Nicola Sturgeon has dismissed a leaked document discussing turning NHS Scotland into a two-tier system where the wealthy pay for care.
Minutes from a meeting of senior health officials in September, seen by the BBC, claimed the chief executive of NHS Scotland, Caroline Lamb, had given the "green light" for the idea to be talked about as the service faces an ongoing crisis.
One suggestion in the minutes was to "design in a two-tier system where the people who can afford to, go private".
But the country's first minister said she was "emphatically" against the idea.
Ms Sturgeon added: "The founding principles of the National Health Service are not up for discussion.
"It's democratically elected governments who decide the policy basis of the National Health Service."
Asked if she or her ministers knew the discussions were taking place, she said: "I don't dictate to NHS chief executives what they can and can't discuss - we live in a democracy."
Other suggestions in the minutes included setting a target to discharge patients within 23 hours, a review of long-term drug prescriptions and applying a charge for freedom of information requests, with officials claiming there was a £1bn fiscal black hole to fill.
But Ms Sturgeon claimed NHS Scotland was outperforming other areas of the UK and had her full support.
"Let me be unequivocally clear, we will do that within those long established, well accepted and, I think, almost universally supported principles of a public service free at the point of use and need," she said.