A brief discussion of the development of Native owned health provider agencies in Alaska within the context of anticipated health and systems issues.

The Self-Determination Act brought about an explosive growth of tribally run programs in Alaska during the 1970s at the same time that the Alaska Native Claims Settlement Act was being implemented. Tribes demonstrated great creativity in blending IHS with other sources of funds to develop more effective and more acceptable delivery of services to their people. Further, the tribes in Alaska have demonstrated great aptitude in developing effective lobbying techniques with the United States Congress, such that they have actually been able to increase their funding base beyond what was assumed at the time of takeover from the IHS. However, several problems loom on the horizon. First, there is the problem of cost shifting within the IHS which contains the potential that tribes opting not to take advantage of the Self-Determination Act may be victimized by those who do. Second, there is the problem of too few resources to serve too many patients, which from time to time, propels the Indian Health Service toward an attempt to change the rules with respect to eligibility for services. Finally, the ability of the Indian Health Service (and by extension, its contract tribes) to provide an adequate level of services to American Indian and Alaska Native clients is being dramatically eroded by the same inflationary forces that are driving the larger system of health care in the United States toward the brink of disaster.