Health boards broke even last year but face more pressure to balance their books in 2012-13, with further savings of over £270 million required, a report has found.
All 23 boards met their budget targets for the fourth year running in 2011-12, according to an Audit Scotland report on the financial performance of the NHS.
But the report found that this was achieved by moving funding across the NHS during the year, which was not clearly reported in boards' financial statements, while some boards also received extra help from the Scottish Government.
Audit Scotland said the requirement for boards to break even each year encouraged a short-term focus on spending. Boards said they will need to save a total of £271.7 million in 2012-13 because of budget pressure.
Auditors reported that these savings plans "will be challenging to achieve, as the level of flexibility within budgets is considerably reduced by cost savings made in previous years".
Capital budgets are also falling which reduces boards' ability to invest in new ways of working and maintain buildings and equipment, they said.
Auditor General for Scotland, Caroline Gardner, said: "The NHS in Scotland continues to manage its finances within its total budget and has achieved this for the fourth year in a row.
"The annual accounts show a picture of good financial performance but this doesn't reflect the pressure boards faced in achieving this. Money was moved between boards, several relied on non-recurring savings and some needed extra help from the Scottish Government to break even in 2011-12.
"The requirement for boards to break even each year encourages a short-term view, and the NHS needs to increase its focus on longer-term financial planning."
Health Secretary Alex Neil said: "We are committed to protecting spending on health and our latest, £11.5 billion budget reflects a funding increase in real terms for every territorial health board across Scotland."