The origin of the public-private relationship in the health system lays on the creation and development of social welfare. Within the SUS, such relationship is maintained and has gained strength and stability, especially in the levels where there is opportunity for profit. This study, of qualitative basis and focused on the State Health Secretariat (SHS) of Mato Grosso, Brazil, aims to explore, in this management sphere, the public-private link within the ambulatory care of high and medium complexity. Data collection included documents and interviews with technicians from that area and empirical material explored through content analysis. The results showed that: the state accredits/enables or hire ambulatory care services of high and medium complexity according to the logic of private offer; health management is poor; the performance of Regional Inter-Management Commissions is passive; Social Health Organizations have different evaluation and control processes and receive values above SUS standards, not meeting established protocols and parameters. There is no evidence that favouritism towards the private sector will be reversed in the current work of the SHS, on this level of care.
