Ensuring privacy and confidentiality in healthcare data management remains a critical challenge. Traditional centralized access control mechanisms are susceptible to security breaches, including unauthorized access, data leakage, and single points of failure, as well as privacy violations such as patient record exposure and improper data sharing. To address these issues, this paper proposes ACHealthChain, a blockchain-based framework leveraging Hyperledger Fabric for decentralized and transparent access control. The framework integrates the InterPlanetary File System (IPFS) for decentralized storage and ensures privacy through Hyperledger Fabric channels. ACHealthChain features PolicyChain for fine-grained access control and revocation, structuring patient health data into separate subchains for EHRs and diagnoses with permissioned access. Additionally, LogChain enhances auditing and accountability. A series of experiments evaluate ACHealthChain’s performance and scalability, considering metrics such as throughput, latency, and resource utilization. Results demonstrate that ACHealthChain improves throughput by 19.7% and reduces latency by 87%, outperforming existing frameworks built on the same platform. The scalability analysis further confirms the framework’s capability to handle increasing workloads within an expanding blockchain network. ACHealthChain presents a promising solution for secure and efficient healthcare data sharing with potential real-world applications.