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The changes come after an agreement between the province and Quebec’s general practitioners aimed at reviewing the billing code for doctors.

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Healthy Quebecers may now have a harder time booking routine annual physical exams after the province became the latest jurisdiction Wednesday to implement rules to eliminate the once-standard practice.

Under the regulations, doctors will be able to bill the health-care system for a full annual exam only for patients over the age of 5 who are vulnerable or have health problems, a spokeswoman for Health Minister Gaetan Barrette said.

"This change supports the College of Physicians guidelines on best practices in medicine, namely that it is not necessary to conduct an annual review with a patient who does not have a health problem," Julie White said in an e-mail.

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"That said, the healthy patients can be examined in the context of a follow-up visit with their doctor or another doctor."

The changes come after an agreement between the province and Quebec's general practitioners aimed at reviewing the billing code for doctors.

In revising its guidelines, the province is following the lead of several others including British Columbia, Newfoundland and Labrador, New Brunswick and Nova Scotia in introducing measures to cut funding for annual checkups.

In 2012 Ontario also brought in new rules geared to "modernizing" the annual health exam and personalizing it to individual needs to reduce unnecessary tests.

Quebec's changes are based on a growing body of evidence that systemic checkups for healthy patients are unnecessary and don't help to prevent disease, according to the president of the province's federation of general practitioners.

"To systemically send someone who is 25, 30 years old and with no symptoms or risk factors to a doctor doesn't hold water," Louis Godin said in a phone interview.

He said doctors can still agree to give checkups to healthy patients who ask for them, but they will now be billed to the system as "follow-up visits" and may be less thorough than exams for sick patients.

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The president of one patients' rights group criticized the new approach as "short-sighted."

Jerome Di Giovanni says it's a mistake to wait to treat people once they're sick instead of focusing on promoting long-term health.

He said annual checkups can help to reinforce healthy habits, make sure people are sticking to treatment plans and weed out potential problems down the line.

"What costs less? Screening out a disease at its beginning or waiting for someone to be gravely ill and who has to go to the emergency room?" said Mr. Di Giovanni.

"We talk a lot about prevention, but in Quebec we invest very little."

The Quebec College of Physicians has recommended against having annual physicals for asymptomatic adults with no risk factors and believes the new guidelines will free up resources in the health system.

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"If you do a whole bunch of useless tests every year, doctors' agendas are filled and they're not seeing sick people, they're seeing healthy people," said college president Charles Bernard.

"We can't use resources blindly, doing things just to do them."

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