Groupon, an online coupon service that aims to offer “a vast mobile and online marketplace where people discover and save on amazing things to do, see, eat and buy,”1 has worked with over one million merchants since its founding in 2008.2,3 These days, many of those merchants are members of the health care field, who—through Groupon—can supply discounted medical services to their patients.4 These services include lung, heart and full-body scans, as well as ultrasounds for expectant parents marketed as “fetal memories.”5 The recent publicity around Groupon’s offerings of upfront costs and coupons for medical imaging has sparked conversation between doctors, CEOs and health care administrators alike.5-7 Ultimately, participants in the debate are investigating what pricing tools may mean for our health care system, both now and in the future.
Aside from just Groupon, the Internet as a whole has had a rapidly evolving influence on health care in the United States. For example, Ranard et al. found that Yelp, a real-time online rating platform for evaluating restaurants, stores and more, may complement the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which is the United States standard for evaluating patients’ experiences after hospitalization.8 Not only did patients’ Yelp reviews cover the majority of HCAHPS domains, but they also covered an additional twelve domains not found in HCAHPS. Another study by Prabhu et al. emphasized the role that Healthgrades, a physician ratings website, plays in patients’ recommendations of radiation oncologists to others and physicians’ reputations.9 Yet another article showed that health social networks like PatientsLikeMe allow patients with similar conditions to emotionally support one another, share information and ask questions of doctors with profile pages on their own expertise, background and affiliations.10 Clearly, patients’ online access to rating and review sites allows them to find the best medical care around, almost as if they were shopping for a product.
The idea that U.S. patients have the freedom to choose their medical care allows companies like Groupon to thrive. After all, out-of-pocket costs are important factors in consumers, whether they are looking for clothes or for medical care.11 Use of Groupon and other pricing tools is ultimately “symptomatic of a health care market where patients desperately want a deal,” and some business professionals have argued that Groupon allows medical companies to meet patients where they are financially.5 Additionally, many health administrators and CEOs claim that the United States health care system is a market in itself, in which medical businesses need to sell themselves and prices can be driven down by competition.5 Groupon also allows patients who do not have insurance to price-check and get discounts on services that would otherwise cost hundreds of dollars. Given these facts, the U.S. health care system is, in part, a capitalist market, and companies like Groupon allow consumers (i.e., patients) to choose their care.
That said, Groupon is not seen as a panacea by all doctors, patients and businesspeople. Groupon not only dictates prices of medical services based on competition in the area, but it also takes a substantial cut of the profits made by imaging centers.5 Additionally, charity care from hospitals may be less expensive than a Groupon-subsidized medical service. Finally, hospitals may not trust images captured by centers that use Groupon, and thus may simply repeat the scans—ultimately costing the health care system even more.5 Thus, Groupon may be taking advantage of health care as a market, but it may not align with the needs of doctors, patients or hospitals.
In sum, using Groupon for health care represents the influence the Internet has had on the health care system. Additionally, it engages with health care as a market, allowing patients to choose health care solutions based on cost. Future research is needed to see if Groupon is successful in advancing quality of care and reducing costs for doctors, patients and health centers.