Health Security Program Research Articles

Institutional Discrimination in Health Security Policies against Immigrants in South Korea

Abstract Background South Korea is poised to become Asia’s first mult-iethnic society with over 5% of its population, totaling more than 2.5 million, being immigrants. This demographic shift presents significant public health challenges linked to widespread, and even intensifying, institutional discrimination in healthcare services. Methods This study reviews discriminatory practices across ten essential health security programs, including National Health Insurance (NHI) system, disability assistance, occupational health services, maternal and child care services, national immunization program, health screening program, and assistance for catastrophic medical expenses. Government data and personal narratives were also reviewed to identify the discriminatory elements that can have significant consequences, including increased disease prevalence, higher incidence of occupational injuries, and broader socio-economic instability among migrants. Results Discriminatory elements were found in most programs, with the exception of emergency medical services. These programs commonly provide fewer benefits or impose stricter eligibility criteria for migrants compared to nationals. In particular, the Korean NHI system demands migrants to pay higher premiums and more rigorous maintenance requirements. Conclusions The findings emphasize the need for urgent reforms to equalize health insurance costs, simplify eligibility criteria for migrants, and broaden the scope of benefits to encompass all residency statuses. Implementing these changes will enhance public health infrastructure, improve occupational safety, and foster better integration of the diverse population, ultimately promoting social cohesion and a fairer health system for all. Key messages • A number of discriminatory elements against migrants have been identified in South Korea’s social security policies that can exacerbate health disparities. • Reforms are needed to expand benefits and relax eligibility criteria for migrants in key healthcare policies, including the National Health Insurance system.

Barriers to Enrollment of National Health Insurance Scheme in Uttargaya Rural Municipality, Rasuwa

The Social Health Security Program (SHSP) is a social protection program of the Government of Nepal that aims to enable all citizens to access quality and effective healthcare services without any financial burden. A cross-sectional household-based and quantitative in-nature study was conducted in Rasuwa district. This study's population was residents of Uttargaya rural municipality wards no 4 and 5. How different factors are related to SHI enrolment. Ethnicity (p=<0.001), religion (p=<0.001), IWI grade (p=0.010), know about health insurance (p=<0.001), the behavior of service providers (p=<0.001), neighbors enrollment (p=<0.001), discussed SHI with neighbors (p=0.001), and family members agreed to enroll (p=0.002) were significantly associated with enrollment in SHI whereas others factors did not show any significant association with enrollment in social health insurance. This study found that enrollment was significantly associated with different independent variables. Poor knowledge of SHI, unfriendly behaviors of service providers, lack of trust, and unaffordability of premium costs were identified as barriers. Furthermore, Inappropriate timing of premium collection, limited services point, feeling that enrollment was not necessary, long queue, inadequate number of enrollment assistant and mandatory refer card were also reasons for not enrolling in SHI.

Strengthening COVID-19 pandemic response coordination through public health emergency operations centres (PHEOC) in Africa: Review of a multi-faceted knowledge management and sharing approach, 2020-2021.

The coronavirus disease 2019 (COVID-19) pandemic disrupted health security program implementation and incremental gains achieved after the West African Ebola outbreak in 2016 across Africa. Following cancellation of in-person events, a multi-faceted intervention program was established in May 2020 by Africa Centres for Disease Control and Prevention (Africa CDC), the World Health Organisation, and partners to strengthen national COVID-19 response coordination through public health emergency operations centres (PHEOC) utilizing continuous learning, mentorship, and networking. We present the lessons learned and reflection points. A multi-partner program coordination group was established to facilitate interventions' delivery including webinars and virtual community of practice (COP). We retrieved data from Africa CDC's program repository, synthesised major findings and describe these per thematic area. The virtual COP recorded 1,968 members and approximately 300 engagements in its initial three months. Fifty-six webinar sessions were held, providing 97 cumulative learning hours to 12,715 unique participants. Zoom data showed a return rate of 85%; 67% of webinar attendees were from Africa, and about 26 interactions occurred between participants and facilitators per session. Of 4,084 (44%) participants responding to post-session surveys, over 95% rated the topics as being relevant to their work and contributing to improving their understanding of PHEOC operationalisation. In addition, 95% agreed that the simplicity of the training delivery encouraged a greater number of public health staff to participate and spread lessons from it to their own networks. This just-in-time, progressively adaptive multi-faceted learning and knowledge management approach in Africa, with a consequential global audience at the peak of the COVID-19 pandemic, served its intended audience, had a high number of participants from Africa and received greatly satisfactory feedback.

