facilitate blockchain adoption in public hospitals in Egypt.</p>