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I ask a question of medical students in a class that I teach:

“List the biggest public health achievements of the past 10 years.”

The WalMart $4 formulary  makes it every time. WalMart claims to have saved patients over $3 billion by providing high quality, low cost generic medications to the American public. In fact, Walmart estimated that 30% of its $4 generic patients in 2007 were uninsured. I use this resource a lot for my patients and they are grateful for it.

However, based on an NPR report today, I thought I might find myself in competition with WalMart myself:

In the same week in late October that Wal-Mart said it would stop offering health insurance benefits to new part-time employees, the retailer sent out a request for partners to help it “dramatically … lower the cost of healthcare … by becoming the largest provider of primary healthcare services in the nation.”

On Tuesday, Wal-Mart spokeswoman Tara Raddohl confirmed the proposal. She declined to elaborate on specifics, calling it simply an effort to determine “strategic next steps.”

The 14-page request, which you can read here, asks firms to spell out their expertise in a wide variety of areas, including managing and monitoring patients with chronic, costly health conditions. Partners are to be selected in January.

Analysts said Wal-Mart is likely positioning itself to boost store traffic, possibly by expanding the number of its in-store medical clinics and the services they offer.

The speculation is that WalMart might even be taking it a step further:

In-store medical clinics, such as those offered by Walmart and other retailers, could also be players in another effort in the health law: encouraging collaborations of doctors and hospitals who want to win financial rewards for streamlining care and lowering costs. Such collaborations, known as “accountable care organizations,” might contract with in-store medical clinics, says Paul Howard, a senior fellow with the Manhattan Institute for Policy Research. He has studied retail clinics, some of which have recently expanded to offer services beyond simple tests and vaccinations, such as helping monitor patients with diabetes or high blood pressure.

NPR later published a semi-retraction:

Updated at 2:52 p.m. ET: Wal-Mart issued a statement Wednesday saying its request for partners to provide primary care services was “overwritten and incorrect.” The firm is “not building a national, integrated low-cost primary health care platform,” according to the statement by Dr. John Agwunobi, a senior vice president for health and wellness at the retailer).

It was fun to speculate on the effect of a true primary care presence in WalMart. According to one source “Their traffic has been declining for over two years and they’ve been losing market share.  If you get someone in the door, you can also sell them milk and a shotgun.”  I don’t know that aren’t going to  be unexpected consequences. It may not be the same in other primary care offices, but our waiting room commonly has people in it who are SICK! They are bleeding, febrile, and I suspect not very fun to be around. Do you really want to stand next to the person with influenza in Line 3? I will also add that no patient has ever ask me if I sell shotguns.