NHS leaders in Scotland have discussed abandoning the founding principles of the service by having the wealthy pay for treatment.
The discussion of a "two-tier" health service is mentioned in draft minutes of a meeting of NHS Scotland health board chief executives in September.
They also raise the possibility of curtailing some free prescriptions.
Scotland's Health Secretary Humza Yousaf insisted the NHS would stay publicly owned and publicly operated.
He added that health services "must always" be based on individual patient need and "any suggestion" that it should be about the ability to pay was "abhorrent".
The minutes of the meeting seen by BBC News highlight the degree of official concern about the sustainability of Scotland's NHS in its present form.
They include suggestions that hospitals should change their appetite for risk by aiming to send patients home more quickly, and pause the funding of some new drugs.
The group were advised that they had been given the "green light to present what boards feel reform may look like" and that "areas which were previously not viable options are now possibilities".
Describing a "billion pound hole" in the budget, the minutes warn that it "is not possible to continue to run the range of programmes" the NHS currently offers while remaining safe "and doing no harm." And they warn that: "Unscheduled care is going to fall over in the near term before planned care falls over."
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Source: BBC News, 21 November 2022