The healthcare system aims to provide a reliable and organized solution to enhance the health of human society. Studying the history of patients can help physicians to consider patients’ needs in healthcare system designing and offering service, which leads to an increase in patient satisfaction. Therefore, healthcare is becoming a growing contesting market. With this significant growth in healthcare systems, such challenges as huge data volume, response time, latency, and security vulnerability are raised. Therefore, fog computing, as a well-known distributed architecture, could help to solve such challenges. In fog computing architecture, processing components are placed between the end devices and cloud components, and they execute applications. This architecture is suitable for such applications as healthcare systems that need a real-time response and low latency. In this paper, a systematic review of available approaches in the field of fog-based healthcare systems is proposed; the challenges of its application in healthcare are explored, classified, and discussed. First, the fog computing approaches in healthcare are categorized into three main classes: communication, application, and resource/service. Then, they are discussed and compared based on their tools, evaluation methods, and evaluation metrics. Finally, based on observations, some open issues and challenges are highlighted for further studies in fog-based healthcare.