Associations of different health check-up types with healthcare utilization and its inequalities among older adults in China: evidence from a nationally representative survey
Year: 2026
Type: article
Abstract: Health check-ups are an important preventive measure linking health risk identification, health management, and subsequent healthcare use. However, longitudinal evidence remains limited on whether different health check-up types are associated with healthcare utilization and related inequalities among older adults. This study utilized panel data from four waves of the China Health and Retirement Longitudinal Study (CHARLS). Health check-up types were categorized as no health check-up, free health check-up, and self-paid health check-up. Associations between health check-up type and healthcare utilization were assessed using two-way fixed-effects ( TWFE ) models. Concentration indices ( CIs ) were employed to quantify inequality in healthcare utilization. Recentered Influence Function ( RIF ) regression decomposition was applied to identify the main factors correlating with this inequality. Overall, 52.8% of older Chinese adults participated in health check-ups (27.86% free, 24.94% self-paid). Compared with no health check-up, self-paid health check-up was significantly associated with a higher probability of hospital admission and with higher medical expenditures, whereas free health check-up showed no consistent association with higher utilization. The CI analysis revealed a “pro-rich” inequality in healthcare utilization, with larger gradients in inpatient care. Pro-rich inequality in annual hospital admissions and annual inpatient expenditure was significantly lower in the free health check-up group than in the no health check-up group (differences=-0.07, P = 0.018; -0.06, P = 0.026) and the self-paid health check-up group (differences=-0.10, P = 0.003; -0.07, P = 0.013). RIF -Oaxaca decomposition showed that the factors accounting for between-group differences in inequality varied across pairwise comparisons. Different health check-up types were associated with distinct patterns of healthcare utilization and inequality among older adults in China. Self-paid health check-up was associated with higher healthcare utilization and medical expenditures, whereas free health check-up showed no higher overall utilization but lower pro-rich inequality in inpatient-related outcomes. Policy efforts should move beyond expanding health check-up coverage alone and strengthen post-check-up follow-up, referral support, and financial protection, so as to avoid “screening without management” and better realize the equity value of free health check-up as a public health service entry point.
Institution: Nanjing Medical University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,690
OpenAlex ID: W7223170837