Do health check-ups for seniors improve diagnosis and management of hypertension and diabetes in China?

We estimate effects of a health check-up on non-communicable disease (NCD) diagnosis and management among Chinese adults aged 50 and older. Using five waves of the China Health and Retirement Longitudinal Study (CHARLS) spanning a period of 9 years and a fixed-effect instrumental variable (IV) framework, we exploit a policy that provided free health check-ups for those 65 and above as an IV for health check-ups to address the endogeneity between health check-ups and health characteristics. We estimate that a check-up increases the probability of diabetes diagnosis by 8.3 percentage points (p=0.042), particularly among females in rural areas (13.3 percentage points, p=0.063). However, there was no significant effect on hypertension diagnosis. Despite improving diabetes detection, check-ups do not significantly increase diabetes treatment, disease control, or provider recommendations. Similarly, while they increase health behavior recommendations for hypertension management -possibly because the policy helped integrate previously diagnosed individuals into formal care- this does not translate into improved hypertension control. These findings highlight the importance of health checkups in improving diagnosis for certain conditions but reveal critical gaps in follow-up care and disease management.