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

For millions of Americans, the cost of keeping a family healthy is a constant calculation. Families weigh the price of a doctor's visit, the cost of a prescription, and the expense of a dental cleaning against their monthly income. When these costs become too high, they can force people to skip necessary care or fall into debt. To understand how widespread this financial pressure is, researchers often look at a simple ratio: how much of a family's income is spent on medical services. If that slice of the pie grows too large, it signals that the family is struggling to afford basic health needs. However, a specific question has long lingered in the background of these calculations: does the money spent on teeth count the same way as the money spent on the heart or lungs? In the United States, dental care is often treated differently by insurance and policy, yet when researchers tally up total medical costs, dental bills are usually added into the same big pot. This creates a puzzle. If a family is already struggling to pay for medical care, does adding a dental bill push them over the edge into a state of financial crisis, or is the dental bill just a small part of a much larger problem?

A team of researchers at the Hospital of Stomatology at Jilin University set out to solve this specific accounting puzzle. They did not ask whether dental care is important or whether people are suffering; instead, they asked a precise question about how we measure that suffering. They wanted to know if including dental bills in the total calculation actually changes the official status of a family's financial health. To do this, they turned to a massive, detailed database of American households known as the Medical Expenditure Panel Survey. This survey tracks the spending habits of thousands of families over time, recording exactly how much they pay out of their own pockets for medical services and what their family income is. The researchers focused on data from 2022 and 2023, looking at 7,423 people who had complete records for both years. They created a strict rule for the study: a family was considered to be under a heavy financial burden if their medical spending exceeded ten percent of their family income in a given year. They then looked at the same families twice. First, they calculated the burden using the total amount spent on all medical services, including dental care. Then, they recalculated the burden for the exact same families, but this time they subtracted the dental bills, looking only at the cost of non-dental medical care.

The goal was to see how many people would change their status if the dental bills were removed from the equation. Imagine a family that spends just enough on medical care to cross the ten percent line. If their dental bill is the only thing pushing them over that line, removing it would drop them back down to a "safe" status. If their non-dental medical bills were already high enough to cross the line, removing the dental bill would not change their status at all. The researchers found that for the vast majority of families, the answer was clear: the dental bills did not change their status. Out of the 7,423 people studied, only 106 individuals changed their classification when the dental costs were taken out. This represents a very small portion of the group, roughly 1.24 percent. For these 106 people, the inclusion of dental costs was the deciding factor that placed them into the category of high financial burden. Without the dental bills, they would have been classified as having manageable costs.

The study also looked at a more extreme scenario, where families spent twenty percent of their income on medical care. In this stricter group, the number of people whose status changed was even smaller, affecting less than half a percent of the total population. The researchers were particularly interested in a rare group of families who spent a large amount on medical care in both 2022 and 2023. Among this small group of 60 people who were consistently struggling, 14 of them would have been classified as having a lower burden if their dental costs had been excluded. This means that for about one in five of these consistently struggling families, the dental bill was the specific factor that kept them in the "high burden" category. However, the researchers were careful to note that this does not mean dental care is the main cause of financial hardship for the country. The numbers show that for nearly 99 percent of the people studied, the dental bill was not the tipping point that determined their financial status.

It is crucial to understand what this study does not tell us. The researchers explicitly state that their findings do not prove that dental care is unaffordable for these families, nor do they show that people are skipping dental visits because of the cost. The data only records what people actually paid. A family might have zero dental spending because they had no dental problems, or because they could not afford to go to the dentist at all. The study simply measures how the math changes when a specific type of bill is added or removed from a total. The authors emphasize that their work is a description of accounting rules, not a diagnosis of poverty or a measure of unmet health needs. They found that while dental payments do shift the classification for a small, measurable group of people, they do not drive the overall picture of medical financial burden in the United States. The study concludes that for most Americans, the decision of whether a family is under financial strain is determined by their non-dental medical costs, not by the price of their teeth.