This article presents the results of comprehensive analysis of informal labor and economic practices in the health care system of the Russian Federation. It is proved that informality is not a random deviation but a persistent systemic element, that is reproduced as the result of fundamental break between formal norms and real conditions of professional activity. The methodological basis of the study included content analysis of scientific publications, analysis of official Rosstat data and application of the balance method to estimate the scale of informal employment. The significant and growing percentage of informal employed in the sector, estimated by the balance method as 29.6% of the total number of workers in 2023 is established. The diversity of forms of informality, including shadow employment, informal payments between patient and physician, doctor records in official reports, activities in private and alternative sectors not regulated by legal field are systematized. The main causes of their existence are break in financing of state guarantees, disparities between expected and factual level of wage, excessive regulation and institutional contradictions. The conclusion is made that informal practices perform compensatory function, ensuring viability of the system in conditions of institutional dysfunctions but at the same time simultaneously generate serious risks for quality of medical care, principles of social justice, and legal protection of citizens. It is proposed to direct the efforts not to forceful suppression of informal practices, but to elimination of their systemic causes through harmonization of normative regulation.

informal employment, health care system, formal norms, informal economy, medical care, corruption..