Trends in Growth Hormone Utilization in Korea: A Nationwide Study from 2019–2023

Trends in Growth Hormone Utilization in Korea: A Nationwide Study from 2019–2023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Trends in Growth Hormone Utilization in Korea: A Nationwide Study from 2019–2023 Jeong-Yeon Kim, Yeryeon Jung, Dohee Ahn, Ji Eun Yun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8739566/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Apr, 2026 Read the published version in BMC Health Services Research → Version 1 posted 13 You are reading this latest preprint version Abstract Background Growth hormone (GH) therapy is indicated for growth hormone deficiency (GHD) and selected growth-related conditions. In South Korea, both the supply and prescription of GH have increased steadily, drawing increased attention to national utilization patterns, particularly among children and adolescents. This study aimed to examine nationwide trends in GH injection supply and prescriptions in South Korea from 2019 to 2023 using Health Insurance Review and Assessment Service (HIRA) data. Methods A nationwide cross-sectional analysis was conducted using supply data for 36 GH injection products and HIRA prescription claims. Temporal trends in GH supply and prescriptions were analyzed over a 5-year period and stratified by year, region, healthcare institution type, and medical specialty. Results Both GH injection supply and prescriptions increased consistently between 2019 and 2023. Total GH supply expenditure reached approximately KRW 480 billion in 2023, representing a 2.5-fold increase compared with 2019. More than half of the national GH supply was concentrated in the Seoul metropolitan area, particularly in Gangnam, Seocho, and Songpa districts. Although tertiary hospitals remained the largest contributors to GH supply, their relative share declined over time, while GH prescriptions in primary care clinics increased substantially. Conclusions GH utilization in South Korea increased across all healthcare institution types, with a notable shift toward primary care settings. These findings highlight the importance of ongoing monitoring of GH utilization patterns and system-level discussions to support appropriate use of GH therapy. Growth Hormone Pediatrics Drug Utilization Prescriptions Health Insurance Claims Figures Figure 1 Figure 2 INTRODUCTION Growth hormone (GH) is a protein hormone secreted by the pituitary gland that plays a vital role in physical growth and development [ 1 ]. Growth hormone deficiency (GHD) presents with distinct clinical symptoms in children and adults and can lead to serious health complications, including growth failure and metabolic disturbances, if untreated [ 2 , 3 ]. Recombinant human growth hormone (rhGH) is the primary treatment for GH-related disorders [ 4 , 5 ]. GH therapy is also indicated for several other conditions, including Turner syndrome, chronic renal failure, and children born small-for-gestational-age [ 6 – 8 ]. Its application has recently expanded to include idiopathic short stature (ISS) [ 9 ]. However, clinical evidence supporting GH treatment in children and adolescents without confirmed GH deficiency remains limited [ 7 ]. A 2024 systematic review suggested that GH therapy may provide short-term growth benefits for patients with ISS [ 9 ]. Nevertheless, concerns persist regarding potential long-term risks associated with GH exposure, particularly in non-GHD populations. The safety profile of GH treatment is another critical consideration, with most adverse reactions being mild, including headache, nasopharyngitis, fever, gastroenteritis, respiratory infection, cough, and vomiting. However, some studies report more serious complications such as slipped capital femoral epiphysis (SCFE), glucose intolerance, scoliosis, and headaches [ 10 – 13 ]. In recent years, the global prescription and use of GH therapy have steadily increased. In particular, demand has grown for rhGH treatment among parents and children aiming to increase height even within the normal range (e.g., height standard deviation score [SDS] ≥ − 2.0, corresponding to the 2.3rd percentile) [ 14 ]. IQVIA's MIDAS global pharmaceutical sales data show that South Korea’s GH market grew considerably from KRW 28.7 billion in the first quarter of 2018 to KRW 57.6 billion in the first quarter of 2022. This corresponds to an 88.5% increase in annual market size, rising from KRW 126.5 billion in 2018 to KRW 238.5 billion in 2022 [ 15 ]. As GH use continues to expand, analyzing supply and prescribing trends is essential for understanding its real-world implications. This study investigated national GH therapy supply and prescribing trends in South Korea by analyzing Health Insurance Review and Assessment Service (HIRA) pharmaceutical supply and prescription data from 2019 to 2023. METHODS Study Design and Data Sources This cross-sectional study investigated national trends in the supply and prescription of GH injections in South Korea. Data were obtained from HIRA, a national claims database that comprehensively captures healthcare utilization data for approximately 97% of the South Korean population under the National Health Insurance program [ 16 ]. The study analyzed data from January 1, 2019, to December 31, 2023. Supply data for 36 GH injection products were extracted from pharmaceutical supply reports submitted by pharmaceutical manufacturers to HIRA in accordance with Article 45 of the Enforcement Rules of the Pharmaceutical Affairs Act. Supply volumes and costs were calculated based on shipment records, with all quantities standardized to the smallest dispensing unit (e.g., one vial) for comparability across products. HIRA’s National Health Insurance claims database was used to assess prescription patterns. The dataset included patient-level prescription records categorized by year, region, medical institution, and medical department. Claims from pharmacies were excluded to avoid potential duplication with outpatient prescription records. Statistical Analyses Descriptive statistics were used to analyze annual trends in GH injection use, including supply volume, supply cost, number of medical institutions supplying and prescribing GH, number of patients receiving GH prescriptions, and total prescription costs. Medical institutions were further classified by type (e.g., clinics, secondary hospitals, tertiary hospitals), clinical department, and region. The number of GH prescriptions and prescribing institutions was analyzed to assess clinical uptake and distribution extent. All cost-related data were converted to United States Dollars (USD) at a fixed rate of 1 USD = 1,430 KRW. Data were analyzed using SAS software (version 9.4; SAS Institute Inc., Cary, NC, USA), and data visualization was performed using R (version 4.4.2; R Foundation for Statistical Computing, Vienna, Austria). RESULTS Annual Supply and Cost of GH Injections GH injection supply in South Korea steadily increased over the 5-year study period. The number of GH injection units supplied rose from 2,457,275 units in 2019 to 4,939,945 units in 2023, representing a significant upward trend. The cumulative supply over this 5-year period was 17,565,356 units (Table 1 ). Correspondingly, total supply costs also increased annually, from 195.7 billion KRW (USD 136.9 million) in 2019 to 484.0 billion KRW (USD 338.5 million) in 2023. Total GH injection expenditure during the study period was 1.6 trillion KRW (USD 1.14 billion) (Fig. 1 A).Medical institutions supplying GH injections increased from 3,112 in 2019 to 4,172 in 2023, totaling 18,595 institutions over the 5-year period (Table 1 ).In 2023, pediatrics (53.8%) and internal medicine (37.6%) had the highest GH injection supply by medical specialty (Supplementary Fig. 1). Table 1 Annual supply status of growth hormone injections. Year Supply volume Supply cost (thousand KRW, USD a ) Number of medical institutions 2019 2,457,275 195,735,487 ( $ 136,878,663 USD) 3,112 2020 2,685,944 232,670,009 ( $ 162,036,365 USD) 3,537 2021 3,400,379 313,524,961 ( $ 219,601,379 USD) 3,806 2022 4,081,813 398,976,909 ( $ 278,311,129 USD) 3,968 2023 4,939,945 484,029,557 ( $ 338,476,187 USD) 4,172 Total 17,565,356 1,624,936,923 ($1,136,324,406 USD) 18,595 a 1 USD = 1,430 KRW Supply Distribution by Medical Institution Type and Medical Department GH injection supply varied across different types of medical institutions. In tertiary hospitals, the number of units supplied increased from 1,025,422 in 2019 to 1,273,706 in 2023. Despite this volume increase, the proportion of