As far as I know, Shanxi and Inner Mongolia have always insisted on newbies obtaining homeland health checks before the issuance of Z visas abroad. Despite this, second health checks in China were also required. In contrast, newbies for Hebei posts weren't required to undergo homeland medical checks in order to obtain a Z visa abroad. After arriving, they were asked to take a Chinese health check before a Residence Permit was issued to supercede the Z visa.