D3.8 Policy report including the determination of redistribution parameters through in-kind health transfers for different countries and needs groups

This deliverable examines the redistributive role of universal public healthcare systems in Europe through the relationship between income and out-of-pocket (OOP) health expenditure. Drawing on a theoretical framework of in-kind transfers and self-targeting, it tests whether wealthier individuals opt out of public provision via private care, concentrating public resources on those with fewer means. The analysis combines SHARE longitudinal data (222,496 observations, 15 countries, 5 waves) with a simulated tax instrument built from the EUROMOD model, applying OLS, instrumental variable (2SLS), and Structural Quantile Treatment Effects (SQTE) methods. Results show a positive and significant causal effect of income on OOP spending (IV elasticity ≈ 0.26), stronger among individuals with multiple chronic conditions. The SQTE analysis reveals marked heterogeneity across the distribution—negative at lower quantiles, flat in the middle, and increasingly positive at the top. The findings call for stronger financial protection, reformed cost-sharing, and systematic monitoring of equity indicators.