total supply from tertiary hospitals decreased over time, indicating a shift in supply toward other institution types. Secondary hospitals also showed growth, with supply increasing from 448,698 units in 2019 to 1,029,100 units in 2023. The most notable growth was observed in clinics, where GH injection supply significantly increased from 177,198 units in 2019 to 1,190,426 units in 2023 (Table 2 ). Although general hospitals recorded the highest total GH injection supply cost over the 5-year period, clinics demonstrated the largest annual supply cost increase, from 2.3% of national GH supply cost in 2019 to 7.8% in 2023 (Supplementary Table 1). Table 2 Characteristics of growth hormone injection supply. Supply volume (unit, %) 2019 2020 2021 2022 2023 Medical institutions Tertiary hospital 1,025,422 (41.73) 1,044,858 (38.90) 1,137,304 (33.45) 1,223,883 (29.98) 1,273,706 (25.78) Secondary hospital 448,698 (18.26) 518,859 (19.32) 710,679 (20.90) 850,916 (20.85) 1,029,100 (20.83) Hospital 91,471 (3.72) 106,111 (3.95) 176,478 (5.19) 244,389 (5.99) 327,057 (6.62) Clinic 177,198 (7.21) 230,696 (8.59) 407,732 (11.99) 680,363 (16.67) 1,190,426 (24.10) Oriental 16,604 (0.68) 17,317 (0.64) 15,496 (0.46) 17,221 (0.42) 18,530 (0.38) Dental 4,149 (0.17) 5,781 (0.22) 5,906 (0.17) 5,958 (0.15) 5,243 (0.11) Others a 693,733 (28.23) 762,322 (28.38) 946,784 (27.84) 1,059,083 (25.95) 1,095,883 (22.18) Medical department b Pediatrics and Adolescent Medicine 19,548 (11.03) 40,371 (17.50) 93,919 (23.03) 230,212 (33.84) 640,442 (53.80) Internal Medicine 17,898 (10.10) 19,693 (8.54) 22,807 (5.59) 24,965 (3.67) 25,096 (2.11) Orthopedics 11,267 (6.36) 9,971 (4.32) 12,869 (3.16) 13,068 (1.92) 17,399 (1.46) Family Medicine 3,694 (2.08) 3,491 (1.51) 5,561 (1.36) 6,481 (0.95) 6,574 (0.55) Internal Medicine 86,181 (48.64) 111,080 (48.15) 216,820 (53.18) 352,479 (51.81) 447,448 (37.59) Others c 38,610 (21.79) 46,090 (19.98) 55,756 (13.67) 53,158 (7.81) 53,467 (4.49) Region Gangwon 34,368 (1.40) 29,206 (1.09) 32,235 (0.95) 42,861 (1.05) 56,708 (1.15) Gyeonggi 357,321 (14.54) 449,486 (16.73) 645,307 (18.98) 790,854 (19.38) 936,274 (18.95) Gyeongnam 98,072 (3.99) 135,683 (5.05) 174,200 (5.12) 173,448 (4.25) 190,413 (3.85) Gyeongbuk 41,951 (1.71) 49,255 (1.83) 62,708 (1.84) 70,083 (1.72) 82,385 (1.67) Gwangju 47,400 (1.93) 62,979 (2.34) 88,458 (2.60) 112,773 (2.76) 140,672 (2.85) Daegu 342,859 (13.95) 354,574 (13.20) 394,511 (11.60) 451,615 (11.06) 477,407 (9.66) Daejeon 143,649 (5.85) 155,596 (5.79) 193,725 (5.70) 221,460 (5.43) 253,298 (5.13) Busan 116,010 (4.72) 135,976 (5.06) 178,145 (5.24) 250,745 (6.14) 311,929 (6.31) Seoul 1,031,715 (41.99) 1,014,682 (37.78) 1,245,537 (36.63) 1,505,547 (36.88) 1,908,178 (38.63) Sejong 1,482 (0.06) 6,573 (0.24) 17,336 (0.51) 28,544 (0.70) 36,015 (0.73) Ulsan 15,426 (0.63) 20,109 (0.75) 25,572 (0.75) 35,729 (0.88) 50,780 (1.03) Incheon 106,570 (4.34) 126,580 (4.71) 131,487 (3.87) 127,885 (3.13) 163,956 (3.32) Jeonnam 5,475 (0.22) 7,469 (0.28) 12,307 (0.36) 16,686 (0.41) 17,655 (0.36) Jeonbuk 46,572 (1.90) 54,518 (2.03) 78,673 (2.31) 89,313 (2.19) 104,529 (2.12) Jeju 7,164 (0.29) 9,951 (0.37) 18,047 (0.53) 29,191 (0.72) 44,462 (0.90) Chungnam 34,104 (1.39) 44,289 (1.65) 54,835 (1.61) 68,582 (1.68) 78,723 (1.59) Chungbuk 27,137 (1.10) 29,018 (1.08) 47,296 (1.39) 66,497 (1.63) 86,561 (1.75) a Public Health/Medical Center, Public Health Subcenter, Pharmacy, Long-term Care Hospital, Psychiatric Hospital b Limited to clinic-level institutions c Anesthesiology and pain medicine, urology, obstetrics and gynecology, plastic surgery, neurology, neurosurgery, cardiovascular and thoracic surgery, ophthalmology, surgery, otolaryngology, rehabilitation medicine, psychiatry, occupational and environmental medicine, laboratory medicine, diagnostic radiology/radiology, dermatology In 2023, pediatrics and adolescent medicine accounted for the largest GH injection volume, increasing from 19,548 units in 2019 to 640,442 units in 2023. In contrast, internal medicine increased its volume from 86,181 units in 2019 to 447,448 units in 2023, though its proportion of total supply volume declined (Table 2 ). Regional Distribution of GH Injection Supply GH injection supply varied by region. Seoul maintained the highest supply volume throughout the study period, from 1,031,715 units in 2019 to 1,908,178 units in 2023. Other major regions included Gyeonggi-do, in which the supply volume increased from 357,321 units in 2019 to 936,274 units in 2023, and Busan, from 116,010 units to 311,929 units (Table 2 ). In 2023, within Seoul, Gangnam-gu had the highest number of medical institutions supplying GH injections (278 institutions), followed by Seocho-gu (126), Songpa-gu (88), and Gangseo-gu (54) (Fig. 2 ). Jeollabuk-do showed the largest increase in the share of GH prescription volume, from 1.7% of the national total in 2019 to 3.7% in 2023 (Supplementary Table 2). Annual Prescription Trends of GH Injections Patients receiving GH injections increased from 13,789 in 2019 to 37,017 in 2023, and prescriptions increased from 95,262 in 2019 to 267,330 in 2023. The total number of prescriptions issued over the 5 years was 867,584 (Table 3 ). Prescription costs increased from 53.6 billion KRW (USD 37.5 million) in 2019 to 144.0 billion KRW (USD 100.7 million) in 2023 (Fig. 1 B). The total prescription cost over the study period was 468.9 billion KRW (USD 327.9 million). Medical institutions issuing GH prescriptions increased from 250 in 2019 to 398 in 2023. Table 3 Annual prescription status of growth hormone injections. Year Number of patients Number of prescriptions Prescription cost (thousand KRW, USD a) Number of medical institutions 2019 13,789 95,262 53,571,855 ( $ 37,462,836 USD) 250 2020 16,457 121,375 64,017,461 ( $ 44,767,455 USD) 277 2021 22,309 161,124 85,884,789 ( $ 60,059,293 USD) 330 2022 31,712 222,493 121,454,200 ( $ 84,933,007 USD) 346 2023 37,017 267,330 143,974,195 ( $ 100,681,255 USD) 398 Total 121,284 867,584 468,902,500 ($ 327,903,847 USD) 1,601 a 1 USD = 1,430 KRW In 2023, elementary school students represented approximately half of all patients receiving GH prescriptions, with upper-grade elementary students being the largest subgroup (36.6%). Among patients under the age of 20, 42.9% of prescriptions were for upper-grade elementary students (Supplementary Table 3). DISCUSSION In this study, the 5-year trends in GH injection supply and prescriptions in Korea were analyzed, categorizing data by year, region, healthcare institution type, and medical specialty. The findings indicated a consistent increase in GH supply and prescription rates, and a 2.5-fold increase in GH prescriptions from 2019 to 2023. Regionally, Seoul and Gyeonggi accounted for more than half of the total GH supply, with the highest concentrations in Seoul’s Gangnam, Seocho, and Songpa districts. Tertiary hospitals accounted for the largest GH supply share; however, their contribution decreased as clinics’ prescription share grew. This shift suggests a redistribution of GH prescribing patterns from tertiary hospitals to primary care institutions, particularly clinics, where non-reimbursed prescriptions appear more common. Previous studies reported a steady increase in GH prescriptions, particularly in tertiary hospitals, which were traditionally the primary institutions for GH treatment [ 17 , 18 ]. However, our findings indicate a growing role of clinics in GH prescribing, diverging from earlier patterns. The increasing involvement of clinics may be attributed to multiple factors, including the expansion of pediatric endocrinology services, more general practitioners prescribing GH, and insurance coverage changes improving GH accessibility in primary care settings. Additionally, unlike previous research focused on approved medical uses, our findings suggest that GH prescriptions are increasingly partially driven by non-medical, height-enhancing purposes, particularly in primary care institutions. This shift aligns with Korean societal trends favoring taller stature [ 19 , 20 ]. Several factors may explain the increasing trend in GH prescriptions in Korea. First, societal preference for taller stature, particularly among pediatric and adolescent populations, may have increased demand for GH treatment. Second, expanding GH-prescribing healthcare providers, particularly in primary care, has likely facilitated greater GH treatment accessibility. The increase in pediatric endocrinologists and GH-prescribing general practitioners has contributed to these observed trends. Third, increased enrollment of children and adolescents