{
  "meta": {
    "api_version": "v1",
    "edition": "2026.1",
    "generated_at": "2026-10-01T07:53:44.424Z",
    "license": "CC-BY-4.0",
    "license_url": "https://creativecommons.org/licenses/by/4.0/",
    "attribution_required": true,
    "attribution": "Real Dental Costs — https://realdentalcosts.com",
    "doi": "https://doi.org/10.5281/zenodo.20531728",
    "methodology": "https://realdentalcosts.com/en/methodology/",
    "docs": "https://realdentalcosts.com/en/api/",
    "disclaimer": "Independent pricing and market research. NOT medical, dental or insurance advice."
  },
  "endpoint": "https://realdentalcosts.com/api/v1/meps/longitudinal.json",
  "title": "U.S. dental spending and utilization, same persons 2023 to 2024 (MEPS Panel 28 longitudinal)",
  "description": "Survey-weighted estimates of dental expenditures, out-of-pocket payments, Medicaid payments and visits for the SAME nationally representative persons in 2023 and 2024, computed by Real Dental Costs from the AHRQ MEPS Panel 28 Longitudinal public use file (HC-257). Unlike two annual cross-sections, this file supports paired person-level change and a transition matrix of dental care use. Person-level survey estimates - NOT a per-procedure price benchmark.",
  "provenance": {
    "source": "AHRQ Medical Expenditure Panel Survey (MEPS), Household Component",
    "source_id": "ahrq_meps_hc257_panel28_longitudinal_2023_2024",
    "files": [
      {
        "puf": "HC-257",
        "name": "MEPS Panel 28 Longitudinal Data File (2023-2024)",
        "released": "2026-09-18",
        "url": "https://meps.ahrq.gov/mepsweb/data_stats/download_data_files_detail.jsp?cboPufNumber=HC-257",
        "data_url": "https://meps.ahrq.gov/data_files/pufs/h257/h257dta.zip",
        "documentation_url": "https://meps.ahrq.gov/data_stats/download_data/pufs/h257/h257doc.pdf",
        "codebook_url": "https://meps.ahrq.gov/data_stats/download_data/pufs/h257/h257cb.pdf"
      }
    ],
    "variables": {
      "person_id": "DUPERSID",
      "panel": "PANEL (28)",
      "weight": "LONGWT (longitudinal weight, Panel 28)",
      "variance_strata": "VARSTR",
      "variance_psu": "VARPSU",
      "round_presence_indicators": [
        "ALL5RDS",
        "DIED",
        "YEARIND",
        "INSCOPY1",
        "INSCOPY2"
      ],
      "year1_2023": [
        "DVTEXPY1",
        "DVTSLFY1",
        "DVTMCDY1",
        "DVTOTY1"
      ],
      "year2_2024": [
        "DVTEXPY2",
        "DVTSLFY2",
        "DVTMCDY2",
        "DVTOTY2"
      ],
      "naming_note": "annual variables DVTEXP/DVTSLF/DVTMCD/DVTOT are suffixed Y1/Y2 on this file; Y1 = calendar year 2023, Y2 = calendar year 2024 (verified on the variable labels, e.g. DVTOTY1 = '# DENTAL CARE VISITS 23')"
    },
    "weighting": "LONGWT > 0 on persons with ALL5RDS = 1 (in scope and data collected for all 5 rounds), the universe documented by AHRQ for two-year longitudinal estimates.",
    "variance_estimation": "Taylor linearization on the stratified with-replacement PSU design (VARSTR x VARPSU), 95pct normal confidence intervals. The estimator is self-tested at runtime against closed-form SRS and hand-computed stratified-total variances.",
    "missing_value_handling": "MEPS reserved negative codes (-1, -7, -8, -9) excluded; none occur in the dental variables inside the analytic sample.",
    "computed_by": "Real Dental Costs Data & Research Team",
    "computed_at": "2026-09-20",
    "generator": "scripts/gen_meps_longitudinal.py",
    "license_of_source": "Public domain (U.S. federal public use file)",
    "license_of_derived": "CC-BY-4.0"
  },
  "caveats": [
    "All dollar amounts are nominal (2023 and 2024 dollars as reported), not inflation-adjusted.",
    "The longitudinal population (persons in scope the whole 2023-2024 period) is NOT the same universe as the annual cross-sections in data/meps-national.json; levels are expected to differ (newborns, immigrants, deaths and institutionalized persons are treated differently).",
    "MEPS measures person-level spending and utilization, not per-procedure prices; do not compare these figures with CDT-code benchmarks.",
    "Expenditures = amounts actually paid (all payers); out-of-pocket = self/family payments; Medicaid amount = payments reported as made by Medicaid.",
    "Changes whose 95pct confidence interval contains 0 are not statistically distinguishable from no change; the sign of such a change carries no information.",
    "Self-reported dental expenditures are subject to reporting error; Medicaid payment amounts are known to be under-reported in household surveys.",
    "These are figures only; no causal or policy interpretation is attached to them."
