Healthcare stigma is often approached as a problem of prejudicial attitudes held by individual professionals or members of the public. That perspective captures an important component of stigma but is insufficient for explaining how stigmatizing conditions are generated, reproduced, anticipated, internalized, resisted, or amplified across healthcare systems. This conceptual article argues that healthcare stigma is better understood as a dynamic multilevel social process whose effects depend on interactions among social classification, identity interpretation, interpersonal enactment, cultural meaning, institutional arrangements, structural inequality, and prior healthcare experience. The proposed account distinguishes stigmatizing attitudes from discrimination, anticipated stigma from enacted treatment, internalized stigma from identity threat, interpersonal interactions from organizational conditions, and structural constraints from individual choice. It further treats healthcare pathways as temporally connected rather than as isolated encounters and recognizes that patients may respond through avoidance, concealment, strategic disclosure, compensatory work, continued engagement, or resistance. Cultural and institutional environments shape both the meaning of stigmatized identities and the opportunities available for responding to them. The resulting dynamic multilevel model is presented as a theoretical synthesis rather than an empirically validated causal architecture. Its value lies in specifying testable cross-level relationships, identifying where attitude-focused explanations are insufficient, and matching potential intervention targets to the level at which stigma is produced. The framework also clarifies priorities for longitudinal, multilevel, intersectional, culturally comparative, organizational, and implementation research.