in private health insurance programs covering GH treatment likely contributed to the GH prescriptions surge. Furthermore, recent growth chart revisions expanded the pool of patients eligible for GH treatment under insurance coverage, further influencing GH prescription trends. Despite its strengths, this study had some limitations. First, many GH prescriptions in Korea are paid out-of-pocket, as GH treatment frequently falls outside insurance-covered indications. This study primarily analyzed data from insurance claims and medical supply data, which may not precisely reflect the extent of GH use. Second, GH supply data may not match actual prescription trends, as GH distribution does not guarantee patient use. Third, the absence of data on non-reimbursed GH prescriptions limits understanding of total GH use, particularly in clinics where off-label use is more prevalent. In conclusion, this study provides a comprehensive overview of nationwide GH prescription trends in South Korea, demonstrating a sustained increase in GH use across all healthcare institution types. A notable shift toward primary care settings suggests evolving GH prescription patterns. The expanding landscape of GH use appears to be influenced by increased access to GH therapy, changes in insurance coverage, and strong societal preferences for height enhancement. Although GH use continues to grow, further research is warranted to assess the long-term clinical and economic implications of these trends. Ensuring the appropriateness of GH prescriptions across healthcare settings remains essential for promoting safe and evidence-based use. Declarations Acknowledgements None. Author contributions Yun JE and Kim J conceived and designed the study and developed the methodology. Kim J performed the formal analysis, and together with Yun JE validated the results and interpreted the findings, while Yun JE supervised the study. Jung Y, and Ahn D were also involved in data collection and revision of the paper. All of the authors contributed in writing the draft of manuscript and agreed to its submission. FUNDING: This work was supported by the National Evidence-Based Healthcare Collaborating Agency of South Korea (Grant No. NECA-A-24-011). Data availability The data that support the findings of this study are available from the Health Insurance Review and Assessment Service (HIRA) of South Korea, but restrictions apply to the availability of these data, which were used under license for the current study and are not publicly available. Data are however available from the authors upon reasonable request and with permission of HIRA. Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of the National Evidence-based Healthcare Collaborating Agency (NECA) (IRB No. NECAIRB24-007). Informed consent was confirmed (or waived) by IRB. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Zelinska N, Iotova V, Skorodok J, Malievsky O, Peterkova V, Samsonova L, et al. Long-acting C-terminal peptide–modified hGH (MOD-4023): results of a safety and dose-finding study in GHD children. J Clin Endocrinol Metabolism. 2017;102(5):1578–87. Krysiak R, Gdula-Dymek A, Bednarska-Czerwińska A, Okopień B. Growth hormone therapy in children and adults. Pharmacol Rep. 2007;59(5):500–16. Ranke MB. Short- and long-term effects of growth hormone in children and adolescents with GH deficiency. Front Endocrinol 2021;12. Richmond E, Rogol AD. Treatment of growth hormone deficiency in children, adolescents and at the transitional age. Best Pract Res Clin Endocrinol Metab. 2016;30(6):749–55. Collett-Solberg PF, Jorge AAL, Boguszewski MCS, Miller BS, Choong CSY, Cohen P, et al. Growth hormone therapy in children; research and practice - A review. Growth Hormon IGF Res. 2019;44:20–32. Gravholt CH, Andersen NH, Conway GS, Dekkers OM, Geffner ME, Klein KO et al. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting. European Journal of Endocrinology. 2017;177(3):G1-G70. Grimberg A, Divall SA, Polychronakos C, Allen DB, Cohen LE, Quintos JB, et al. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-Like growth factor-I deficiency. Hormone Res Paediatrics. 2016;86(6):361–97. Clayton PE, Cianfarani S, Czernichow P, Johannsson G, Rapaport R, Rogol A. Management of the child born small for gestational age through to adulthood: a consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society. J Clin Endocrinol Metabolism. 2007;92(3):804–10. Muammar T, Alhasaeri M. A systematic review of the impact of growth hormone therapy on final adult height of children with idiopathic short stature. J Diabetes Endocr Pract. 2024;07(01):25–34. Miller BS, Blair JC, Rasmussen MH, Maniatis A, Kildemoes RJ, Mori J, et al. Weekly somapacitan is effective and well tolerated in children with GH deficiency: the randomized phase 3 REAL4 trial. J Clin Endocrinol Metabolism. 2022;107(12):3378–88. Deal CL, Steelman J, Vlachopapadopoulou E, Stawerska R, Silverman LA, Phillip M, et al. Efficacy and safety of weekly somatrogon vs daily somatropin in children with growth hormone deficiency: a phase 3 study. J Clin Endocrinol Metabolism. 2022;107(7):e2717–28. Thornton PS, Maniatis AK, Aghajanova E, Chertok E, Vlachopapadopoulou E, Lin Z, et al. Weekly lonapegsomatropin in treatment–naïve children with growth hormone deficiency: the phase 3 heiGHt trial. J Clin Endocrinol Metabolism. 2021;106(11):3184–95. Clayton PE, Cowell CT. Safety issues in children and adolescents during growth hormone therapy—a review. Growth Hormon IGF Res. 2000;10(6):306–17. Mendonca BB, Arnhold IJP. GH treatment in children of normal height. J Clin Endocrinol Metabolism. 2024;109(10):e1955–8. IQVIA. MIDAS Global Sales Database, South Korea Market Analysis. 2022. Kyoung D-S, Kim H-S. Understanding and utilizing claim data from the Korean National Health Insurance Service (NHIS) and Health Insurance Review & Assessment (HIRA) database for research. J Lipid Atherosclerosis. 2022;11(2):103. Rhie Y-J, Yoo J-H, Choi J-H, Chae H-W, Kim JH, Chung S, et al. Long-term safety and effectiveness of growth hormone therapy in Korean children with growth disorders: 5-year results of LG Growth Study. PLoS ONE. 2019;14(5):e0216927. Chae HW, Hwang I-T, Lee J-E, So CH, Rhie Y-J, Lim JS et al. Height outcomes in Korean children with idiopathic short stature receiving growth hormone treatment. Front Endocrinol 2022;13. Jang S, Park S, Lee B. Key elements of Korean medicine treatment for idiopathic short-stature: a qualitative SWOT analysis based on Korean medicine doctors’ views. Medicine. 2024;103(30):e39116. Jung YJS, Choi JS. Subjectivity to height growth of mothers with elementary school children. J KSSSS. 2017;38:103–19. Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterials0202.docx Cite Share Download PDF Status: Published Journal Publication published 21 Apr, 2026 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 20 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviews received at journal 13 Mar, 2026 Reviewers agreed at journal 12 Mar, 2026 Reviewers agreed at journal 20 Feb, 2026 Reviewers invited by journal 18 Feb, 2026 Editor invited by journal 04 Feb, 2026 Editor assigned by journal 03 Feb, 2026 Submission checks completed at journal 03 Feb, 2026 First submitted to journal 30 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8739566","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":595006088,"identity":"264419fa-232b-440f-af1c-e81478d5f613","order_by":0,"name":"Jeong-Yeon Kim","email":"","orcid":"","institution":"National Evidence-based Healthcare Collaborating Agency","correspondingAuthor":false,"prefix":"","firstName":"Jeong-Yeon","middleName":"","lastName":"Kim","suffix":""},{"id":595006089,"identity":"38aab15c-67e4-44cc-b3db-a86fde6d7340","order_by":1,"name":"Yeryeon Jung","email":"","orcid":"","institution":"National Evidence-based Healthcare Collaborating Agency","correspondingAuthor":false,"prefix":"","firstName":"Yeryeon","middleName":"","lastName":"Jung","suffix":""},{"id":595006090,"identity":"e6c46b74-ec86-4dc2-bd11-0c0aafcb4dae","order_by":2,"name":"Dohee Ahn","email":"","orcid":"","institution":"National Evidence-based Healthcare Collaborating Agency","correspondingAuthor":false,"prefix":"","firstName":"Dohee","middleName":"","lastName":"Ahn","suffix":""},{"id":595006091,"identity":"845270df-25c6-440f-9774-690f58b6b267","order_by":3,"name":"Ji Eun Yun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYBACxgYQWQHnJxCr5QwpWiD62kjRwtzeYyZdOO+OHH/7AbYPHxjS8glb0HPGTHrmtmfGEmcSmGfOYMixbCCoZUaOmTTvtsOJGxgSmJl5GCoMCNsy/w1Qy5zD9Rv4HzAz/yFKywweoJaGwwkGEkBbGBhyiNDSk1ZszXPssOGMGw+bGXsM0ghrMWw/vPE2T81hef7+5MMMPyqSidDSwAFTBIpVwhoYGOQZ2B8QoWwUjIJRMApGNAAANbY1jAAHG7oAAAAASUVORK5CYII=","orcid":"","institution":"National Evidence-based Healthcare Collaborating Agency","correspondingAuthor":true,"prefix":"","firstName":"Ji","middleName":"Eun","lastName":"Yun","suffix":""}],"badges":[],"createdAt":"2026-01-30 09:23:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8739566/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8739566/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-026-14557-4","type":"published","date":"2026-04-21T15:57:20+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":103345359,"identity":"5484cf31-3695-4dc8-b9fc-7d1c76f1084e","added_by":"auto","created_at":"2026-02-24 16:11:39","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":401149,"visible":true,"origin":"","legend":"\u003cp\u003eAnnual supply and prescription costs of growth hormone injections. (A) Annual supply costs of growth hormone injections (in USD), representing the total cost required to procure the drug from a manufacturer or supplier. (B) Annual prescription costs of growth hormone injections (in USD) reflect the actual costs incurred by patients or the medical claims system based on the growth hormone prescribed.