The Treasure Valley on Monday will get another walk-in medical clinic, this one at a Wal-Mart supercenter in Caldwell.

The clinic, operated by Idaho-based Primary Health Medical Group, will take all patients, including those on Medicaid, a public health-insurance program for the poor. The program may expand into Ada County later.

The Valley is a very small part of a larger national trend. Thousands of similar clinics have cropped up in pharmacies, stores and a few malls in the past few years and more are expected.

There are five clinics in the Valley operated by Saint Alphonsus Medical Group. Four have been open about a year in Ada County Albertsons grocery stores and Rite-Aid pharmacies. The fifth, in Caldwell's Rite-Aid, opened in April. Those clinics also take Medicaid patients.

"We applaud the move to bring more accessible care to the Boise area," said Tom Reinhardt, chief planning officer for the Saint Al's Medical Group. "We need more providers who are willing to do that."

The clinics, which Reinhardt said usually take a couple of years before they become profitable, benefit Medicaid patients because many doctors limit the number of Medicaid patients they see.

Studies for years have shown Idaho has fewer primary care physicians per capita than almost any other state.

The new Wal-Mart clinic charges a flat fee of $55 for a menu of services listed in plain view. Saint Al's clinics charge a flat fee of $45 now, which will increase to $55 in December.

The clinic may be a winner for patients, Wal-Mart and Primary Health. Patients get convenient, affordable access to a basic menu of care.

Wal-Mart, the nation's biggest retailer and one of Idaho's largest employers, gets people into the store who might shop while they wait for care. Primary Health benefits because it reaches more patients. And both companies will likely get a "halo effect" for doing good in the community.

For community clinics that already treat lots of uninsured patients and patients on Medicaid or Medicare, the doc-in-a-box retail outlet is a mixed blessing.

It's great to make it easier to get treatment for the flu, but Terry Reilly Health Services, which provides care based on patients' income, likely will lose patients it needs.

The clinic gets extra funding for treating low-income patients, and Medicaid patients are patients with insurance. Two-thirds of the patients Terry Reilly sees have no insurance.

Terry Reilly has considered trying to open clinics in retail settings, but the grants it receives to help stay on its feet make the effort complicated.

"I am on the fence about whether we should continue in that direction," said Dr. Erwin Teuber, executive director of Terry Reilly, based in Nampa.

Colleen LaMay: 377-6448