Humza Yousaf has insisted the NHS in Scotland will stick to its "founding principles" and will not start charging patients for treatment.
The under-pressure health secretary spoke out after a leaked document revealed senior bosses had debated the creation of a "two-tier system" which could see wealthier Scots asked to pay.
The minutes were compiled from a meeting in September given the "green light" by NHS Scotland chief executive Caroline Lamb to discuss reform of a service which finds itself in crisis.
Yousaf said: "The Scottish Government’s policy could not be clearer, our National Health Service must be maintained to the founding principles of Bevan – publicly owned, publicly operated, and free at the point of need.
"The provision of health services must always be based on the individual needs of a patient – and any suggestion that this should in some way be based on ability to pay is abhorrent."
The leaked document also mentioned a review of free prescription drugs and the funding of new drugs.
It mentioned it would no longer be possible to "continue to run the range of programmes" offered by the health service as it faced a £1 billion funding gap. One suggestion in the minutes is to “design in a two-tier system where the people who can afford to, go private,” the document said.
Other ideas included changing the “risk appetite from what we see in hospitals” by setting a target of discharging patients to their home for treatment within 23 hours.
But the minutes of the meeting accept that “it is not gold standard but what other countries can do without an NHS”.
The SNP minister added: "Prescription charges are a tax on illness, they were scrapped by this Government and they will not be returning in any shape or form.
"I routinely meet the Scottish Government’s senior clinical team, led by the Chief Medical Officer, at least weekly and have further specific engagement on individual matters with these vital advisers. There is also frequent engagement between Ministers and NHS board chief executives, and daily discussions between the Scottish Government and individual health boards on service performance and pressures.
"Our NHS and care services continually evolve to meet the changing needs of the people of Scotland, and reflect changes in practice and medicine. In our five-year NHS Recovery Plan we have outlined our commitment to continued investment and reform of the NHS, alongside delivering the National Care Service.
"As we continue our recovery from Covid we must recognise the enormous impact the pandemic has had on our health service.
As a result of the global pandemic, which has affected health services across the world, a number of targets have not been met."
Nicola Sturgeon said the principle of the NHS being free for all is "not up for discussion" and denied the meeting between health bosses was a reflection of Scottish Government policy.
"The founding principles of the National Health Service are not up for discussion," the First Minister said. "It’s democratically elected governments who decide the policy basis of the National Health Service.”
When asked if she or her ministers knew NHS leaders were taking part in these discussions, the SNP leader added: "I don’t dictate to NHS chief executives what they can and can’t discuss – we live in a democracy."
Scottish Labour branded Yousaf "the worst health secretary in the history of the Scottish Parliament" and has called on him to resign ahead of what the party feared could turn into a humanitarian crisis in the NHS this winter.
Jackie Baillie, the party's health spokeswoman, said: "The facts are clear for all to see – the SNP has crashed our NHS at the expense of staff and patients.
"Across our country hospitals are overwhelmed, staff are demoralised and patients are being put in danger. Years of SNP missed targets and broken promises are coming home to roost. Behind every failed standard are thousands of patients who have been let down, many of whom are desperate for treatment and are left in pain and anxiety. It simply isn’t good enough.
"Rather than acting to arrest the decline of our NHS under the SNP, Humza Yousaf has only added fuel to the fire – and we are now heading towards a humanitarian crisis this winter.
"Without doubt, Mr Yousaf is the worst Health Secretary in the history of the Scottish Parliament. We simply can’t go on like this – it’s time Mr Yousaf did the right thing and go."
Alex Cole-Hamilton, the Scots Lib Dems leader, said: "Our health service is being overwhelmed. It's a damning verdict on the SNP's handling of the NHS that senior health bosses are discussing proposals like this.
"It’s not just that they are worried about budgets not being able to meet demand without tearing up the foundations of our health service, it’s that they feel that the Scottish Government might tacitly approve.
"As the party responsible for free personal care, eye checks and dental checks, Scottish Liberal Democrats have been at forefront of the battle to ensure that NHS should be free at the point of use.
"Humza Yousaf is looking increasingly lonely and embattled. He needs to come forward with a new plan to cut waiting times and end the chaos in emergency care. If he can’t do that, he should go.”
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