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From a US perspective, even this seems wild to me. I've always been told that at least an annual physical exam with bloodwork is highly recommended as the standard of care for adults of all ages.

Not everyone chooses to get them, of course. But ACA insurance plans here offer at least one annual physical exam free of charge (considered preventative care).

Cynically - this sounds like an opportunity to sell you more medical care.

The NHS isn't perfect, but one of the things it does well because of it's structure is minimise costs holistically. It's cheaper to treat conditions early, so usually implements appropriate screening to catch things. If they don't do regular checkups like this it's because they're of minimal value.

There’s a decent amount of public health research that suggests that annual physical exams don’t actually have a large impact on health.

In the US case specifically, I always wonder how much of the benefit is just “here’s a free appointment with a doctor once a year”.

It's not free. If you bring anything up, you will be charged. I know because I've paid hundreds of dollars for "free" physicals that way.
It's free if you don't bring up things that should technically have been a dedicated own appointment.

The idea behind physicals is they're considered preventative care... catching problems early, often before there's any overt symptoms. For example, checking your cholesterol and A1c levels before they progress to heart failure or diabetes.

Once you're showing symptoms, you've left the realm of preventative care and it's now diagnostic/treatment for a established issue.

(ACA only provides 100% free coverage for visits that are 100% within the "preventative care" box.)

Annual exams were included in the ACA but as I understand it there is no evidence to show that they improve health outcomes. I had one once in 15 years when it was incentivised by my employer (presumably trying to show that we were low risk to reduce the rates they paid?) but otherwise my doctor has never tried to book me for one.

I think I'd prefer the UK system where if you worry something is wrong you can see a doctor free of charge.

Anecdotally, I've found yearly physicals with full blood workup very helpful in heading off issues before they become much larger issues. For example, a random blood marker pointed at mold exposure. I thought that was strange, I didn't think we had any mold. Then I tore open one of my ceilings, there was a very slow leak in the bathroom above the top of that drywall was covered in mold. I replaced all of that drywall, and that blood marker shot down, and a few others improved drastically, and my energy levels improved. By going regularly, you get to see the trend lines on various things - those other markers had been going in a worrying direction over time.
Do you happen to recall, which blood marker this was? In my living situation, mold might be an issue, but it seems to be hard to actually test for it.
C4a, iirc, followed up by some specific tests for mycotoxins in urine.

And yeah, it can be really tricky to find the mold itself.

I wonder how accurate that is. As in, these screenings are meant to detect early signs of issues like diabetes, liver problems, cholesterol, blood pressure, and so on. Is the case that many people are healthy and don't need it? That we haven't had a long enough sample time to know how screening in the 30s affects outcomes in the 60s?
That tends to be part of the regular health checkup.

I think that there's a working assumption amongst US folk that because the NHS is is publicly funded, it must be terrible.

Actually, I would've have assumed the other way - that the NHS was better than the US system. Which was why I was shocked when you said health checkups aren't allowed before age 40. :)

US healthcare plans offer an annual physical exam every year at all ages. Looking at the UK NHS website, it seems to be only offered there after age 40, and limited to once every 5 years? Am I reading that right?

> Actually, I would've have assumed the other way - that the NHS was better than the US system.

I thought it was relatively uncontroversial that the major problem with US healthcare is not quality but cost. And the UK NHS is widely regarded as one of the lower quality implementations of single payer in any modern social democracy [0].

[0] https://www.usnews.com/news/best-countries/rankings/health (#23, but Canada is actually worse!)

That’s exactly what they said?

> it's entirely possible you'd simply never see a doctor again in your life until you're ready for your prostate exam in older life

I'm confused too. Prostrate screening starts at age 50 in the US. Every response seemed to corroborate the original point at least as applied to men.