Healthcare inequity is often described through differences in access, utilization, adherence, or health behavior, yet these downstream observations can conceal the psychological consequences of unequal social conditions. This article develops a proposed structural-to-psychological account of healthcare inequity in which structural disadvantage alters not only material resources but also the conditions under which health-related decisions are made. Material scarcity can narrow feasible options; discrimination and stigma can increase perceived interpersonal risk; repeated difficult encounters can alter expectations of care; and organizational complexity can shift cognitive and navigational demands onto patients with unequal capacity to absorb them. Under these conditions, delayed care, nondisclosure, discontinuity, or apparently low engagement may represent constrained adaptation rather than unconstrained preference. The proposed model therefore separates structural exposure, psychological response, observed behavior, realized health opportunity, and clinical outcome rather than treating them as interchangeable. It also recognizes reciprocal processes: prior encounters can influence future trust and vigilance, while institutional responses to patient behavior can reinforce or interrupt inequity. The framework is intended as a bounded conceptual synthesis rather than an empirically validated causal model. Its principal implication is that equitable healthcare requires attention not only to whether services exist, but also to whether patients can use them without disproportionate material, psychological, relational, or organizational cost.
