Digital navigation as an access barrier: waiting times, equity, and universal health coverage in a digitalizing health system

Background Universal Health Coverage (UHC) aims to ensure equitable access to timely and appropriate healthcare without financial hardship. Under persistent capacity constraints, access is increasingly governed through non-financial mechanisms such as waiting times. Digitalization is widely promoted to improve efficiency and sustain UHC, yet its equity implications remain contested. Methods This qualitative study examines how digitalization reshapes healthcare in Tyrol, Austria, a health system with near-universal health insurance coverage and urban-rural disparities. Drawing on 222 in-depth interviews conducted between 2020 and 2025, the analysis triangulates perspectives from individuals experiencing access vulnerabilities related to financial or digital access constraints, contrast cases with greater access resources, and healthcare experts. Data were analyzed using inductive qualitative content analysis with systematic cross-group comparison. Results Digitalization does not eliminate waiting times but redistributes the burden of waiting. Digital tools such as online appointment booking and teleconsultations compress delays and reduce coordination effort for users with sufficient digital skills, connectivity, and institutional trust. For others, limited digital literacy, material and accessibility constraints, language barriers, and reliance on intermediaries intensify uncertainty and prolonged time-to-care. Under capacity pressure, digital navigation becomes a key determinant of effective access, transforming waiting from a temporal delay into a socially stratified burden. These dynamics are particularly pronounced in mental healthcare and in rural settings. Discussion In a near-universal healthcare system, digitalization operates as an access-governance mechanism rather than a neutral upgrade. By conditioning access on digital navigation capacities, digitalization produces stratified waiting trajectories despite formal universality of coverage. The pandemic exposed and accelerated these dynamics without resolving the underlying inequalities on which they rest. For UHC implementation, equity depends not only on coverage and financing, but on whether individuals can convert digital access pathways into timely care. Equity-sensitive digital transformation therefore requires multi-channel access, supported navigation, accessibility-by-design, and institutional capacity for mediation to prevent digitalization from amplifying health inequalities and undermining health service coverage.