Replace generic annual checkup packages with screening appropriate to your age and sex

Avoiding packages saves hundreds to thousands of RMB a year. You do need to keep track of which screenings are due and at what intervals.

The 2019 Cochrane update included 17 randomized controlled trials. The all-cause mortality analysis combined 11 trials, 233,298 participants, and 21,535 deaths: RR 1.00 (95% CI 0.97–1.03). A risk ratio of 1 means the groups were alike. Cardiovascular mortality, across nine trials with 170,227 people and 6,237 deaths, had an RR of 1.05 (0.94–1.16). Cancer mortality, across eight trials with 139,290 people and 3,663 deaths, had an RR of 1.01 (0.92–1.12). Neither showed a clear difference. The authors concluded that general health checks were unlikely to be beneficial. China’s nationwide basic public-health services provide residents aged 35 or older with an annual free blood-pressure measurement, and those aged 65 or older with an annual free examination. The latter includes a physical examination, blood count, urinalysis, fasting glucose, and ECG; liver tests for AST, ALT, and total bilirubin; kidney tests for serum creatinine and urea; total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol; and abdominal ultrasound of the liver, gallbladder, pancreas, and spleen.

The target is treating an annual package as a proven disease-prevention strategy, not refusing every examination. The Chinese services described above are already publicly funded. Continue tests that have a clear indication: blood pressure, blood glucose, hepatitis B, breast screening, cervical screening, colorectal screening, H. pylori, and low-dose chest CT. After a relevant exposure, seek appropriate testing. Those entries explain starting ages and intervals. The original advises attending employer-funded checks; its focus is avoiding self-funded packages and unnecessary add-ons. Tests ordered for symptoms, an existing chronic disease, or a specific clinical reason are medical care, not generic screening. For common unsupported extras, see whole-body imaging and tumor-marker packages. For incidental findings, see asymptomatic high uric acid and asymptomatic gallstones. Most Cochrane trials took place in high-income countries with relatively good access to care; applying the result to places with limited medical resources requires caution.

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; China’s National Health and Family Planning Commission (2017). National Basic Public Health Service Standards, third edition, sections on older-adult health management and hypertension management. https://www.nhc.gov.cn/ewebeditor/uploadfile/2017/04/20170417104506514.pdf.