Iran's referral system and family physician program face persistent equity challenges. This article identifies three missing links of justice in this system: (1) justice in prevention and primary care — where many never enter the system; (2) justice in referral decision quality — including over-referral and under-referral; and (3) structural justice in access to specialized services and feedback — where underserved areas lack specialists or proper feedback. Analysis reveals that horizontal and vertical equity require equality, distributive justice, and procedural justice, while structural justice addresses root causes of inequalities. Reform strategies must focus sequentially on prevention coverage, referral quality, and structural access to specialists. An equity impact assessment focusing on these three links is the essential policy recommendation. A referral system without effective prevention, quality referral decisions, and structural access to specialists merely manages the disadvantaged in a waiting line.