  ],
  "data": {
    "analytic_sample": {
      "records_in_file": 8872,
      "n_analytic": 8389,
      "selection": "PANEL = 28 and ALL5RDS = 1 and LONGWT > 0 and no reserved negative code",
      "weighted_population": 321415177,
      "weighted_population_millions": 321.4,
      "ahrq_documented_benchmark": "AHRQ documentation states LONGWT on the 8,389 ALL5RDS = 1 cases yields 321.4 million persons",
      "excluded_records": 483,
      "reserved_negative_codes_in_file": {
        "DVTEXPY1": 57,
        "DVTEXPY2": 106,
        "DVTSLFY1": 57,
        "DVTSLFY2": 106,
        "DVTMCDY1": 57,
        "DVTMCDY2": 106,
        "DVTOTY1": 57,
        "DVTOTY2": 106
      },
      "variance_strata": 105,
      "variance_psu_total": 259,
      "single_psu_strata": [
        2053
      ],
      "single_psu_strata_note": "strata with a single PSU contribute 0 to the variance (certainty-unit convention); standard errors for affected estimates are slightly understated"
    },
    "y2023": {
      "mean_expenditure_per_person_usd": {
        "value": 494.17,
        "se": 24.46,
        "ci95": [
          446.23,
          542.11
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "mean_oop_per_person_usd": {
        "value": 231.36,
        "se": 16.19,
        "ci95": [
          199.62,
          263.1
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "mean_medicaid_paid_per_person_usd": {
        "value": 42.5,
        "se": 4.61,
        "ci95": [
          33.47,
          51.53
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "mean_visits_per_person": {
        "value": 1.0957,
        "se": 0.0326,
        "ci95": [
          1.0318,
          1.1595
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "pct_with_dental_visit": {
        "value": 49.11,
        "se": 1.05,
        "ci95": [
          47.06,
          51.17
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "pct_with_dental_expenditure": {
        "value": 48.5,
        "se": 1.05,
        "ci95": [
          46.44,
          50.55
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "oop_share_of_expenditure_pct": {
        "value": 46.82,
        "se": 1.67,
        "ci95": [
          43.55,
          50.08
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "mean_visits_among_users": {
        "value": 2.2309,
        "se": 0.039,
        "ci95": [
          2.1546,
          2.3073
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "total_dental_expenditure_usd_billion": {
        "value": 158.833,
        "se": 8.735,
        "ci95": [
          141.712,
          175.954
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "total_out_of_pocket_usd_billion": {
        "value": 74.363,
        "se": 5.375,
        "ci95": [
          63.829,
          84.897
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "total_medicaid_paid_usd_billion": {
        "value": 13.66,
        "se": 1.517,
        "ci95": [
          10.686,
          16.634
        ],
        "n": 8389,
        "significant_at_95pct": true
      }
    },
    "y2024": {
      "mean_expenditure_per_person_usd": {
        "value": 491.4,
        "se": 20.82,
        "ci95": [
          450.59,
          532.21
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "mean_oop_per_person_usd": {
        "value": 216.97,
        "se": 12.81,
        "ci95": [
          191.85,
          242.09
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "mean_medicaid_paid_per_person_usd": {
        "value": 41.84,
        "se": 4.77,
        "ci95": [
          32.49,
          51.18
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "mean_visits_per_person": {
        "value": 1.1401,
        "se": 0.0345,
        "ci95": [
          1.0724,
          1.2078
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "pct_with_dental_visit": {
        "value": 48,
        "se": 1.06,
        "ci95": [
          45.92,
          50.07
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "pct_with_dental_expenditure": {
        "value": 47.32,
        "se": 1.06,
        "ci95": [
          45.24,
          49.39
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "oop_share_of_expenditure_pct": {
        "value": 44.15,
        "se": 1.6,
        "ci95": [
          41.02,
          47.28
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "mean_visits_among_users": {
        "value": 2.3754,
        "se": 0.0395,
        "ci95": [
          2.2979,
          2.4528
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "total_dental_expenditure_usd_billion": {
        "value": 157.944,
        "se": 8.563,
        "ci95": [
          141.161,
          174.727
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "total_out_of_pocket_usd_billion": {
        "value": 69.737,
        "se": 4.782,
        "ci95": [
          60.364,
          79.11
