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This article aims to problematize the interaction between Family and Community Medicine and the supplementary health system (private healthcare services and private health plans) in Brazil’s current scenario. The point of departure is a historical contextualization, proceeding to some central aspects in this movement. In the history of health policies in Brazil before and after the creation of the Unified National Health System (SUS), one of the greatest challenges has been public-private relations. This process shaped a field of interests, actors, and disputes that weaken the possibilities for achieving health as a civil right and the SUS as a social policy of the State 1. While arguments indicate that inclusion of the private sector in health was a condition for the approval of the chapter on health in the 1988 Federal Constitution 2, different forms of incentives have been granted by the state to the private sector, while major underfunding still exists in the SUS 3. Added to this is the symbolic and imaginary construction in Brazilian society, positively valuing the private health sector to the detriment of the public sector. Primary healthcare (PHC) has been one of the key strategies in the implementation of the SUS, considering the guarantee of universal access. The principal model instituted in 1994 was the Family Health Program, later reconceptualized as the Family Health Strategy (ESF in Portuguese). The ESF was expanded and improved in the subsequent decades and currently has 42,000 teams (with general medical practitioners, nurses, nurse technicians, and community health agents), covering 63% of Brazil’s territory 4. In addition to internationally acknowledged attributes such as access and first contact, comprehensiveness, continuity over time, and coordination of care 5, Brazil’s PHC also features multidisciplinary teamwork and a strong territorial approach. This is seen in the population’s modes of enrollment in the system, in the approach to collective health problems and risks, and in the community health agents 6. The main challenges in the history of the implementation of the ESF have been training, distribution, hiring, pay scales, and development of health professionals, especially physicians 7. In this sense, although Family and Community Medicine has existed in Brazil since the 1970s 8, more intensely since 2011 9, national policies were formulated that targeted the physician workforce in PHC. The More Doctors Program (PMM in Portuguese), with its components of emergency provision and training (undergraduate medical education and residency) was quite emblematic, with a central focus on Family and Community Medicine in national law and on the government agenda 7,10. Family and Community Medicine in the supplementary health system in Brazil: implications for the Unified National Health System and for physicians

Medicina de Família e Comunidade na saúde suplementar do Brasil: implicações para o Sistema Único de Saúde e para os médicos