Jeanene Smith, M.D

February 1, 2007

Jeanene Smith is the administrator of the Office for Oregon Health Policy & Research (OHPR), which serves as the policymaking body for the Oregon Health Plan. Smith has also served as assistant clinical professor for the Department of Family Medicine at Oregon Health & Sciences University . Smith's published and policy-related work has focused primarily on healthcare benefit design, cost-sharing strategies for Medicaid populations and quality of care in new, emerging models.

In 2004, Smith took the lead on a HCFO grant, which examined the impact of benefit reductions and changes to the Oregon Health Plan, Oregon 's Medicaid program. The study was conducted by a unique collaborative of Oregon 's policy and health services research community, the Oregon Health Research and Evaluation Collaborative (OHREC).

Researchers from the OHPR, Portland State University (PSU), and the Oregon Health & Science University (OHSU) set out to determine how increased cost sharing and benefit reductions would impact access to preventive care and the economic viability of Oregon 's Medicaid adult "expansion" enrollees. Drs. Neal Wallace (PSU) and John McConnell (OHSU) explored the effect of imposing co-payments and eliminating benefits on patterns of service use and expenditures. In addition, Drs. Robert Lowe (OHSU) and McConnell examined differences in emergency department utilization before and after plan changes.

The researchers concluded that the imposition of co-payments did not reduce expenditures under the Oregon Health Plan. While use and expenditures fell for prescription drugs, expenditures for all other medical services increased, including increased use of inpatient and hospital outpatient care. An examination of the elimination of behavioral health benefits showed that individuals who lost methadone treatment coverage had significantly increased expenditures, driven primarily by increased inpatient admissions. There was also an abrupt and sustained increase in emergency department use following the plan cutbacks and a disproportionate impact on patients' chemical dependency diagnoses.

The researchers' findings suggest that benefit design changes and cost-sharing strategies may have impacts within a Medicaid population that are different than what might be expected in a commercial population. "We believe findings from this work will info rm Medicaid programs nationwide as they consider increased copays and cost sharing structures," says Smith.

Smith received her M.D. from OHSU and her M.P.H. from the Oregon Masters in Public Health Program. She has more than 15 years of clinical experience, including a year long rotation at the Alaska Native Medical Center and two years working for the Urban Indian Health Clinic.

For more info rmation on research by the OHPR, contact Jeanene Smith at or go to the Office's website at

For more information on the Medicaid program impacts of increased cost sharing, contact Neal Wallace, Ph.D. at PSU,, or John McConnell, Ph.D. at OHSU,

For more information on the impact of cost sharing structures on emergency department use, contact Robert A. Lowe, MD, MPH at OHSU,