Seventeen randomized trials have tested the general health check against no health check. The pooled effect on total mortality is a risk ratio of 1.00, with a 95% confidence interval of 0.97 to 1.03, across 11 trials, 233,298 participants and 21,535 deaths. Cochrane grades that finding high-certainty evidence.
We sell health screening packages. That number is still the honest place to start, because the useful part of this subject only appears once you stop defending the annual physical as a whole.
What did the Cochrane review actually find?
Nothing, on every mortality outcome it could pool. The 2019 update by Krogsboll, Jorgensen and Gotzsche included 17 trials, of which 15 reported outcome data on 251,891 participants.
| Outcome | Risk ratio, 95% CI | Trials and participants | Certainty |
|---|---|---|---|
| Total mortality | 1.00, 0.97 to 1.03 | 11 trials, 233,298 | High |
| Cancer mortality | 1.01, 0.92 to 1.12 | 8 trials, 139,290 | High |
| Cardiovascular mortality | 1.05, 0.94 to 1.16 | 9 trials, 170,227 | Moderate |
| Ischemic heart disease | 0.98, 0.94 to 1.03 | 4 trials, 164,881 | High |
| Stroke | 1.05, 0.95 to 1.17 | 3 trials, 107,421 | Moderate |
The review's own one-line conclusion is that general health checks are unlikely to be beneficial. Risk of bias was generally low for the primary outcomes.
What counts as a "general health check" in those trials?
Something very specific, and it is not every test you might buy. Cochrane defined a health check as screening for more than one disease or risk factor, in more than one organ system.
The trials enrolled adults unselected for disease or risk factors. Geriatric trials were excluded. So the finding is about offering a bundle to a general adult population, not about any single test inside it.
That distinction is the whole article. A bundle can be useless on average while a component inside it is one of the best-evidenced interventions in medicine.
What do the USPSTF grades actually mean?
They are statements about net benefit in a population, with a stated level of certainty. They are not opinions about whether a test is interesting.
| Grade | What the Task Force concluded | Suggested practice |
|---|---|---|
| A | High certainty the net benefit is substantial | Offer or provide this service |
| B | Net benefit moderate, or moderate certainty of more | Offer or provide this service |
| C | At least moderate certainty the net benefit is small | Offer selectively, by circumstance |
| D | No net benefit, or harms outweigh benefits | Discourage the use of this service |
| I | Evidence insufficient to weigh benefits and harms | Explain the uncertainty if offered |
A grade D is the interesting one for anyone buying a screening package. It does not mean the test is unproven. It means the Task Force decided the harms win.
Which screening tests do have evidence behind them?
The ones the US Preventive Services Task Force grades A or B, which means it found net benefit and recommends offering them. Colorectal cancer screening is the clean example, because the Task Force grades it A for adults aged 50 to 75.
| Screening | Population | USPSTF grade |
|---|---|---|
| Blood pressure | Adults 18 and over | A |
| Cervical cancer, cytology | Women 21 to 65 | A |
| Colorectal cancer | Adults 50 to 75 | A |
| Colorectal cancer | Adults 45 to 49 | B |
| Breast cancer, biennial mammography | Women 40 to 74 | B |
| Lung cancer, low-dose CT | Adults 50 to 80 with 20 pack-years | B |
| Abdominal aortic aneurysm, one ultrasound | Men 65 to 75 who ever smoked | B |
| Osteoporosis | Women 65 and over | B |
Colorectal screening also comes with a menu rather than one procedure. The Task Force lists annual fecal immunochemical testing, stool DNA-FIT every one to three years, CT colonography every five years, flexible sigmoidoscopy every five years, and colonoscopy every ten years.
Which tests does the USPSTF recommend against?
Several that appear inside commercial screening bundles. A grade D means the Task Force found the harms outweigh the benefits. An I statement means the evidence is insufficient to say either way.
| Screening | Population | USPSTF grade |
|---|---|---|
| Thyroid cancer | Asymptomatic adults | D |
| Ovarian cancer | Asymptomatic women | D |
| Pancreatic cancer | Asymptomatic adults | D |
| Carotid artery stenosis | Asymptomatic adults | D |
| PSA-based prostate screening | Men 70 and over | D |
| PSA-based prostate screening | Men 55 to 69 | C, individual decision |
| Vitamin D deficiency | Community-dwelling adults | I |
| Osteoporosis | Men | I |
| Mammography | Women 75 and over | I |
Korea is what a D grade looks like when it is ignored at national scale. Thyroid cancer diagnoses rose roughly fifteenfold between 1993 and 2011 after screening spread, and thyroid cancer mortality stayed flat.