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "total_medicaid_paid_usd_billion": {
        "value": 13.447,
        "se": 1.566,
        "ci95": [
          10.378,
          16.517
        ],
        "n": 8389,
        "significant_at_95pct": true
      }
    },
    "paired_change_2024_minus_2023": {
      "mean_expenditure_per_person_usd": {
        "value": -2.77,
        "se": 28.17,
        "ci95": [
          -57.99,
          52.46
        ],
        "n": 8389,
        "significant_at_95pct": false
      },
      "mean_oop_per_person_usd": {
        "value": -14.39,
        "se": 18.81,
        "ci95": [
          -51.27,
          22.48
        ],
        "n": 8389,
        "significant_at_95pct": false
      },
      "mean_medicaid_paid_per_person_usd": {
        "value": -0.66,
        "se": 5.26,
        "ci95": [
          -10.96,
          9.64
        ],
        "n": 8389,
        "significant_at_95pct": false
      },
      "mean_visits_per_person": {
        "value": 0.0444,
        "se": 0.024,
        "ci95": [
          -0.0026,
          0.0914
        ],
        "n": 8389,
        "significant_at_95pct": false
      },
      "pct_with_dental_visit": {
        "value": -1.12,
        "se": 0.75,
        "ci95": [
          -2.59,
          0.36
        ],
        "n": 8389,
        "significant_at_95pct": false
      },
      "pct_with_dental_expenditure": {
        "value": -1.18,
        "se": 0.76,
        "ci95": [
          -2.66,
          0.3
        ],
        "n": 8389,
        "significant_at_95pct": false
      },
      "oop_share_of_expenditure_pct": {
        "value": -2.67,
        "se": 2.11,
        "ci95": [
          -6.81,
          1.48
        ],
        "n": 8389,
        "significant_at_95pct": false
      },
      "mean_visits_among_users": {
        "value": 0.1445,
        "se": 0.0427,
        "ci95": [
          0.0609,
          0.2281
        ],
        "n": 8389,
        "significant_at_95pct": true,
        "basis": "unpaired: two different domains (users of each year)"
      },
      "total_dental_expenditure_usd_billion": {
        "value": -0.889,
        "se": 9.051,
        "ci95": [
          -18.629,
          16.851
        ],
        "n": 8389,
        "significant_at_95pct": false
      },
      "total_out_of_pocket_usd_billion": {
        "value": -4.626,
        "se": 6.024,
        "ci95": [
          -16.433,
          7.181
        ],
        "n": 8389,
        "significant_at_95pct": false
      },
      "total_medicaid_paid_usd_billion": {
        "value": -0.213,
        "se": 1.689,
        "ci95": [
          -3.523,
          3.098
        ],
        "n": 8389,
        "significant_at_95pct": false
      }
    },
    "utilization_transition_matrix_pct": {
      "visit_both_years": {
        "value": 36.84,
        "se": 1.02,
        "ci95": [
          34.85,
          38.83
        ],
        "n": 8389,
        "significant_at_95pct": true,
        "n_unweighted": 3132,
        "weighted_population": 118406636
      },
      "visit_2023_only": {
        "value": 12.27,
        "se": 0.44,
        "ci95": [
          11.4,
          13.14
        ],
        "n": 8389,
        "significant_at_95pct": true,
        "n_unweighted": 992,
        "weighted_population": 39446754
      },
      "visit_2024_only": {
        "value": 11.16,
        "se": 0.53,
        "ci95": [
          10.11,
          12.2
        ],
        "n": 8389,
        "significant_at_95pct": true,
        "n_unweighted": 917,
        "weighted_population": 35860745
      },
      "visit_neither_year": {
        "value": 39.73,
        "se": 1.05,
        "ci95": [
          37.68,
          41.79
        ],
        "n": 8389,
        "significant_at_95pct": true,
        "n_unweighted": 3348,
        "weighted_population": 127701043
      },
      "retention_among_2023_users_pct": {
        "value": 75.01,
        "se": 0.91,
        "ci95": [
          73.22,
          76.8
        ],
        "n": 8389,
        "significant_at_95pct": true
      },
      "uptake_among_2023_nonusers_pct": {
        "value": 21.92,
        "se": 1.03,
        "ci95": [
          19.91,
          23.94
        ],
        "n": 8389,
        "significant_at_95pct": true
      }
    },
    "comparison_with_cross_sectional": {
      "reference_file": "data/meps-national.json",
      "reference_source_id": "ahrq_meps_hc256_2024",
      "method": "cross-sectional change = difference between two annual full-year files that share Panel 28 respondents (not independent samples) (HC-256 minus HC-251, no variance estimated in that file); longitudinal change = paired within-person change on Panel 28 with Taylor standard errors",
