The Administration of Group Health Insurance Schemes in Nigerian Tertiary Hospitals

This study examines the administration of group health insurance schemes in selected Nigerian tertiary hospitals, with evidence drawn from teaching hospitals in Enugu, Ibadan, and Kano. Group health insurance represents a critical component of employee benefits in the healthcare sector, yet its administration in Nigerian public hospitals is frequently characterized by delayed reimbursements, inadequate coverage ceilings, and beneficiary dissatisfaction. This research employs a case study design with primary data collected from 90 hospital administrators, human resource officers, and health maintenance organization (HMO) representatives at three teaching hospitals. Structured questionnaires and focus group discussions assess enrollment procedures, benefit utilization rates, claims submission and reimbursement timelines, and satisfaction with HMO service delivery. Secondary data from hospital records and NHIS coordination offices supplement the primary analysis. Thematic analysis and descriptive statistics characterize administrative patterns and identify systemic bottlenecks. Preliminary findings are expected to identify that capitation payment delays from NHIS to HMOs create cascading service delivery failures and that coverage ceilings are inadequate for managing complex inpatient care costs. The study recommends administrative reforms including electronic claims processing systems and revised capitation payment schedules to improve scheme functionality in Nigeria's public tertiary hospitals. Keywords: Group Health Insurance, Hospital Administration, HMO, NHIS, Tertiary Hospital.