Equitable healthcare is often judged by eligibility, coverage, or service availability. These conditions are necessary but can misrepresent whether patients possess a meaningful opportunity to obtain and use care. This normative systems analysis applies the Capability Approach and systems-responsibility reasoning to interpretation, navigation support, and institutional access conditions. It distinguishes formal eligibility and access resources from the conversion conditions through which those resources become usable healthcare opportunities. Evidence across digital access, language barriers, organizational health literacy, and patient navigation shows that formally equal entry conditions can produce unequal practical opportunities when patients face avoidable informational, linguistic, administrative, technological, or coordination burdens. Navigation and interpretation support, however, are not uniformly effective, and nonuse cannot itself establish institutional failure. Fair access therefore requires attention to remediable conversion deficits while preserving patient agency and calibrating responsibility to what health systems can reasonably shape. Equal eligibility is ethically incomplete when system-shaped barriers prevent available healthcare from becoming a genuine option.
