Dental out-of-pocket spending and the measurement of medical financial burden in the United States

Abstract Background Dental payments are included in total medical-service out-of-pocket spending, but their contribution to a threshold-based classification cannot be inferred from spending amounts alone. We estimated how including the dental component changes the same person’s two-year medical financial burden state under fixed accounting rules. Methods We conducted a descriptive paired accounting analysis of MEPS Panel 27 for 2022–2023. The analytic population comprised 7423 persons with complete observation, valid spending, positive longitudinal weights and positive family income in both years. Annual person-specific medical-service out-of-pocket payments were compared with contemporaneous family income. Total and nondental payments were classified at a primary 10% threshold and a prespecified 20% sensitivity threshold, then combined into four two-year states. Survey-weighted proportions and beta-method 95% confidence intervals incorporated the complex design. Results At 10%, 106 of 7423 persons changed two-year states after subtracting dental payments (weighted 1.24%; 95% CI 0.92%–1.63%). Fourteen met the total-spending threshold in both years but had a different nondental state: 0.10% (95% CI 0.05%–0.19%) overall and 20.50% (14/60; 95% CI 8.72%–37.64%) within the rare both-year state. At 20%, any reclassification was 0.46% (46/7423; 95% CI 0.29%–0.69%). Conclusions Dental payments changed the fixed two-year classification for a small, measurable proportion of the analytic population. The comparison identifies a spending component’s accounting contribution; it does not establish continuous hardship, unmet dental need, or a causal effect of eliminating payments or care.