What are the harms of screening a healthy person?
More tests, more procedures, and treatment for disease that would never have surfaced. Cochrane names the mechanism directly: screening increases the use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial.
The Task Force publishes the arithmetic for PSA screening, and it is worth reading in full. These are the estimated effects of inviting 1,000 men aged 55 to 69 to screening over thirteen years.
| Outcome | Men out of 1,000 |
|---|---|
| At least one positive PSA result | 240 |
| One or more prostate biopsies | 220 |
| Diagnosed with prostate cancer | 100 |
| Sexual dysfunction after treatment | 50 |
| Urinary incontinence after treatment | 15 |
| Avoided metastatic prostate cancer | 3 |
| Avoided dying of prostate cancer | 1.3 |
That is why the Task Force grades PSA screening C for this age band rather than B. The benefit is real and the harms are also real, so it made the decision an individual one.
Nothing in that table argues against PSA testing. It argues for knowing the shape of the trade before you buy it inside a package.
What is the difference between a screening program and a bundle of tests?
A program is defined by what happens after the result, and a bundle usually is not. That is the practical difference, and it is why the Cochrane finding and the USPSTF grades do not contradict each other.
A screening program specifies who is eligible, how often the test repeats, what counts as a positive, and what the next step is. Colorectal screening has all four. So does cervical screening.
A bundle specifies what is in the box. It usually does not specify the interval, the eligibility, or who pays for the workup when something is abnormal.
- A program names its population by age and risk. A bundle sells to whoever buys it.
- A program has a repeat interval derived from trial data.
- A program has a defined action for a positive result.
- A program is measured against a hard outcome, usually mortality.
So what does a reasonable person do with this?
Insist on the components a named body already recommends for their age and risk group, and treat the rest as optional. That is what the evidence supports, and no more.
| Age band | Recommended by USPSTF for most adults | Depends on risk |
|---|---|---|
| 18 to 39 | Blood pressure, cervical cytology from 21 | Little else by age alone |
| 40 to 44 | Blood pressure, cervical, mammography from 40 | Lung CT if smoking history qualifies |
| 45 to 49 | Add colorectal screening, grade B | Lung CT from 50 |
| 50 to 64 | Colorectal grade A, blood pressure, mammography | Lung CT, AAA ultrasound for men |
| 65 to 75 | All of the above, plus osteoporosis in women | One AAA ultrasound if male and ever smoked |
Everything in the "depends on risk" column is a conversation with your own physician, not a purchase decision. The Task Force writes its recommendations for populations, not for individuals.
What should you ask before buying a screening package?
Four questions, and they are the same four that a screening program has to answer about itself. Any provider should be able to answer all four.
- Which components carry a grade A or B for someone my age and risk profile?
- Which components carry a grade D or an insufficient-evidence statement?
- What is the repeat interval for this package, and where does that number come from?
- Who arranges and pays for the workup if something comes back abnormal?
The fourth question is the one most likely to go unanswered. The Cochrane review's stated concern about health checks is exactly this, that screening increases downstream diagnostic and therapeutic activity.
What this costs in Taipei
We sell screening packages, and every one of them is a bundle of the kind the Cochrane trials tested. The honest framing is that you can buy a smaller one, or buy only the parts that are graded for you.
| Package | Listed visit length | Price |
|---|---|---|
| Convenient | 1.5 hours | $299 |
| Convenient Pro | 2 hours | $399 |
| Vital | 2–3 hours | $699 |
| Light | 2 hours | $1,399 |
| Complete | 2.5 hours | $1,699 |
| Premium | 5 hours | $1,699 |
| Plus | 3.5 hours | $3,099 |
| Advanced | 6 hours | $3,499 |
Some components map onto a named recommendation for someone, and some carry a grade D for people without symptoms. Here is where they sit in our lineup.
| Component | USPSTF position | Our packages that include it |
|---|---|---|
| Low-dose lung CT | Grade B, adults 50 to 80 with a 20 pack-year history | Light, Complete, Plus, Premium, Advanced |
| Bone density scan | Grade B, women 65 and over; grade I for men | Vital, Complete, Plus, Premium, Advanced |
| Colonoscopy | Grade A, adults 50 to 75; grade B, 45 to 49 | None; it is a $499 add-on |
| Thyroid ultrasound | Grade D for thyroid cancer screening in asymptomatic adults | Convenient Pro, Vital, Light, Complete, Plus, Premium, Advanced |
| CA-125 tumor marker | Grade D for ovarian cancer screening in asymptomatic women | Convenient Pro, Vital, Premium, Advanced |
| Carotid ultrasound | Grade D for carotid stenosis screening in asymptomatic adults | Vital, Plus, Premium, Advanced |
Read that second table the way the Cochrane result suggests. The colonoscopy, the test with the strongest grade, is not inside any package, and several package components carry a grade D.
