The paper examined the conditions that allow alternative logics a long standing coexistence, when no one logic predominates in the supplementary health field in Brazil. It contributes to the literature bringing the analysis of the coexistence over several decades of the following competitive logics - professional, public, market, regulatory, and social protection logic, in an institutional order level, while medical groups, insurance companies, and cooperatives established alternative health provision logics in the market level. The state’s incapacity or unwillingness to alienate the private sector is the main reason for the emergence of the various market medical providers with their distinct forms of service delivery.