OBJECTIVE Describe the Alaska Native Health Care delivery system and some of the historical elements that shaped it. METHODS Retrospective program review. METHODS Retrospective review of existing administrative and clinical programs. RESULTS Over the last 10,000-15,000 years the Alaska Native Health System developed from at traditional tribal based self-care system to a complex system that is interdependent on local, state, federal, and private insurance payers. The Alaska Tribal Health System takes an intentional approach to planning. While the system may face an uncertain future, it is poised to continue it remarkable success. The regional health corporations are the backbone of the system and it is the regional health corporations that own the Alaska Tribal Health System. In addition, it is the Alaska Tribal Health System that is responsive to the needs and priorities of the regional health corporations and their Native constituents. The spirit of the Alaska Native has inspired their health care providers at all levels to develop innovative "work arounds" to provide state of the art care through regionalization and telemedicine. Despite the many challenges ahead, the Alaska Tribal Health System will continue to strive to increase the health of Alaska Native people to the highest status possible. CONCLUSIONS The Alaska Native health care system is a dynamic system administered by and for Alaska Native peoples. This system has risen to many challenges in the past and has made great strides through both ingenuity and necessity.