      "reading": "The differences between the two annual cross-sections (HC-256 minus HC-251) are not confirmed by the paired Panel 28 estimates: no paired change in spending, out-of-pocket or Medicaid-paid amounts is statistically significant at the 95 percent level. We therefore report no national 2023-2024 trend in either direction. The cross-sectional differences carry their own sampling error, which data/meps-national.json does not estimate.",
      "metrics": {
        "mean_expenditure_per_person_usd": {
          "cross_sectional_change_2023_to_2024": 39.03,
          "cross_sectional_field": "per_capita_expenditure_usd",
          "longitudinal_change_2023_to_2024": -2.77,
          "longitudinal_se": 28.17,
          "longitudinal_ci95": [
            -57.99,
            52.46
          ],
          "longitudinal_significant_at_95pct": false,
          "same_direction": false,
          "note": "longitudinal change is not statistically significant at 95pct (CI contains 0); direction comparison is indicative only"
        },
        "mean_oop_per_person_usd": {
          "cross_sectional_change_2023_to_2024": 23.712,
          "cross_sectional_field": "derived: total_out_of_pocket_usd_billion / weighted_population",
          "longitudinal_change_2023_to_2024": -14.39,
          "longitudinal_se": 18.81,
          "longitudinal_ci95": [
            -51.27,
            22.48
          ],
          "longitudinal_significant_at_95pct": false,
          "same_direction": false,
          "note": "longitudinal change is not statistically significant at 95pct (CI contains 0); direction comparison is indicative only"
        },
        "pct_with_dental_visit": {
          "cross_sectional_change_2023_to_2024": 0.86,
          "cross_sectional_field": "pct_with_dental_visit",
          "longitudinal_change_2023_to_2024": -1.12,
          "longitudinal_se": 0.75,
          "longitudinal_ci95": [
            -2.59,
            0.36
          ],
          "longitudinal_significant_at_95pct": false,
          "same_direction": false,
          "note": "longitudinal change is not statistically significant at 95pct (CI contains 0); direction comparison is indicative only"
        },
        "pct_with_dental_expenditure": {
          "cross_sectional_change_2023_to_2024": 0.77,
          "cross_sectional_field": "pct_with_dental_expenditure",
          "longitudinal_change_2023_to_2024": -1.18,
          "longitudinal_se": 0.76,
          "longitudinal_ci95": [
            -2.66,
            0.3
          ],
          "longitudinal_significant_at_95pct": false,
          "same_direction": false,
          "note": "longitudinal change is not statistically significant at 95pct (CI contains 0); direction comparison is indicative only"
        },
        "oop_share_of_expenditure_pct": {
          "cross_sectional_change_2023_to_2024": 1.24,
          "cross_sectional_field": "oop_share_of_expenditure_pct",
          "longitudinal_change_2023_to_2024": -2.67,
          "longitudinal_se": 2.11,
          "longitudinal_ci95": [
            -6.81,
            1.48
          ],
          "longitudinal_significant_at_95pct": false,
          "same_direction": false,
          "note": "longitudinal change is not statistically significant at 95pct (CI contains 0); direction comparison is indicative only"
        },
        "mean_visits_among_users": {
          "cross_sectional_change_2023_to_2024": 0.05,
          "cross_sectional_field": "mean_visits_among_users",
          "longitudinal_change_2023_to_2024": 0.1445,
          "longitudinal_se": 0.0427,
          "longitudinal_ci95": [
            0.0609,
            0.2281
          ],
          "longitudinal_significant_at_95pct": true,
          "same_direction": true,
          "note": "significant, but NOT a within-person paired change: two different domains (users of each year)"
        },
        "total_dental_expenditure_usd_billion": {
          "cross_sectional_change_2023_to_2024": 15.64,
          "cross_sectional_field": "total_dental_expenditure_usd_billion",
          "longitudinal_change_2023_to_2024": -0.889,
          "longitudinal_se": 9.051,
          "longitudinal_ci95": [
            -18.629,
            16.851
          ],
          "longitudinal_significant_at_95pct": false,
          "same_direction": false,
          "note": "longitudinal change is not statistically significant at 95pct (CI contains 0); direction comparison is indicative only"
        },
        "total_out_of_pocket_usd_billion": {
          "cross_sectional_change_2023_to_2024": 9.13,
          "cross_sectional_field": "total_out_of_pocket_usd_billion",
          "longitudinal_change_2023_to_2024": -4.626,
          "longitudinal_se": 6.024,
          "longitudinal_ci95": [
            -16.433,
            7.181
          ],
          "longitudinal_significant_at_95pct": false,
          "same_direction": false,
          "note": "longitudinal change is not statistically significant at 95pct (CI contains 0); direction comparison is indicative only"
        }
      }
    }
  }
}