PEMANFAATAN PROGRAM BPJS KESEHATAN DI KECAMATAN PEKAT KABUPATEN DOMPU NTB

The Government is working to improve the quality of public health with the use of social security. Social security is one form of social protection organized by the government of useful guarantee citizens or communities to meet the basic necessities of life. One of them is through the health security program which is organized by the organizer of the social security (BPJS). BPJS health is a government program to meet the basic needs of life of the community in the field of health. The program is expected to serve and provide protection so that all people get access health equally. Based on the background of this research aims to know the effectiveness of the program BPJS in Dompu and inhibiting factors in the effectiveness of BPJS Health Program in the city of Dompu. This study used quantitative descriptive research type with a total sample of 100 patients who use the services BPJS Health at Public Health Center Pekat. This study uses five indicators to measure the effectiveness of programs that socialization program, program understanding, precision targeting, program objectives and real change. Based on data analysis, conclusion that the effectiveness of BPJS Health program in Dompu can be said to be effective. Based on the five indicators, which have the lowest level of effectiveness is an indicator socialization program that scores of 1.86 (less effective). Factors that are considered obstacles in the effectiveness BPJS program is socialization programs, services and dues BPJS

Social Health Security Program and Poor: A Case Study of Dhangadhi Sub-Metropolitan City

It is a well-known fact that Alma Ata Conference on Primary Health Care held in Kazakhstan in 1978 called for all the countries to implement primary health care for increasing health care access to all the people at affordable cost and achieving the targets of "Health for All" by the year 2000.The conference had also emphasized the provision of preventive, promotive, curative, and rehabilitative services up to the community level for addressing main health problems (Gilllam, 2008). The World Health Organization also affirms that: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” To ensure these rights to its citizens, every state has to invest organizational, human and financial resources to its optimum level.

Co-creation and priority setting for applied and implementation research in One Health: Improving capacities in public and animal health systems in Kenya

BackgroundThe Kenyan government has successfully been implementing sector specific and multisectoral projects aligned to the Global Health Security Agenda (GHSA). For operational readiness and to enhance the effective planning and implementation of Global Health Security Programs (GHSP) at national and subnational level, there is an urgent need for stakeholders' engagement process to seek input in identifying challenges, prioritise activities for field implementation, and identify applied research and development questions, that should be addressed in the next five years. MethodsThe modified Child Health and Nutrition Research Initiative (CHNRI) method was used to identify global health security related priorities for multisectoral implementation in Kenya. Subject matter experts from human, animal and environmental health sectors at national and subnational level contributed to predefined research questions from a number of sources and activities for consideration for implementation using a One Health approach. Sixty-two experts scored the 193 questions based on five pre-defined criteria: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity. Data resulting from this process was then analysed in a Microsoft Excel spreadsheet to determine the research priorities and experts' agreements. ResultsAmong the priority activities identified for implementation research were; strengthening One Health governance and legal frameworks; integration of ecosystem health into One Health programming; strengthening disease reporting, integrated data collection, information sharing and joint outbreak response; socio-anthropological and gender-based approaches in improving risk and behavioural change communication and community engagement; and one health workforce development. In addition, the potentials to invest in collaborative predictive risk modelling to enhance epidemic intelligence systems, while strengthening the One Health approach in the food safety incident and emergency response plans are feasible. InterpretationSuccessful multisectoral implementation of global health security program in Kenya calls for a whole of society approach that will harness community and private sector knowledge to build preparedness and response capacities while targeting neglected and marginalised populations. This research provides a framework that is worth emulating for cost-effective planning and implementation of overarching One Health programs.

Utilization of social health security scheme among the households of Illam district, Nepal.

