Scotland's health secretary Nicola Sturgeon has vowed to press ahead with direct elections to NHS boards, despite strong opposition from the health service.
In an unusual move, around a third of NHS boards have publicly opposed the plans, which would see members of the public elected to health boards, while a further third have voiced reservations.
Other influential bodies, including the British Medical Association in Scotland, have also criticised the proposal, which is expected to cost£20m to introduce.
On Monday the Scottish Parliament's health and sport committee offered only conditional support for the legislation required to set the system up, saying elections should be piloted alongside alternative public participation schemes.
Ms Sturgeon told HSJ many people felt there was a "democratic deficit" in health board decisions and the proposals would "allow the public voice to be heard and listened to at the heart of the decision making process".
She said she was encouraged by support from the unions Unite and Unison, and called on NHS boards to work with her.
"While there are clearly differences of opinion among health boards at present, I am confident we can work together to ensure elected health boards are a great success [and] bring greater accountability and transparency," she said.
In response to the health and sport committee's call for evidence on the bill, NHS boards across Scotland had mixed views, with only one, NHS Fife, supporting it. Concerns raised include the cost.
NHS Tayside chair Sandy Watson, said: "The board would emphasise that if these funds were made available across each board area, they could make a sizeable contribution to the development of other means of public engagement, particularly community engagement."
NHS Forth Valley cautioned against "additional bureaucracy" and said: "[It] seems likely that the costs associated with introducing direct elections might be better spent on direct patient care." NHS Lothian warned elections could be overwhelmed by single issue candidates.
BMA Scottish GPs committee chair Dean Marshall, who also opposes the move, was surprised that the boards were so outspoken.
"It's unusual for health boards in Scotland to oppose the government so this shows the strength of feeling against this plan," he said.
A project to offer health checks to those most at risk of heart disease, stroke and diabetes in Scotland is to expand. Keep Well checks - which offer early intervention and advice to people in deprived communities - will now operate in almost all of Scotland's NHS boards.