Dr Coleman's Cabinet committee paper is among a tranche of documents released this week under the Official Information Act.
The papers also reveal changes will be implemented in southern health in 2017.
Dr Coleman's view on the election changed, as a Bill passed its first reading this month to extend the commissioner regime at Southern District Health Board until 2019.
The reason for the change of heart is unclear.
"It was decided the best option was to hold it at the same time as the next . . . election [in] 2019,'' a spokeswoman told the Otago Daily Times yesterday.
Dr Coleman's paper for Cabinet's social policy committee meeting on November 4 expressed concern about the loss of democratic input.
"[Cancelling the election] would mean that a commissioner would have been in office at the DHB for a term of four and a-half years.''
"This is too long a period without democratically elected DHB representation and I expect the commissioner to have completed the task well before then.''
The task includes shaking up some health services to make them "more efficient and/or effective''.
He proposed postponing the election, holding it in October 2018 at the latest.
He feared the postponement could draw criticism for "negatively impacting local democratic processes''.
Concern could be mitigated by telling the commissioner to do more public consultation on major service changes, the paper says.
Also released was advice to Dr Coleman from a senior official spelling out his options and the potential risks.
"There is a risk of criticism because of a perceived diminution of democracy ... While there was little public criticism of the initial appointment of the commissioner, the extension of the commissioner's term past the DHB election period may exacerbate potential concerns.
"Action to extend the term of the current commissioner may attract criticism if she has not demonstrated improved DHB performance by December 2016.
"This is potentially mitigated by [legal provisions] which provide that you may at any time after the dismissal of the board, dismiss a commissioner from office and appoint a new one if desired,'' National Health Board acting national director Michael Hundleby told Dr Coleman.
Mr Hundleby's paper mentions 2017 service changes as a cost-cutting measure, but gives no detail of service changes.
The ODT was refused a copy of a special communications plan drawn up by the Ministry of Health and board commissioner Kathy Grant.
The request was declined under the "free and frank expression'' provision of the OIA.
The ODT has complained to the Office of the Ombudsman over the decision.
The board members were sacked six months ago.
Mrs Grant and her deputy commissioners have kept a low profile, and there has been little discernible action apart from a one-page "work plan'' released last month promising more staff input into decisions.
Without a law change, Mrs Grant's term expires in December next year.
She could not be contacted.
