Securing the Electronic Health Records (EHRs) in Blockchain based Internet of Things (IoT) healthcare systems remains a big challenge due to the computational constraints, privacy concerns, and scalability limitations. This paper introduces Blockchain-based Privacy-preserving, Access-controlled, and Cost-efficient IoT Healthcare Framework (B- PACIoT), a novel three-layer framework that uniquely integrates the zk-Rollups-based transaction batching, Ciphertext-Policy Attribute-Based Encryption )CP-ABE( based access control, and edge-assisted Advanced Encryption Standard with 128-bit key )AES-128( decryption to deliver the scalable, privacy-preserving, and cost-efficient EHR management solutions in Blockchain and IoT driven healthcare. Unlike the existing IoT frameworks, our B-PACIoT offloads heavy decryption tasks to edge servers while maintaining the privacy using Zero-Knowledge proofs (zk-SNARKs), which is significantly reducing the computational load on IoT devices. Our framework used zk-Rollups in transaction management for enabling the aggregation of multiple access transactions into a single blockchain proof, minimizing the on-chain overhead and finally improving the throughput. Decentralized Interplanetary File System (IPFS) network is used for secure storage of encrypted EHRs and on-chain ethereum smart contracts are used to manage the metadata anchoring and fine-grained access control. Experimental results proven that, our B-PACIoT framework reduced the transaction costs by 90%, improved the retrieval efficiency by 40%, and achieved the 99.8% of fault-tolerant availability through IPFS replication. Moreover, our B-PACIoT lowers the decryption latency by 85% when compared to the traditional on-chain models. These outcomes from experiments are emphasizing that our B-PACIoT is not just technically novel and but also practically an effective solution for next-generation EHR management in IoT-driven healthcare.

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