Assessment of Sales and Marketing of Online Vouchers for Discounted Direct-to-Consumer Medical Imaging Services

“The expansion of the direct-to-consumer (DTC) medical imaging market elicits several safety and ethical concerns. Discounted DTC imaging may lead to unnecessary testing and subsequent incidental findings, false-positive results, radiation exposure, and downstream interventions. Groupon, Inc, a global e-commerce marketplace, has garnered media attention for its vouchers for discounted DTC medical imaging services. In this study, we evaluated the scope, pricing, customer feedback, and claims of medical imaging services offered through Groupon vouchers.

We performed a cross-sectional analysis of Groupon offerings in the US on February 6, 2020. On the Groupon home page, in the Imaging and Scans section [..], we identified nonduplicate and active vouchers offered in each of the 50 states and in each state’s largest city. Then we used Google to search the internet for the keywords, Groupon medical scans and each of the 50 state names.

For each imaging-service voucher identified, we collected core metrics: type of imaging, price of service, retail location, company rating, and number of vouchers purchased per customer. For group discount offers, we calculated the unit price per individual. Each offer was assessed to determine whether the company had outlined potential risks, required a preimaging consultation, offered physician or technician interpretation of results, made unsubstantiated medical claims, or included disease prevention and risk estimation assertions. For each company offering a Groupon voucher, the first 100 customer reviews were assessed for comments about preimaging consultations, motivation(s) for purchasing imaging services, upselling, and/or additional testing. [..]

We found 84 companies offering Groupon vouchers for 130 different types of medical imaging and scanning services in 27 states. [..] At least 28,380 vouchers for imaging had sold by February 6, 1990, with computed tomography accounting for 11,720 (41.3%) purchases. The average price per imaging service ranged from $60 for a body or biofeedback scan to $687 for magnetic resonance imaging. The average customer rating was 4.8 out of 5.

Unsubstantiated claims were made by 38 (45.2%) of the 84 companies offering vouchers. Only 1 offer mentioned the potential risks of imaging. While 57 (67.9%) companies stated that a consultation would be required to assess the purchaser’s eligibility for imaging services, none mentioned this requirement in their other advertisements.

An analysis of 2044 customer reviews found 90 comments (4.4%) suggesting that upselling of added imaging had occurred at the visit. Of reviews that included a motivation for purchasing imaging services, 100% (25 of 25) of patients noted that they were self-referred.

[..] Although free-market solutions can increase patient flexibility and curtail health care costs, consumer independence must be balanced with the potential for harm. None of the customers in this study indicated that they had been referred for imaging by a physician. The combination of patient self-referral, uncorroborated marketing claims, and upselling leads to a challenging consumerization of medicine that can put patient safety and benefit at odds with financial goals.”

Full article, Desai S, Manjaly P, Lee K et al. JAMA Internal Medicine 2020.11.2