Nepal has implemented the social health security program in certain health facilities to improve access to quality health services. The aim of the study is to understand the utilization pattern of social health security schemes and community's perception of the social health security program. A descriptive cross-sectional mixed-method study was conducted among 300 households of Illam district who had enrolled in the social health security scheme. A multi-stage random sampling method was used. A semi-structured questionnaire was used to collect quantitative data whereas focus group discussions (FGDs) were conducted for qualitative data. Descriptive analysis, bivariate and multivariate analysis was done. FGDs were transcribed and thematic analysis was done. The utilization rate of social health security scheme was 88.7%. Factors associated with the utilization of program included: presence of under-five children and chronic illness in households, sex and age group. Focus group discussion revealed that people were aware of social health insurance and pleased with program implemented by government. However, the hospitals under the social health insurance were not able to meet their expectations. Although the utilization of social health security scheme was high, people were dissatisfied with the service provided by the hospital under the social health security scheme. Therefore, the social health insurance board should closely monitor the hospitals and develop a feedback mechanism from the users.

Development of DNA Bio-chip for Detection of Mutations of rpoB, embB and inhA Genes inDrug-Resistant Mycobacterium Tuberculosis.

Drug-resistant (DR) tuberculosis (TB) is a global threat to health security and TB control programs. Since conventional drug susceptibility testing (DST) takes several weeks, we have developed a molecular method for the rapid identification of DR strains of Mycobacterium Tuberculosis (M.tb) utilizing DNA bio-chips. DNA bio-chips were prepared by immobilizing oligonucleotides (probes) on highly microporous polycarbonate track-etched membranes (PC-TEM) as novel support. Bio-chip was designed to contain 15 specific probes to detect mutations in three genes (rpoB, embB, and inhA). A sensitive and specific chemiluminescence based bio-chip assay was developed based on multiplex PCR followed by hybridization on bio-chip. Fifty culture isolates were used to evaluate the ability of in-house developed bio-chip to detect the mutations. Bio-chip analysis shows that 37.7% of samples show wild type sequences, 53.3% of samples were monoresistance showing resistance to either rifampicin (RMP), isoniazid (INH), or ethambutol (EMB). 4.4% of samples were polydrug resistant showing mutations in both the rpoB gene and embB gene while 4.4% of samples were multidrug-resistant (MDR), harboring mutations in the rpoB and inhA genes. The results were compared with DST and sequencing. Compared to sequencing, bio-chip assay shows a sensitivity of 96.5% and specificity of 100% for RMP resistance. For EMB and INH, the results were in complete agreement with sequencing. This study demonstrates the first-time use of PC-TEMs for developing DNA bio-chip for the detection of mutations associated with drug resistance in M.tb. Developed DNA bio-chip accurately detected different mutations present in culture isolates and thus provides detailed and reliable data for clinical diagnosis.

The Size, Growth, and Composition of Government: Analysis and Evidence for Canada and the United States

The topic of measuring the growth and size of government, on which there is now a robust literature and policy debate, held little interest for economists in the 18th and 19th centuries and throughout much of the 20th century. Although it is a bit dangerous to date when perceptions of the importance of the topic began to shift, a good place to start is with Richard Bird's research for the Canadian Tax Foundation in 1970 on the growth of government spending in Canada. The purpose of this paper is to briefly review what Bird recognized is an evolutionary process, and then to examine the manner in which the growth and size of government can be measured in Canada and the United States. The trends in four key measures following the Second World War are defined and documented. The paper reveals two especially important features. The first is the increase in the role of the subnational government sector. The second is that, in both countries, the public sector is trending away from spending on (and taxing for) the public's physical infrastructure and toward transfers to individuals, particularly in the form of health and income security programs.

Community-based study on renew or dropout status of social health insurance program in Bharatpur Metropolitan City, Chitwan

Health insurance is emerging as the most preferred form of the health financing mechanism. Higher dropout puts a threat to governments target (Social health security program) of 100% enrolment by 2030.This study aimed at accessing the factors associated with current SHI status (renew or dropout) in Bharatpur metropolitan city.
 The community based descriptive cross-sectional study using face to face interview was carried out in Bharatpur Metropolitan city, Chitwan. Total 342 household heads that have enrolled in Social Health Insurance for past year are considered as a sample to describe the Renewal status among SHI Enroll household. We used Pearson’s chi-square test to investigate the effect of some explanatory variables on renewal and dropout status of SHI.
 Among 342 household enroll SHI scheme, there were 203(59.4%) Renewed for next year and 139(40.6%) household dropout SHI Scheme. Results shows that current status of SHI (renew or dropout) differ significantly with Sex of household head (P< 0.01), education status (P<0.01), family type (P < 0.01), highest level of education in family (P < 0.01)), presence of children (P < 0.001), presence of pregnant women in family (P = 0.009), presence of ageing population in family (P < 0.001), Disability in family (P = 0.016), Chronic disease in family (P < 0.01).
 The study concluded that the influence factors for Renew or Dropout status of SHI were: type of family, household education status, presence of children, pregnant women in family, the ageing population in family, presence of disability and chronic disease in the family.

