The Limits of ‘Choice’ in Healthcare Access: A Critical Conceptual Perspective on Ethnic Minority Inequalities

Jadhakhan, Ferozkhan (2026) The Limits of ‘Choice’ in Healthcare Access: A Critical Conceptual Perspective on Ethnic Minority Inequalities. European Medical Journal. ISSN 2397-6764

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Abstract

Background: Healthcare access is frequently framed in policy and practice as a matter of patient choice. This framing assumes that individuals are able to make informed and voluntary decisions about whether, when, and how to seek care. While widely used to interpret patterns of healthcare use, this assumption sits uneasily alongside persistent ethnic inequalities in access and health outcomes, particularly across European healthcare systems characterised by universal coverage but persistent inequities. Aim: This paper critically examines the concept of ‘choice’ as it is applied to healthcare access for ethnic minority patients, and advances a theoretically grounded alternative based on structural competence. Approach: The paper adopts a critical conceptual approach, drawing on scholarship from public health, medical sociology, and health policy. Rather than offering a systematic review, it uses established theoretical frameworks and selected empirical studies to examine how healthcare access is shaped by social position, institutional practices, and lived experience. It develops a conceptual framework that repositions healthcare access as structurally conditioned rather than individually determined. Key arguments: Behaviours frequently interpreted as patient choice, such as delayed presentation, non-attendance, or disengagement from services, are often better understood as responses to constrained circumstances. Language barriers, economic insecurity, administrative complexity, and experiences of discrimination significantly limit the options available to many ethnic minority patients. Building on this critique, the paper elaborates the concept of structural competence as a framework for understanding and addressing these constraints at the level of healthcare systems. Framing access as a matter of choice risks moralising disadvantage and shifting responsibility away from healthcare institutions. Implications: Moving beyond individualised notions of choice has important implications for policy, practice, and research. This paper proposes a structurally competent approach to healthcare access, outlining how institutions can operationalise this perspective through service design, accountability, and equity-oriented practice. Addressing ethnic inequalities in healthcare access requires greater attention to institutional responsibility, structural competence, and equity-oriented service design as foundations for meaningful patient autonomy, especially within European systems where formal universality coexists with stratified access. This paper makes a novel conceptual contribution by challenging dominant choice-based explanations of healthcare access and advancing structural competence as an alternative analytical framework for understanding ethnic minority inequalities within European universal healthcare systems.

Item Type:	Article
Identification Number:	10.33590/emj/776KIQ5X
Dates:	Date Event 22 May 2026 Accepted 16 June 2026 Published Online
Uncontrolled Keywords:	Discrimination, ethnic minority health, healthcare access, patient choice, structural inequality
Subjects:	CAH03 - biological and sport sciences > CAH03-01 - biosciences > CAH03-01-01 - biosciences (non-specific)
Divisions:	Life and Health Sciences > Life and Sports Sciences
Depositing User:	Gemma Tonks
Date Deposited:	03 Jul 2026 12:57
Last Modified:	03 Jul 2026 12:57
URI:	https://www.open-access.bcu.ac.uk/id/eprint/17099

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