A reader who wants only the guideline-backed parts should say so and buy accordingly. Some single tests, such as the DEXA scan, can be booked on their own. The full list is on the health screening page, and our guide to choosing between the tiers goes through the same trade in more detail.
The bottom line
The annual physical, tested as a bundle in 17 randomized trials, does not lower the chance of dying. That result is stable, high-certainty, and about twenty years old in its first form.
The individual tests are a different story, and a short list of them has genuinely good evidence for specific populations. If you buy nothing else, colorectal screening from 45 and a blood pressure reading are where the evidence is strongest.
Whether a larger bundle is worth the money to you is a judgment about information, not about survival. Make it with your own physician, and read our note on what to add and what to skip before you decide.
Sources
- Cochrane Database of Systematic Reviews — Krogsbøll, Jørgensen & Gøtzsche, General health checks in adults for reducing morbidity and mortality from disease, 2019 (accessed 2026-09-09)
- US Preventive Services Task Force — Grade Definitions (accessed 2026-09-09)
- US Preventive Services Task Force — Hypertension in Adults: Screening (accessed 2026-09-09)
- US Preventive Services Task Force — Cervical Cancer: Screening (accessed 2026-09-09)
- US Preventive Services Task Force — Colorectal Cancer: Screening (accessed 2026-09-09)
- US Preventive Services Task Force — Breast Cancer: Screening (accessed 2026-09-09)
- US Preventive Services Task Force — Lung Cancer: Screening (accessed 2026-09-09)
- US Preventive Services Task Force — Abdominal Aortic Aneurysm: Screening (accessed 2026-09-09)
- US Preventive Services Task Force — Osteoporosis to Prevent Fractures: Screening (accessed 2026-09-09)
- US Preventive Services Task Force — Prostate Cancer: Screening (accessed 2026-09-09)
- US Preventive Services Task Force — Thyroid Cancer: Screening (accessed 2026-09-09)
- US Preventive Services Task Force — Ovarian Cancer: Screening (accessed 2026-09-09)
- US Preventive Services Task Force — Pancreatic Cancer: Screening (accessed 2026-09-09)
- US Preventive Services Task Force — Asymptomatic Carotid Artery Stenosis: Screening (accessed 2026-09-09)
- US Preventive Services Task Force — Vitamin D Deficiency in Adults: Screening (accessed 2026-09-09)
- New England Journal of Medicine — Ahn, Kim & Welch, Korea's thyroid-cancer epidemic, screening and overdiagnosis, 2014 (accessed 2026-09-09)
- American College of Radiology — ACR Statement on Screening Total Body MRI, 17 April 2023 (accessed 2026-09-09)
US / UK terms and the closest Taiwan context
Read this first: These are comparison aids, not claims that coverage, credentials, or care pathways are equivalent. Europe is not one health system; UK examples below refer specifically to NHS England.
Annual Wellness Visit (AWV), annual physical, health checkup
- What it means there
- Medicare describes the AWV as a prevention-planning conversation and explicitly says it is not a routine physical exam.
- Closest Taiwan context
- Taiwan HPA adult preventive services (成人預防保健) include defined history, measurements, examinations, laboratory items, and counselling for eligible age groups. Private self-pay checkups are a separate service whose contents vary.
- Do not treat as equivalent
- AWV, a US routine physical, Taiwan government-funded preventive care, and an executive self-pay package are not interchangeable names or benefit sets.
- What to ask
- Request the exact item list, eligibility rule, physician consultation, follow-up plan, and whether each item is NHI-funded or self-pay.
Screening vs diagnostic work-up
- What it means there
- Screening generally concerns people without recognized signs or symptoms. A symptom, abnormal examination, or positive screen can require a separate diagnostic assessment.
- Closest Taiwan context
- Taiwan uses 篩檢 for defined screening programs and 診斷／進一步檢查 for evaluation of symptoms or abnormal findings.
- Do not treat as equivalent
- Calling a scan a “screening” test does not establish that it is recommended for every asymptomatic person, covered by insurance, or sufficient to diagnose or exclude disease.
- What to ask
- Tell the clinic about symptoms and risk factors, then ask whether the proposed test is screening or diagnostic and what follow-up is planned for normal, unclear, and abnormal results.