Pelaksanaan Audit Medis Rujukan Non Spesialistik (RNS) dengan Time, Age, Comorbid, Complication (TACC) pada Fasilitas Kesehatan Tingkat Pertama (FKTP) di wilayah Kota Administrasi Jakarta Utara

In the era of the National Health Security (Jaminan Kesehatan Nasional-JKN) program, the Primary Care Health Facility (Fasilitas Kesehatan Tingkat Pertama-FKTP) has become a frontline to management of non specialistic diagnoses, although it is still possible for non specialistic diagnoses to be referred to hospitals on the grounds of Time, Age, Complication, and Comorbidity (TACC) at National Health Insurance (Badan Penyelenggara Jaminan Sosial- BPJS Kesehatan) application system, but it is not yet known whether TACC is only used as for passing referrals, even though the actual condition of the patient can still be handled completely at the first level, or FKTP is actually not able to handle the diagnosis. Purposes: Data collection for this study was carried out through medical audit activities aimed at detecting whether TACC has been used according to the actual patient's condition or only as a means for passing referrals. Methods: Medical audit has compare the suitability between the choice of TACC in the BPJS Health application system and the patient's medical record. Results: The results of the medical audit, it was found that 32,8% of participants had discrepancy between the diagnosis writing and the TACC choice in the BPJS Health application system and medical records; medical records of 35,75% of participants have not been written in full in accordance with Regulation of the Minister of Health No. 269/2008 concerning Medical Records; and 44,62% of participants still received medical treatment that did not refer to the prevailing medical consensus. Keywords: TACC; Aplication System; Medical Record

The Role of Noncommunicable Diseases in the Pursuit of Global Health Security.

Noncommunicable diseases and their risk factors are important for all aspects of outbreak preparedness and response, affecting a range of factors including host susceptibility, pathogen virulence, and health system capacity. This conceptual analysis has 2 objectives. First, we use the Haddon matrix paradigm to formulate a framework for assessing the relevance of noncommunicable diseases to health security efforts throughout all phases of the disaster life cycle: before, during, and after an event. Second, we build upon this framework to identify 6 technical action areas in global health security programs that are opportune integration points for global health security and noncommunicable disease objectives: surveillance, workforce development, laboratory systems, immunization, risk communication, and sustainable financing. We discuss approaches to integration with the goal of maximizing the reach of global health security where infectious disease threats and chronic disease burdens overlap.

Nigeria's Joint External Evaluation and National Action Plan for Health Security.

Nigeria is working to protect against and respond more effectively to disease outbreaks. Quick mobilization and control of the Ebola epidemic in 2014, at least 4 major domestic outbreaks each year, and significant progress toward polio eradication led to adoption of the World Health Organization's Global Health Security Joint External Evaluation (JEE) and National Action Plan for Health Security (NAPHS). The process required joint assessment and planning among many agencies, ministries, and sectors over the past 2 years. We carried out a JEE of 19 core programs in 2017 and launched a detailed NAPHS to improve prevention, detection, and response in December 2018, which required us to create topic-specific groups to document work to date and propose JEE scores. We then met with an international team for 5 days to review and revise scoring and recommendations, created a 5-year implementation plan, developed a management team to oversee implementation, drafted legislation to manage outbreaks, trained professionals at state and local levels of government, and set priorities among the many possible activities recommended. Management software and leadership skills were developed to monitor global health security programs. We learned to use international assistance strategically to strengthen planning and mentor national staff. Finally, a review of every major disease outbreak was used to prepare for the next challenge. Review and adaptation of this plan each year will be critical to ensure sustained momentum and progress. Many low-income countries are skilled at managing vertical disease control programs. Balancing and combining the 19 core activities of a country's public health system is a more demanding challenge.