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8739566/v1/c6f4a4377c79ea0bd0fda371.jpeg"},{"id":103345356,"identity":"0678141f-315d-49fa-94c8-b62f33913c0f","added_by":"auto","created_at":"2026-02-24 16:11:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":110748,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of medical institutions providing growth hormone injections in Seoul (2023), focusing on the top 10 autonomous districts.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8739566/v1/56b25e7a8ed9eddb15c8e646.png"},{"id":107927668,"identity":"59f60813-74fe-443b-ae77-fbc70d80bc5c","added_by":"auto","created_at":"2026-04-27 16:00:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":813051,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8739566/v1/2d900f78-fd61-45cc-bdf5-eb0a2489d8ef.pdf"},{"id":103345358,"identity":"5a83fd2a-3040-4fc0-8fb1-348a207fcd3d","added_by":"auto","created_at":"2026-02-24 16:11:39","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":92063,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterials0202.docx","url":"https://assets-eu.researchsquare.com/files/rs-8739566/v1/ad6300a6042866a49c4d585d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trends in Growth Hormone Utilization in Korea: A Nationwide Study from 2019–2023","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eGrowth hormone (GH) is a protein hormone secreted by the pituitary gland that plays a vital role in physical growth and development [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Growth hormone deficiency (GHD) presents with distinct clinical symptoms in children and adults and can lead to serious health complications, including growth failure and metabolic disturbances, if untreated [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Recombinant human growth hormone (rhGH) is the primary treatment for GH-related disorders [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGH therapy is also indicated for several other conditions, including Turner syndrome, chronic renal failure, and children born small-for-gestational-age [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Its application has recently expanded to include idiopathic short stature (ISS) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, clinical evidence supporting GH treatment in children and adolescents without confirmed GH deficiency remains limited [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A 2024 systematic review suggested that GH therapy may provide short-term growth benefits for patients with ISS [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Nevertheless, concerns persist regarding potential long-term risks associated with GH exposure, particularly in non-GHD populations.\u003c/p\u003e \u003cp\u003eThe safety profile of GH treatment is another critical consideration, with most adverse reactions being mild, including headache, nasopharyngitis, fever, gastroenteritis, respiratory infection, cough, and vomiting. However, some studies report more serious complications such as slipped capital femoral epiphysis (SCFE), glucose intolerance, scoliosis, and headaches [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, the global prescription and use of GH therapy have steadily increased. In particular, demand has grown for rhGH treatment among parents and children aiming to increase height even within the normal range (e.g., height standard deviation score [SDS]\u0026thinsp;\u0026ge;\u0026thinsp;\u0026minus;\u0026thinsp;2.0, corresponding to the 2.3rd percentile) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. IQVIA's MIDAS global pharmaceutical sales data show that South Korea\u0026rsquo;s GH market grew considerably from KRW 28.7\u0026nbsp;billion in the first quarter of 2018 to KRW 57.6\u0026nbsp;billion in the first quarter of 2022. This corresponds to an 88.5% increase in annual market size, rising from KRW 126.5\u0026nbsp;billion in 2018 to KRW 238.5\u0026nbsp;billion in 2022 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs GH use continues to expand, analyzing supply and prescribing trends is essential for understanding its real-world implications. This study investigated national GH therapy supply and prescribing trends in South Korea by analyzing Health Insurance Review and Assessment Service (HIRA) pharmaceutical supply and prescription data from 2019 to 2023.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Data Sources\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis cross-sectional study investigated national trends in the supply and prescription of GH injections in South Korea. Data were obtained from HIRA, a national claims database that comprehensively captures healthcare utilization data for approximately 97% of the South Korean population under the National Health Insurance program [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study analyzed data from January 1, 2019, to December 31, 2023. Supply data for 36 GH injection products were extracted from pharmaceutical supply reports submitted by pharmaceutical manufacturers to HIRA in accordance with Article 45 of the Enforcement Rules of the Pharmaceutical Affairs Act. Supply volumes and costs were calculated based on shipment records, with all quantities standardized to the smallest dispensing unit (e.g., one vial) for comparability across products.\u003c/p\u003e \u003cp\u003eHIRA\u0026rsquo;s National Health Insurance claims database was used to assess prescription patterns. The dataset included patient-level prescription records categorized by year, region, medical institution, and medical department. Claims from pharmacies were excluded to avoid potential duplication with outpatient prescription records.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStatistical Analyses\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eDescriptive statistics were used to analyze annual trends in GH injection use, including supply volume, supply cost, number of medical institutions supplying and prescribing GH, number of patients receiving GH prescriptions, and total prescription costs. Medical institutions were further classified by type (e.g., clinics, secondary hospitals, tertiary hospitals), clinical department, and region. The number of GH prescriptions and prescribing institutions was analyzed to assess clinical uptake and distribution extent. All cost-related data were converted to United States Dollars (USD) at a fixed rate of 1 USD\u0026thinsp;=\u0026thinsp;1,430 KRW.\u003c/p\u003e \u003cp\u003eData were analyzed using SAS software (version 9.4; SAS Institute Inc., Cary, NC, USA), and data visualization was performed using R (version 4.4.2; R Foundation for Statistical Computing, Vienna, Austria).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAnnual Supply and Cost of GH Injections\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eGH injection supply in South Korea steadily increased over the 5-year study period. The number of GH injection units supplied rose from 2,457,275 units in 2019 to 4,939,945 units in 2023, representing a significant upward trend. The cumulative supply over this 5-year period was 17,565,356 units (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Correspondingly, total supply costs also increased annually, from 195.7\u0026nbsp;billion KRW (USD 136.9\u0026nbsp;million) in 2019 to 484.0\u0026nbsp;billion KRW (USD 338.5\u0026nbsp;million) in 2023. Total GH injection expenditure during the study period was 1.6 trillion KRW (USD 1.14\u0026nbsp;billion) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003eA).Medical institutions supplying GH injections increased from 3,112 in 2019 to 4,172 in 2023, totaling 18,595 institutions over the 5-year period (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).In 2023, pediatrics (53.8%) and internal medicine (37.6%) had the highest GH injection supply by medical specialty (Supplementary Fig.