Communication is often treated as a neutral vehicle through which healthcare information passes from professionals to patients. This view underestimates how opportunities to receive, interpret, question, contest, and use information are distributed unevenly across healthcare encounters and systems. Language discordance, health-literacy demands, cultural expectations, unequal credibility, digital access, and institutional communication practices can each affect participation, yet they operate through distinct mechanisms and should not be collapsed into a single patient-level deficit. This conceptual article defines communication inequality as unequal capacity to participate effectively in healthcare communication under differing linguistic, cognitive, relational, organizational, and technological conditions. It distinguishes information availability from interpretability, speaking from being heard, access from usable access, and patient participation from adherence or preferred decisional control. Evidence across language-concordance research, health-literacy studies, interactional analyses, digital-health research, and shared decision-making interventions is used to identify component processes and their boundaries. The article argues that communication disadvantage can become cumulative when unresolved difficulties at one stage narrow opportunities at later stages, while repair remains possible through relational and organizational adaptation. A communication-inequality pathway model is subsequently proposed to integrate these processes without treating the complete architecture as empirically validated. The framework shifts equity-oriented communication from correcting presumed patient deficits toward matching communicative demands, resources, recognition, and institutional response.