Social Health Security Program in Nepal: Opportunities and Challenges

The study aims to assess the opportunities and challenges of the health insurance program carried out by Health Insurance Board as a social insurance program by Government of Nepal. Data have been collected through in-depth interview with 21 persons including the social health insurance policyholders, and non-policyholders who are inhabitants of Rantanagar Municipality- 6, and Bharatapur Metropolitan City- 10 of Chitwan district. Besides, experts in insurance and senior managers of insurance companies were also interviewed. It has followed the interpretive-naturalistic approach with the method of interviewing. As per the opinion of respondents HIP is effective in cost reduction of rich, and access to health service for poor. In government hospitals policyholders suffer from prolonging waiting, lack of facilities and experts and in private hospitals there is undue expenditure and discrimination in expert service. Even though the objective of the social health program is established social justice, cash-payer and insurance-payers are discriminated; corroborating the nature of neoliberal society. There are still uninsured persons because of ignorance, lack of premium, and distrust of HI service. The study suggests that HI service should be delivered through non-profit hospitals, the highest quality without discrimination of cashpayer and insurance-payer, and prolonged waiting.

Stakeholder Analysis Approach: Who Is Authorized to Regulate the National Health Insurance Benefits?

BPJS Kesehatan (Badan Penyelenggara Jaminan Sosial Kesehatan) is an agency that liable to organize the nationalhealth security system in Indonesia. The health services director of BPJS Kesehatan has issued three regulations as an effort to control deficits which currently hit since 2014. The issuance of the regulations reaped controversy over its contents governing the limitation of health benefits that assured by BPJS Kesehatan. Besides that, BPJS Kesehatan has assumed not an authorized institution to issue that policy. This study aims to analyze the issuance of the regulations as a public policy. Data collection is obtained by in-depth interviews with top-level management, literature review and observation. Stakeholder analysis used to find out where the position of BPJS Kesehatan in the national health security system environment is. It will help in carrying out its functions and roles to succeed that program. Through stakeholder analysis is known that the government and the participants are the primary stakeholders of the national health security system. While BPJS Kesehatan is an agent representing the government providing health benefits to the participants. BPJS Kesehatan is not the primary stakeholder but secondary stakeholder, then the determination of any health benefits provided to the participants is an authority of the government rather than BPJS Kesehatan. Inaccuracy in the reading relationship between stakeholders could be at risk for BPJS Kesehatan in making a strategic decision. BPJS Health's lack of understanding of its authority, lead to ineffective decision-making and policies. The ineffectiveness of policies or decisions makes the goals of BPJS Health as providers of national health security programs difficult to achieve. By understanding the limits of its authority, BPJS Kesehatan able to take strategic steps according to the company's goals

The incremental economic burden of heart failure: A population-based investigation from South Korea.

BackgroundThe prevalence of heart failure (HF) and its economic burden are increasing with age of the South Korean population. This study aimed to assess the economic impact of HF from the societal perspective.MethodsA prevalence-based, incremental cost-of-patient study was performed to estimate the cost ratio between patients with HF and those without HF based on the claims database of the national health insurance in South Korea. We defined adult HF patients as those aged ≥19 years who had at least one insurance claim record with a primary or secondary diagnosis of HF. Age- and gender-matched controls were defined using a 1:4 greedy matching method. Costs were estimated by including medical costs for insurance-covered and non-covered services, transportation costs, caregiver’s cost, and time costs of patients. The ratio of costs between patients with HF and those without HF was adjusted for age, gender, and type of universal health security program in the multivariate regression model.ResultsThe average annual per-capita cost was estimated to be $6,601 for patients with HF (n = 14,252), which is about 3.38 (95% confidence interval [CI]: 3.31–3.46) times higher than that for patients without HF (n = 1,116,882) and 1.64 (95% CI: 1.59–1.70) times higher than that for the age- and gender-matched patients without HF (n = 57,008). In the multivariate regression model, the annual per-capita total costs were 1.98-fold (95% CI: 1.94–2.02) statistically higher for patients with HF than for patients without HF after adjustment for age, gender, and type of universal health security program.ConclusionsThis study demonstrates a significant incremental burden of HF. Given that the prevalence of HF is expected to increase with an increase in the aging population, the national economic burden is expected to be substantial in the future. Thus, greater emphasis on the prevention and treatment of HF is warranted.

Building Laboratory-Based Arbovirus Sentinel Surveillance Capacity During an Ongoing Dengue Outbreak, Burkina Faso, 2017.