\u0026nbsp;1).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnnual supply status of growth hormone injections.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupply volume\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupply cost\u003c/p\u003e \u003cp\u003e(thousand KRW, USD \u003csup\u003ea\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of medical institutions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,457,275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e195,735,487\u003c/p\u003e \u003cp\u003e(\u003cspan\u003e$\u003c/span\u003e136,878,663 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,685,944\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e232,670,009\u003c/p\u003e \u003cp\u003e(\u003cspan\u003e$\u003c/span\u003e162,036,365 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,537\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,400,379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e313,524,961\u003c/p\u003e \u003cp\u003e(\u003cspan\u003e$\u003c/span\u003e219,601,379 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,806\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,081,813\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e398,976,909\u003c/p\u003e \u003cp\u003e(\u003cspan\u003e$\u003c/span\u003e278,311,129 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,968\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,939,945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e484,029,557\u003c/p\u003e \u003cp\u003e(\u003cspan\u003e$\u003c/span\u003e338,476,187 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e17,565,356\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1,624,936,923\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e($1,136,324,406 USD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e18,595\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e 1 USD\u0026thinsp;=\u0026thinsp;1,430 KRW\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSupply Distribution by Medical Institution Type and Medical Department\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eGH injection supply varied across different types of medical institutions. In tertiary hospitals, the number of units supplied increased from 1,025,422 in 2019 to 1,273,706 in 2023. Despite this volume increase, the proportion of total supply from tertiary hospitals decreased over time, indicating a shift in supply toward other institution types. Secondary hospitals also showed growth, with supply increasing from 448,698 units in 2019 to 1,029,100 units in 2023.\u003c/p\u003e \u003cp\u003eThe most notable growth was observed in clinics, where GH injection supply significantly increased from 177,198 units in 2019 to 1,190,426 units in 2023 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Although general hospitals recorded the highest total GH injection supply cost over the 5-year period, clinics demonstrated the largest annual supply cost increase, from 2.3% of national GH supply cost in 2019 to 7.8% in 2023 (Supplementary Table\u0026nbsp;1).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of growth hormone injection supply.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupply volume (unit, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eMedical institutions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,025,422 (41.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,044,858 (38.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,137,304 (33.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,223,883 (29.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,273,706 (25.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e448,698 (18.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e518,859 (19.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e710,679 (20.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e850,916 (20.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,029,100 (20.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91,471 (3.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106,111 (3.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e176,478 (5.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e244,389 (5.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e327,057 (6.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e177,198 (7.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e230,696 (8.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e407,732 (11.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e680,363 (16.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,190,426 (24.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOriental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16,604 (0.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17,317 (0.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15,496 (0.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17,221 (0.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18,530 (0.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,149 (0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,781 (0.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,906 (0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5,958 (0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5,243 (0.11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e693,733 (28.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e762,322 (28.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e946,784 (27.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,059,083 (25.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,095,883 (22.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical department\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePediatrics and Adolescent Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19,548 (11.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40,371 (17.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93,919 (23.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e230,212 (33.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e640,442 (53.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17,898 (10.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19,693 (8.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22,807 (5.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24,965 (3.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25,096 (2.11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrthopedics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11,267 (6.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,971 (4.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12,869 (3.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13,068 (1.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17,399 (1.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,694 (2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,491 (1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,561 (1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6,481 (0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6,574 (0.55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86,181 (48.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111,080 (48.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e216,820 (53.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e352,479 (51.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e447,448 (37.59)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers \u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38,610 (21.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46,090 (19.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55,756 (13.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53,158 (7.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53,467 (4.49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGangwon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34,368 (1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29,206 (1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32,235 (0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42,861 (1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56,708 (1.