{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T07:59:56Z","timestamp":1780646396126,"version":"3.54.1"},"reference-count":18,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T00:00:00Z","timestamp":1775347200000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine whether the November 2022 Massachusetts Dental Loss Ratio ballot initiative was associated with an increase in dental service prices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>We used quarterly price data from the Fluent DentaBase commercial claims dental database. Data was aggregated by state and quarter. We extracted data for Massachusetts and five comparison states: Connecticut, Maryland, New Jersey, New York, and Rhode Island from Quarter 1, 2022 through Quarter 2, 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>To account for the small number of states in our study, we used a pre\u2010intervention unit\u2010demeaning difference\u2010in\u2010differences estimator. We estimated cross\u2010sectional regressions to estimate the average treatment effect on the treated over the entire post\u2010intervention period after Quarter 4, 2022 and quarter\u2010specific treatment effects. Exact inference was used to ascertain statistical significance of policy effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Allowed prices for dental procedures increased 5.2% (95% CI: 2.3%\u20138.0%), and the insurer discount applied to submitted charges declined 2.8 percentage points (95% CI: \u22125.3 to \u22120.19 percentage points) relative to the comparison states.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prior to full implementation of the dental loss ratio requirement in 2025, dental insurers in Massachusetts increased reimbursement to dentists to possibly meet the required dental loss ratio threshold.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70111","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T03:35:14Z","timestamp":1775446514000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Early Look at the Effects of the 2022 Dental Loss Ratio Ballot Initiative in Massachusetts. Have Dental Insurers Increased Prices for Dental Services?"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9644-2900","authenticated-orcid":false,"given":"Kamyar","family":"Nasseh","sequence":"first","affiliation":[{"name":"American Dental Association Health Policy Institute  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Vujicic","sequence":"additional","affiliation":[{"name":"American Dental Association Health Policy Institute  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,5]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Kaiser Family Foundation \u201cExplaining Healthcare Reform: Medical Loss Ratio (MLR) KFF \u201d(2012) https:\/\/www.kff.org\/affordable\u2010care\u2010act\/fact\u2010sheet\/explaining\u2010health\u2010care\u2010reform\u2010medical\u2010loss\u2010ratio\u2010mlr\/."},{"key":"e_1_2_9_3_1","unstructured":"\u201cFederal Register \u201cMedical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act \u201d(2025) National Archives and Records Administration (Health and Human Services Department 2011) https:\/\/web.archive.org\/web\/20120118010324\/http:\/\/www.federalregister.gov\/articles\/2011\/12\/07\/2011\u201031289\/medical\u2010loss\u2010ratio\u2010requirements\u2010under\u2010the\u2010patient\u2010protection\u2010and\u2010affordable\u2010care\u2010act."},{"key":"e_1_2_9_4_1","unstructured":"United States Congress \u201cFederal Requirements on Private Health Insurance Plans \u201d(2025) https:\/\/www.congress.gov\/crs\u2010product\/R45146#:~:text=Because%20self%2Dinsured%20plans%20are%20financed%20directly%20by state%2Dlicensed%20insurers%20and%20the%20plans%20they%20offer.\/."},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1377\/hblog20140929.041684"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.0441"},{"key":"e_1_2_9_7_1","unstructured":"Massachusetts Dental Society \u201cDental Loss Ratio \u201d(2025) https:\/\/www.massdental.org\/Advocacy\/Legislative\u2010Action\/Dental\u2010Loss\u2010Ratio."},{"key":"e_1_2_9_8_1","article-title":"Dental Loss Ratios: Understanding the Landscape in Massachusetts and Beyond","author":"Stevenson S.","year":"2023","journal-title":"National Academy for State Health Policy"},{"key":"e_1_2_9_9_1","volume-title":"Question 2: New Rules for Dental Insurance","author":"Howowitz E.","year":"2022"},{"key":"e_1_2_9_10_1","unstructured":"Fluent \u201cFluent in Big Data. DentaBase At\u2010A Glance \u201d(2025) https:\/\/fluent.dental\/dentabase."},{"key":"e_1_2_9_11_1","unstructured":"American Dental Association \u201cCDT 2025. Current Dental Terminology \u201d(2025)."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1162\/AJHE_a_00012"},{"key":"e_1_2_9_13_1","unstructured":"Health Resources and & Services Administration \u201cDemand Modeling Overview \u201d(2024) https:\/\/bhw.hrsa.gov\/data\u2010research\/projecting\u2010health\u2010workforce\u2010supply\u2010demand\/technical\u2010documentation\/modeling\u2010demand\u2010health\u2010care#modeling."},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12130"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00181-025-02807-z"},{"key":"e_1_2_9_16_1","doi-asserted-by":"crossref","unstructured":"S. J.LeeandJ. M.Wooldridge \u201cSimple Approaches to Inference With Difference\u2010In\u2010Differences Estimators With Small Cross\u2010Sectional Sample Sizes \u201d SSRN (2026) http:\/\/dx.doi.org\/10.2139\/ssrn.5325686.","DOI":"10.2139\/ssrn.6269677"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1162\/rest.89.2.221"},{"key":"e_1_2_9_18_1","volume-title":"Stata 18.0","year":"2025"},{"key":"e_1_2_9_19_1","unstructured":"K.Keith \u201cFinal 2023 Payment Rule Part 1: Essential Health Benefits and Other Market Reforms Health Affairs Forefront \u201d(2022) https:\/\/www.healthaffairs.org\/content\/forefront\/final\u20102023\u2010payment\u2010rule\u2010part\u20101\u2010essential\u2010health\u2010benefits\u2010and\u2010other\u2010market\u2010reforms#:~:text=2023%20Final%20Payment%20Rule in%20order%20to%20be%20nondiscriminatory."}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70111","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1475-6773.70111","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70111","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T07:06:38Z","timestamp":1780643198000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.70111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":18,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/1475-6773.70111"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.70111","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-09-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70111"}}