Health examinations are performed so that diseases can be identified and treated earlier. Several studies have evaluated the determinants of participation in health examinations including cancer screening, but few have evaluated the relationship between the size of the enterprise and their participation in Workers’ General Health Examinations (WGHE). The aim of the present study was to estimate the association of WGHE participation with the size of the enterprise and the type of policyholder.

The eligible population from 2006 through 2013 was extracted from the National Health Insurance Service (NHIS) database. The population size ranged from 14–17 million. After adjustment for age and gender, multiple logistic regression analysis was performed to estimate the odds ratios of participating in the WGHE (by age group) based on the type of policyholder (reference: public officers) and the size of the enterprise (reference: enterprise size ≥300 employees), respectively.

Workers employed at enterprises with <50 persons were less likely to participate in WGHEs than those employed at enterprises with ≥300 persons. After policyholders were stratified by type (non-office workers vs. public officers), a disparity in the WGHE participation rate was found between the different types of policyholders at enterprises with <50 employees (reference: those employed at enterprises with ≥300 employees); the odds ratios for subjects in their 40s and 50s were 0.2–0.3 for non-office workers vs. 0.8–2.0 for public officers.

Workplace policyholders at small enterprises comprised a vulnerable group less likely to participate in WGHEs. Efforts should be made to raise the WGHE participation rate among the vulnerable employees belonging to small enterprises, as well as among their dependents.

Our study evaluated the effectiveness of the Workers’ General Health Examination by health examination period and compliance.

A retrospective cohort of the health examination participants in 2006 (baseline year: N = 6,527,045) was used. We identified newly occurring cardio-cerebrovascular disease over 7 years (from 2007 to 2013). After stratification by age, sex, and national health insurance type, we identified 7 years’ cumulative incidence of cardio-cerebrovascular disease by health examination compliance and estimated its relative risk by health examination period and compliance.

The compliant group presented a lower cumulative incidence of cardio-cerebrovascular disease than the non-compliant group; this result was consistent across sex, working age (40s and 50s), and workplace policyholder. Relative risk of cardio-cerebrovascular disease by health examination period (1 and 2 years) showed statistically significant results in ischemic heart disease for male participants. Of men in their 40s, office workers (over a 2-year period) presented statistically higher relative risk of ischemic heart disease than non-office workers (over a 1-year period: 1.03; 95% confidence interval, 1.02–1.03). However, there were no consistent results in ischemic cerebrovascular disease and hemorrhagic cerebrovascular disease for men or cardio-cerebrovascular disease for women.

A 1-year period of Workers’ General Health Examinations in non-office workers had a more significant prevention effect on ischemic heart disease than a 2-year period in office workers among working age (40s–50s) men. It is, however, necessary to consider that prevention of cardio-cerebrovascular disease can be partially explained by their occupational characteristics rather than by health examination period.