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGyeonggi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e357,321 (14.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e449,486 (16.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e645,307 (18.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e790,854 (19.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e936,274 (18.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGyeongnam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98,072 (3.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135,683 (5.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e174,200 (5.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e173,448 (4.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e190,413 (3.85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGyeongbuk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41,951 (1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49,255 (1.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62,708 (1.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70,083 (1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82,385 (1.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGwangju\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47,400 (1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62,979 (2.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88,458 (2.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e112,773 (2.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e140,672 (2.85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDaegu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e342,859 (13.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e354,574 (13.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e394,511 (11.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e451,615 (11.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e477,407 (9.66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDaejeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e143,649 (5.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155,596 (5.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e193,725 (5.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e221,460 (5.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e253,298 (5.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBusan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116,010 (4.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135,976 (5.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e178,145 (5.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e250,745 (6.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e311,929 (6.31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeoul\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,031,715 (41.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,014,682 (37.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,245,537 (36.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,505,547 (36.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,908,178 (38.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSejong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,482 (0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,573 (0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17,336 (0.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28,544 (0.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36,015 (0.73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUlsan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15,426 (0.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20,109 (0.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25,572 (0.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35,729 (0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50,780 (1.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncheon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106,570 (4.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126,580 (4.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131,487 (3.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e127,885 (3.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e163,956 (3.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJeonnam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,475 (0.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7,469 (0.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12,307 (0.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16,686 (0.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17,655 (0.36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJeonbuk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46,572 (1.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54,518 (2.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78,673 (2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89,313 (2.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e104,529 (2.12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJeju\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,164 (0.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,951 (0.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18,047 (0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29,191 (0.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44,462 (0.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChungnam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34,104 (1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44,289 (1.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54,835 (1.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68,582 (1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78,723 (1.59)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChungbuk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27,137 (1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29,018 (1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47,296 (1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66,497 (1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e86,561 (1.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e Public Health/Medical Center, Public Health Subcenter, Pharmacy, Long-term Care Hospital, Psychiatric Hospital\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e Limited to clinic-level institutions\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e Anesthesiology and pain medicine, urology, obstetrics and gynecology, plastic surgery, neurology, neurosurgery, cardiovascular and thoracic surgery, ophthalmology, surgery, otolaryngology, rehabilitation medicine, psychiatry, occupational and environmental medicine, laboratory medicine, diagnostic radiology/radiology, dermatology\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn 2023, pediatrics and adolescent medicine accounted for the largest GH injection volume, increasing from 19,548 units in 2019 to 640,442 units in 2023. In contrast, internal medicine increased its volume from 86,181 units in 2019 to 447,448 units in 2023, though its proportion of total supply volume declined (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRegional Distribution of GH Injection Supply\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eGH injection supply varied by region. Seoul maintained the highest supply volume throughout the study period, from 1,031,715 units in 2019 to 1,908,178 units in 2023. Other major regions included Gyeonggi-do, in which the supply volume increased from 357,321 units in 2019 to 936,274 units in 2023, and Busan, from 116,010 units to 311,929 units (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 2023, within Seoul, Gangnam-gu had the highest number of medical institutions supplying GH injections (278 institutions), followed by Seocho-gu (126), Songpa-gu (88), and Gangseo-gu (54) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Jeollabuk-do showed the largest increase in the share of GH prescription volume, from 1.7% of the national total in 2019 to 3.7% in 2023 (Supplementary Table\u0026nbsp;2).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnnual Prescription Trends of GH Injections\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003ePatients receiving GH injections increased from 13,789 in 2019 to 37,017 in 2023, and prescriptions increased from 95,262 in 2019 to 267,330 in 2023. The total number of prescriptions issued over the 5 years was 867,584 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Prescription costs increased from 53.6\u0026nbsp;billion KRW (USD 37.5\u0026nbsp;million) in 2019 to 144.0\u0026nbsp;billion KRW (USD 100.7\u0026nbsp;million) in 2023 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). The total prescription cost over the study period was 468.9\u0026nbsp;billion KRW (USD 327.9\u0026nbsp;million). Medical institutions issuing GH prescriptions increased from 250 in 2019 to 398 in 2023.