With the new year comes opportunity and another chance at change.

Without a doubt, the health care industry will continue to face challenges, for better or worse.

Doctors (and their patients) could be facing a serious crisis, Larry Matheis, executive director of the Nevada State Medical Association, said in an e-mail.

"2008 is likely to see the consequences of the actions and decisions of 2007," Matheis said. "All in all, 2008 may well be the most challenging year yet to Nevada health care professionals, public officials and to the health care system itself. We have the resources to meet the challenges, but it will be a test of our community will and individual flexibility as to whether we make the best of those resources."

Matheis cited state-approved budget cuts to Nevada Medicaid (which covers more than 300,000 people) and Nevada Checkup (covers 30,000 children).

The programs, he said, "are likely to see cuts from the state budget approved last June depending on the depth of the state revenue shortfall. Since the Nevada Medicaid program already is 50th in eligibility requirements, there is already a larger percentage of indigent patients for whom no coverage is available."

As Southern Nevada continues its exponential growth, Matheis said the number of the state's uninsured is likely to increase, continually stressing hospital emergency departments and various clinics for uninsured, low-income people.

Matheis said it's likely Nevada's "worst-in-the-nation statistics" will continue for rankings such as most pregnant women in their first trimester not receiving prenatal care, the rate of pregnant women showing up to emergency departments for delivery and low preschool immunization rates.

Budget cuts could adversely affect mental health services, he said, especially if additional beds at the psychiatric hospital are delayed or if the supply of mental health workers fails to meet the demand. Those cuts will initially be noticed in emergency rooms where more patients will be kept for psychiatric observation, reducing service to other incoming emergency patients, he said.

Other cuts may affect treatment for autistic youngsters and methamphetamine use, and the development of a child immunization registry, which were all new programs approved in the 2007 budget.

Matheis said the priority needs to be getting more nurses and doctors.

"We must grow our own medical specialty community, our own future faculties and researchers," he said. "In 2008, we either build on the momentum that has developed over the last three years or we lose that momentum and probably fail to meet our long-term needs, although we won't know until 2012 to 2018 if we've failed on that."

At the federal level, the situation is just as uncertain, with the likelihood that 2008 will be worse than 2007, he said.

"The biggest failure was to deal with a flaw in the Medicare payment formula for professional services," Matheis said.

He expects the proposed concentration of power into the UnitedHealth Group "supermergers" by way of acquiring health insurer Sierra Health Services and health plan administrator FISERV to continue to draw regulatory scrutiny well into 2008, he said.

"Litigation to block the unprecedented consolidation of health insurance products is also certainly possible," he said. "Nationally, the consolidation of health insurance companies is likely to continue, but the UnitedHealth experience in Nevada is likely to determine how the others proceed."