Healthcare commercialisation not the enemy

A recent article published by Business Daily, titled Healthcare Commercialisation Erodes Professional Integrity (April 22), argues that the growing commercialisation of healthcare is undermining professional ethics and transforming medicine from a moral calling into a profit-driven industry.

These concerns are understandable. Across the world, healthcare systems are grappling with rising costs, unequal access, aggressive billing practices and growing public distrust. In Kenya, where many households still struggle to afford treatment and a single hospital admission can be financially devastating, these anxieties are especially real.

However, while the article correctly identifies genuine risks within modern healthcare systems, it draws a flawed conclusion by suggesting that commercialisation itself is the primary problem.

Healthcare commercialisation is not the enemy. The real challenges lie in weak regulation, poor governance, underfunded public systems, policy inconsistency, corruption and the failure to build sustainable healthcare ecosystems that balance ethics with economic reality.

Framing healthcare as a moral battle between ethics and profit risks oversimplifying a complex system.

There is often a romanticised view of an earlier era when medicine was perceived as purely service-driven. Yet modern healthcare is among the most technologically advanced and capital-intensive sectors of the global economy.

A contemporary hospital is not just a building with doctors and nurses. It is a complex ecosystem requiring imaging equipment, laboratories, digital health systems, cybersecurity infrastructure, intensive care units, emergency response systems, pharmaceuticals, oxygen plants and highly specialised personnel. All of this demands continuous and substantial investment.

For instance, an MRI machine can cost hundreds of millions of shillings when installation, maintenance, staffing and upgrades are included. Intensive care units require ventilators, monitoring systems and highly trained staff.

Hospitals also face rising energy costs, import taxes on medical equipment, insurance delays, currency fluctuations and strict regulatory requirements.

These realities cannot be sustained through goodwill alone. Hospitals must pay staff, maintain infrastructure and continuously invest in improved care. Without financial sustainability, healthcare systems collapse. Without reinvestment, there is no innovation or improvement in patient outcomes.

In Kenya, private investment has played a major role in expanding access to healthcare. Over the past two decades, much of the growth in diagnostics, dialysis, oncology, fertility services, specialist care and digital health infrastructure has come from the private sector. In many regions, private hospitals have filled critical gaps left by overstretched public facilities.

For many Kenyans today, private healthcare is not a luxury but often the only route to timely diagnostics, specialist consultations and emergency care. It is therefore misleading to portray all commercial healthcare as exploitative.

This does not mean the private sector is beyond scrutiny. Concerns around overbilling, unnecessary procedures and unethical practices are valid and must be addressed through stronger regulation, transparent pricing, clinical governance and ethical leadership. However, it is both simplistic and misleading to assume that all financial activity in healthcare is inherently immoral.

Financial sustainability and patient welfare are not opposing forces. They are interdependent. One weakness in the anti-commercialisation argument is that it ignores the economic fragility of healthcare systems globally. Hospitals operate under severe pressure from underfunding, delayed insurance reimbursements and rising healthcare inflation.

In Kenya, these pressures are even more pronounced due to high taxation on imported medical equipment, costly energy, delayed payments from insurers and public schemes, rapid population growth and heavy reliance on out-of-pocket payments by households. Even commonly cited examples such as rising Caesarean section rates are more complex than often presented.

While unnecessary procedures must be discouraged, global increases in C-sections are also driven by higher-risk pregnancies, maternal age, litigation fears, patient preferences and improved medical monitoring. Reducing this to profit motives alone is misleading.

The real policy question is not whether healthcare should involve finance, but how systems can align incentives with patient outcomes, ethical standards and transparency. This is where regulation becomes critical.

Successful healthcare systems do not eliminate commercial activity; they regulate it effectively through strong oversight, transparent pricing, universal coverage frameworks and quality monitoring.

The debate should not be framed as public versus private or profit versus morality, but as system design.

Healthcare cannot function as purely charitable in a complex, modern medical environment. But neither should it become an unregulated marketplace devoid of ethics. The solution lies in balance. 

Kenya’s Social Health Authority (SHA) reforms should also be viewed in this context. Predictable healthcare financing is not unethical; it is necessary for stability. Hospitals cannot plan, retain staff or expand infrastructure without reliable reimbursement systems.

If well implemented, SHA could improve access, reduce catastrophic household spending, enhance continuity of care and strengthen healthcare data systems. The challenge lies in ensuring strong accountability and safeguards against abuse.

Kenya does not need hostility towards healthcare commercialisation. It needs smarter governance, stronger institutions and better regulatory frameworks. At the same time, it should continue encouraging responsible private investment in infrastructure, training, research and innovation.

Medicine must remain grounded in dignity, compassion and integrity, while also being financially sustainable. Commercialisation itself does not erode ethics; weak governance, corruption and misaligned incentives do.

That is the real challenge facing Kenya and global healthcare today.

Albert Mandela Ogendi is the CEO & Executive Director Luton Medical Hospital