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnnual prescription status of growth hormone injections.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of prescriptions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrescription cost\u003c/p\u003e \u003cp\u003e(thousand KRW, USD a)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNumber of medical institutions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13,789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95,262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53,571,855\u003c/p\u003e \u003cp\u003e(\u003cspan\u003e$\u003c/span\u003e 37,462,836 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16,457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121,375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64,017,461\u003c/p\u003e \u003cp\u003e(\u003cspan\u003e$\u003c/span\u003e 44,767,455 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e277\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22,309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e161,124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85,884,789\u003c/p\u003e \u003cp\u003e(\u003cspan\u003e$\u003c/span\u003e 60,059,293 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e330\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31,712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e222,493\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e121,454,200\u003c/p\u003e \u003cp\u003e(\u003cspan\u003e$\u003c/span\u003e 84,933,007 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e346\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37,017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e267,330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e143,974,195\u003c/p\u003e \u003cp\u003e(\u003cspan\u003e$\u003c/span\u003e 100,681,255 USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e398\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e121,284\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e867,584\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e468,902,500\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e($ 327,903,847 USD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1,601\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e 1 USD\u0026thinsp;=\u0026thinsp;1,430 KRW\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn 2023, elementary school students represented approximately half of all patients receiving GH prescriptions, with upper-grade elementary students being the largest subgroup (36.6%). Among patients under the age of 20, 42.9% of prescriptions were for upper-grade elementary students (Supplementary Table\u0026nbsp;3).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eIn this study, the 5-year trends in GH injection supply and prescriptions in Korea were analyzed, categorizing data by year, region, healthcare institution type, and medical specialty. The findings indicated a consistent increase in GH supply and prescription rates, and a 2.5-fold increase in GH prescriptions from 2019 to 2023. Regionally, Seoul and Gyeonggi accounted for more than half of the total GH supply, with the highest concentrations in Seoul\u0026rsquo;s Gangnam, Seocho, and Songpa districts. Tertiary hospitals accounted for the largest GH supply share; however, their contribution decreased as clinics\u0026rsquo; prescription share grew. This shift suggests a redistribution of GH prescribing patterns from tertiary hospitals to primary care institutions, particularly clinics, where non-reimbursed prescriptions appear more common.\u003c/p\u003e \u003cp\u003ePrevious studies reported a steady increase in GH prescriptions, particularly in tertiary hospitals, which were traditionally the primary institutions for GH treatment [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, our findings indicate a growing role of clinics in GH prescribing, diverging from earlier patterns. The increasing involvement of clinics may be attributed to multiple factors, including the expansion of pediatric endocrinology services, more general practitioners prescribing GH, and insurance coverage changes improving GH accessibility in primary care settings. Additionally, unlike previous research focused on approved medical uses, our findings suggest that GH prescriptions are increasingly partially driven by non-medical, height-enhancing purposes, particularly in primary care institutions. This shift aligns with Korean societal trends favoring taller stature [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral factors may explain the increasing trend in GH prescriptions in Korea. First, societal preference for taller stature, particularly among pediatric and adolescent populations, may have increased demand for GH treatment. Second, expanding GH-prescribing healthcare providers, particularly in primary care, has likely facilitated greater GH treatment accessibility. The increase in pediatric endocrinologists and GH-prescribing general practitioners has contributed to these observed trends. Third, increased enrollment of children and adolescents in private health insurance programs covering GH treatment likely contributed to the GH prescriptions surge. Furthermore, recent growth chart revisions expanded the pool of patients eligible for GH treatment under insurance coverage, further influencing GH prescription trends.\u003c/p\u003e \u003cp\u003eDespite its strengths, this study had some limitations. First, many GH prescriptions in Korea are paid out-of-pocket, as GH treatment frequently falls outside insurance-covered indications. This study primarily analyzed data from insurance claims and medical supply data, which may not precisely reflect the extent of GH use. Second, GH supply data may not match actual prescription trends, as GH distribution does not guarantee patient use. Third, the absence of data on non-reimbursed GH prescriptions limits understanding of total GH use, particularly in clinics where off-label use is more prevalent.\u003c/p\u003e \u003cp\u003eIn conclusion, this study provides a comprehensive overview of nationwide GH prescription trends in South Korea, demonstrating a sustained increase in GH use across all healthcare institution types. A notable shift toward primary care settings suggests evolving GH prescription patterns. The expanding landscape of GH use appears to be influenced by increased access to GH therapy, changes in insurance coverage, and strong societal preferences for height enhancement. Although GH use continues to grow, further research is warranted to assess the long-term clinical and economic implications of these trends. Ensuring the appropriateness of GH prescriptions across healthcare settings remains essential for promoting safe and evidence-based use.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Yun JE and Kim J conceived and designed the study and developed the methodology. Kim J performed the formal analysis, and together with Yun JE validated the results and interpreted the findings, while Yun JE supervised the study. Jung Y, and Ahn D were also involved in data collection and revision of the paper. All of the authors contributed in writing the draft of manuscript and agreed to its submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Evidence-Based Healthcare Collaborating Agency of South Korea (Grant No. NECA-A-24-011).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the Health Insurance Review and Assessment Service (HIRA) of South Korea, but restrictions apply to the availability of these data, which were used under license for the current study and are not publicly available. Data are however available from the authors upon reasonable request and with permission of HIRA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of the National Evidence-based Healthcare Collaborating Agency (NECA) (IRB No. NECAIRB24-007). Informed consent was confirmed (or waived) by IRB.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZelinska N, Iotova V, Skorodok J, Malievsky O, Peterkova V, Samsonova L, et al. Long-acting C-terminal peptide\u0026ndash;modified hGH (MOD-4023): results of a safety and dose-finding study in GHD children. J Clin Endocrinol Metabolism. 