Free health check-ups and chronic disease care among older adults in China

We evaluate the impact of a free health check-up program targeting older adults in China on the diagnosis and management of chronic diseases, focusing on hypertension and diabetes. Drawing on nine years of panel data from five waves of the China Health and Retirement Longitudinal Study (CHARLS), we use a fixed-effects instrumental variable (IV) strategy that leverages age-based eligibility (65+) for free check-ups to address endogeneity in health service uptake. Our findings show that eligibility for a check-up increases the probability of diabetes diagnosis by 8.3 percentage points (p = 0.042), with even stronger effects for women in rural areas (13.3 percentage points, p = 0.063). In contrast, we find no significant impact on hypertension diagnosis. Although the check-up policy improves diabetes detection, our causal estimates show no statistically significant effects on treatment, disease control, or provider recommendations. For hypertension, the policy raises lifestyle advice, but we estimate no precise impacts on clinical outcomes. These results suggest that while preventive screening can enhance disease detection among older adults, substantial gaps remain in the delivery of effective follow-up care and disease management. This has important implications for designing cost-effective chronic disease interventions in aging populations.