In West Africa, identification of nonmalarial acute febrile illness (AFI) etiologic pathogens is challenging, given limited epidemiologic surveillance and laboratory testing, including for AFI caused by arboviruses. Consequently, public health action to prevent, detect, and respond to outbreaks is constrained, as experienced during dengue outbreaks in several African countries. We describe the successful implementation of laboratory-based arbovirus sentinel surveillance during a dengue outbreak in Burkina Faso during fall 2017. We describe implementation, surveillance methods, and associated costs of enhanced surveillance during an outbreak response as an effort to build capacity to better understand the burden of disease caused by arboviruses in Burkina Faso. The system improved on existing routine surveillance through an improved case report form, systematic testing of specimens, and linking patient information with laboratory results through a data management system. Lessons learned will improve arbovirus surveillance in Burkina Faso and will contribute to enhancing global health security in the region. Elements critical to the success of this intervention include responding to a specific and urgent request by the government of Burkina Faso and building on existing systems and infrastructure already supported by CDC's global health security program.

Federal Funding for Health Security in FY2019

This article is the latest in an annual series analyzing federal funding for health security programs. We examine proposed funding in the President's Budget Request for FY2019, provide updated amounts for FY2018, and update actual funding amounts for FY2010 through FY2017. Building health security for the nation is the responsibility of multiple agencies in the US federal government, as well as that of state, tribal, territorial, and local governments and the private sector. This series of articles focuses on the federal government's role in health security by identifying health security-related programs in public health, health care, national security, and defense and reporting funding levels for that ongoing work.

Aksesibilitas Mahasiswa Kesehatan dan Mahasiswa Non Kesehatan Strata S-1 Universitas Airlangga terhadap Program Jaminan Kesehatan Nasional

The participant of National Health Security in October 2016 still reached 66,11% of population. Public and students knowledge about benefits and uses of National Health Security still low. The lack of knowledge, used, and community participation showed the lack of community accessibility in National Health Security program. Students as agents of change are expected to make National Health Security success The objectives of this research was to analyze the differences of health student’s accessibility and non-helath student’s accesssibility to National Health Security program. The method of this research used online questionnairre with analytic type of research used observational research and cross sectional design. The results showed there were differences of accessibility between health students and non-health students based on knowledge aspect, proximity of health facility that accept National Health Security, perception of the importance of National Health Security, National Health Security participants, utilization of National Health Security, ease of National Health Security used, affordability of National Health Security, and satisfaction of National Health Security. Meanwhile health students accessibility with non-health students did not have differences on ease of gets information aspect, accomodation availability, and perception of the accuracy of National Health Security program.Keywords: accessibility, national health security, students

Nationwide Epidemiologic Study of Atypical Antipsychotic Use Among Pediatric Population with Mental Illness in Korea.

Objective: This population-based epidemiologic study aimed to analyze the prevalence and trends of atypical antipsychotic (AAP) use and identify factors associated with AAP prescribing among children and adolescents in Korea. Methods: Using the Health Insurance Review and Assessment Service-Pediatric Patients Sample data between 2010 and 2014, we assessed the prevalence of and secular trends in AAP use; utilization of individual AAP drug based on the type of healthcare services, healthcare institutions, and health security programs; and factors associated with AAP use. Results: The average annual prevalence of AAP use was 417 per 100,000 children and adolescents, which increased by 40% from 2010 to 2014. The major AAP drug of choice has shifted from risperidone (72.70% and 49.29% in 2010 and 2014, respectively) to aripiprazole (11.31% and 34.64% in 2010 and 2014, respectively). Quetiapine was mainly prescribed for inpatients. Therefore, hospitals have 2-3 times higher proportion of quetiapine use than clinics. A prominent difference exists in the prescribing rates and AAP drug of choice based on income level. Patients enrolled in the Medical Aid (MA) program had a higher AAP prescription rate than those enrolled in the National Health Insurance (NHI) program (adjusted odds ratio: 7.78). Moreover, MA recipients were more frequently prescribed with cheaper alternatives, such as risperidone, compared with NHI recipients. Conclusion: AAP has been increasingly used among the pediatric population in Korea. Future studies are needed to identify the causes of this increase and establish evidence on appropriate AAP use. In addition, relevant policies should be developed to ensure that low-income mentally ill children could take advantage of the best available therapy.