2017;102(5):1578\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrysiak R, Gdula-Dymek A, Bednarska-Czerwińska A, Okopień B. Growth hormone therapy in children and adults. Pharmacol Rep. 2007;59(5):500\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRanke MB. Short- and long-term effects of growth hormone in children and adolescents with GH deficiency. Front Endocrinol 2021;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichmond E, Rogol AD. Treatment of growth hormone deficiency in children, adolescents and at the transitional age. Best Pract Res Clin Endocrinol Metab. 2016;30(6):749\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCollett-Solberg PF, Jorge AAL, Boguszewski MCS, Miller BS, Choong CSY, Cohen P, et al. Growth hormone therapy in children; research and practice - A review. Growth Hormon IGF Res. 2019;44:20\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGravholt CH, Andersen NH, Conway GS, Dekkers OM, Geffner ME, Klein KO et al. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting. European Journal of Endocrinology. 2017;177(3):G1-G70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrimberg A, Divall SA, Polychronakos C, Allen DB, Cohen LE, Quintos JB, et al. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-Like growth factor-I deficiency. Hormone Res Paediatrics. 2016;86(6):361\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClayton PE, Cianfarani S, Czernichow P, Johannsson G, Rapaport R, Rogol A. Management of the child born small for gestational age through to adulthood: a consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society. J Clin Endocrinol Metabolism. 2007;92(3):804\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuammar T, Alhasaeri M. A systematic review of the impact of growth hormone therapy on final adult height of children with idiopathic short stature. J Diabetes Endocr Pract. 2024;07(01):25\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiller BS, Blair JC, Rasmussen MH, Maniatis A, Kildemoes RJ, Mori J, et al. Weekly somapacitan is effective and well tolerated in children with GH deficiency: the randomized phase 3 REAL4 trial. J Clin Endocrinol Metabolism. 2022;107(12):3378\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeal CL, Steelman J, Vlachopapadopoulou E, Stawerska R, Silverman LA, Phillip M, et al. Efficacy and safety of weekly somatrogon vs daily somatropin in children with growth hormone deficiency: a phase 3 study. J Clin Endocrinol Metabolism. 2022;107(7):e2717\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThornton PS, Maniatis AK, Aghajanova E, Chertok E, Vlachopapadopoulou E, Lin Z, et al. Weekly lonapegsomatropin in treatment\u0026ndash;na\u0026iuml;ve children with growth hormone deficiency: the phase 3 heiGHt trial. J Clin Endocrinol Metabolism. 2021;106(11):3184\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClayton PE, Cowell CT. Safety issues in children and adolescents during growth hormone therapy\u0026mdash;a review. Growth Hormon IGF Res. 2000;10(6):306\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMendonca BB, Arnhold IJP. GH treatment in children of normal height. J Clin Endocrinol Metabolism. 2024;109(10):e1955\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIQVIA. MIDAS Global Sales Database, South Korea Market Analysis. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKyoung D-S, Kim H-S. Understanding and utilizing claim data from the Korean National Health Insurance Service (NHIS) and Health Insurance Review \u0026amp; Assessment (HIRA) database for research. J Lipid Atherosclerosis. 2022;11(2):103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRhie Y-J, Yoo J-H, Choi J-H, Chae H-W, Kim JH, Chung S, et al. Long-term safety and effectiveness of growth hormone therapy in Korean children with growth disorders: 5-year results of LG Growth Study. PLoS ONE. 2019;14(5):e0216927.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChae HW, Hwang I-T, Lee J-E, So CH, Rhie Y-J, Lim JS et al. Height outcomes in Korean children with idiopathic short stature receiving growth hormone treatment. Front Endocrinol 2022;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJang S, Park S, Lee B. Key elements of Korean medicine treatment for idiopathic short-stature: a qualitative SWOT analysis based on Korean medicine doctors\u0026rsquo; views. Medicine. 2024;103(30):e39116.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJung YJS, Choi JS. Subjectivity to height growth of mothers with elementary school children. J KSSSS. 2017;38:103\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Growth Hormone, Pediatrics, Drug Utilization, Prescriptions, Health Insurance Claims","lastPublishedDoi":"10.21203/rs.3.rs-8739566/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8739566/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eGrowth hormone (GH) therapy is indicated for growth hormone deficiency (GHD) and selected growth-related conditions. In South Korea, both the supply and prescription of GH have increased steadily, drawing increased attention to national utilization patterns, particularly among children and adolescents. This study aimed to examine nationwide trends in GH injection supply and prescriptions in South Korea from 2019 to 2023 using Health Insurance Review and Assessment Service (HIRA) data.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA nationwide cross-sectional analysis was conducted using supply data for 36 GH injection products and HIRA prescription claims. Temporal trends in GH supply and prescriptions were analyzed over a 5-year period and stratified by year, region, healthcare institution type, and medical specialty.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBoth GH injection supply and prescriptions increased consistently between 2019 and 2023. Total GH supply expenditure reached approximately KRW 480\u0026nbsp;billion in 2023, representing a 2.5-fold increase compared with 2019. More than half of the national GH supply was concentrated in the Seoul metropolitan area, particularly in Gangnam, Seocho, and Songpa districts. Although tertiary hospitals remained the largest contributors to GH supply, their relative share declined over time, while GH prescriptions in primary care clinics increased substantially.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eGH utilization in South Korea increased across all healthcare institution types, with a notable shift toward primary care settings. These findings highlight the importance of ongoing monitoring of GH utilization patterns and system-level discussions to support appropriate use of GH therapy.\u003c/p\u003e","manuscriptTitle":"Trends in Growth Hormone Utilization in Korea: A Nationwide Study from 2019–2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-24 16:11:30","doi":"10.21203/rs.3.rs-8739566/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-20T11:01:01+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T18:21:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T09:46:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75447819933109950235427548233492883821","date":"2026-03-17T02:08:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72878168830557888465184576308422794402","date":"2026-03-16T15:00:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-13T06:00:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126669938290591114832303973878604211207","date":"2026-03-12T08:03:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4493351993119999861485600715617663584","date":"2026-02-20T16:20:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-19T01:58:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-04T13:47:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-03T10:50:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-03T10:44:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-01-30T08:55:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1d0a61a5-fec2-4e1d-9d2b-ee4ab0bd1313","owner":[],"postedDate":"February 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:00:37+00:00","versionOfRecord":{"articleIdentity":"rs-8739566","link":"https://doi.org/10.1186/s12913-026-14557-4","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2026-04-21 15:57:20","publishedOnDateReadable":"April 21st, 2026"},"versionCreatedAt":"2026-02-24 16:11:30","video":"","vorDoi":"10.1186/s12913-026-14557-4","vorDoiUrl":"https://doi.org/10.1186/s12913-026-14557-4","workflowStages":[]},"version":"v1","identity":"rs-8739566","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8739566","identity":"rs-8739566","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}