Don't rely on a general checkup package to prevent disease; get the few screenings that have evidence for your age and sex

Cost

Free, and you save the several hundred to several thousand CNY a year a package costs. In return you owe the work of remembering which few tests to get and how often.

What you get

The 2019 update of a Cochrane systematic review included 17 randomized controlled trials. For total deaths, it pooled 11 of those trials, with 233,298 participants and 21,535 deaths. The group that had general health checks was the same as the comparison group, RR 1.00. RR is the risk ratio; 1 means the two sides are the same. 95% CI 0.97–1.03 is the plausible range. For death from heart and blood vessel disease, it pooled 9 trials, 170,227 people and 6,237 deaths, RR 1.05 (95% CI 0.94–1.16). For death from cancer, it pooled 8 trials, 139,290 people and 3,663 deaths, RR 1.01 (95% CI 0.92–1.12). Neither of these showed a difference either. The authors concluded that “general health checks are unlikely to be beneficial.” The National Basic Public Health Service Program (国家基本公共卫生服务项目) gives permanent residents aged 35 and over a free blood pressure measurement once a year, and gives people aged 65 and over a free health checkup once a year. This free checkup includes a physical exam, complete blood count, urinalysis, fasting blood glucose and an ECG. Liver function covers AST, ALT and total bilirubin. Kidney function covers serum creatinine and blood urea. Blood lipids cover total cholesterol, triglycerides, LDL cholesterol and HDL cholesterol. Finally there is an abdominal ultrasound of the liver, gallbladder, pancreas and spleen (nationwide)

Notes

What is being ruled out is “using the yearly package as a way to prevent disease,” not that you should skip every test. Also, the free blood pressure measurement once a year from age 35 and the free checkup once a year from age 65 are already provided by the National Basic Public Health Service Program, so you do not need to pay for them. Get the items you have a reason to get. For blood pressure, blood sugar and hepatitis B, see §1.7, §1.8, §1.14. For breast, cervical and colorectal, see §1.17, §1.18, §1.19. For Helicobacter pylori and low-dose CT, see §1.23, §1.24. For bone density tests for women over 65, see §1.39 (bone density test). If you have done something high-risk, get tested; see §1.31. The age to start and the interval are written there. Go to checkups your employer organizes or someone else pays for; what to hold back is buying a package yourself and adding items yourself. People who already have a chronic disease, people with symptoms, or tests ordered by a doctor for a condition are not covered; that is medical care, not screening. The most common items in a package with no evidence are tumor markers and whole-body imaging; see §6.7 (whole-body PET-CT and tumor marker packages). For what to do if a checkup finds high uric acid but you have never had pain, or gallstones but you have never had pain, see §6.19 (high uric acid without symptoms) and §6.20 (gallstones without symptoms). Also, most trials Cochrane included were done in high-income countries, where seeing a doctor is easy anyway, so places where medical resources are tight should not copy this conclusion directly.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Krogsbøll LT, Jørgensen KJ, Gøtzsche PC (2019). General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database of Systematic Reviews, 1, CD009009. https://doi.org/10.1002/14651858.CD009009.pub3
2. 国家卫生计生委 (2017). 国家基本公共卫生服务规范（第三版）（老年人健康管理服务、高血压患者健康管理服务）. https://www.nhc.gov.cn/ewebeditor/uploadfile/2017/04/20170417104506514.pdf

Translated from the Chinese original. Original book, section 6, tip 18. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer