<p>This paper addresses the growing security challenges of smart card–based healthcare systems, which are increasingly targeted by attacks such as data tampering, authentication bypass, and malware injection. To overcome the limitations of isolated security mechanisms, we propose a unified security and privacy-preserving architecture that integrates smart cards, blockchain technology and artificial intelligence. In the proposed framework, smart cards provide secure authentication and controlled data access, while blockchain ensures decentralized integrity verification, immutability, and traceability of system interactions through smart contracts. An AI-based monitoring layer is introduced to detect anomalous behaviors in real time, enhancing the system’s resilience against cyber threats. To evaluate the effectiveness of the proposed approach, separate experimental assessments are conducted for the blockchain and AI layers. The blockchain layer is evaluated through smart-contract deployment and execution metrics, demonstrating low deployment and execution overhead. The AI component is assessed using Random Forest and XGBoost models for anomaly detection, achieving classification accuracy exceeding 99% and stable behavior across multiple evaluation metrics. The integration of these technologies results in a comprehensive defense strategy that significantly enhances the security, transparency, reliability, and resilience of healthcare data management systems.</p>