There has been little enthusiasm from MSPs over plans for health boards to be directly elected.
MSPs on Holyrood's health committee gave their support to a pilot scheme to have health board elections in two areas, but said there was no "overwhelming case for direct elections".
The committee said while there is a need to improve public accountability, the results of the pilot should be compared with other schemes to improve public involvement before the practice is considered further.
Under the scheme, the boards would have three types of member – a chair and other members appointed by ministers, local councillors appointed by ministers, and members directly elected by postal ballot for a four-year term.
The elections, which are part of a pledge made by the Scottish Nationalist Party (SNP), have been welcomed by unions, but health boards have not given them much support.
Under the plans, 16-year-olds would qualify to vote, but this has been met with "serious concerns" and is opposed by the Electoral Commission.
The pilots will now run for up to seven years before potentially being extended nationwide.