The article examines the structural causes of informal employment and corruption practices in public healthcare institutions. Unlike the traditional approach, which views informality as a shadow activity outside of legal institutions, the authors argue that it can be integrated into formal employment as a systemic response to the household budget deficit of healthcare workers. Based on an analysis of a large dataset (wages, hours worked, and staff turnover from 2015 to 2024), they identify and mathematically prove a critical relationship between the deviation of wages from regional averages and the amount of additional work. Results. A direct correlation (r = 0.994; p < 0.001) has been established between income deficiency and the necessary intensification of labor. It has been proven that when the physiological limit of working time (1.5—2.0 rates) is reached, the employee's survival strategy transforms into an intensive form, namely, the implementation of administrative and professional resources in the informal sector (monetization of status). Conclusions. The paper substantiates that informal payments for access to services (quota VMP, issuance of sick leave) are not a deviation, but a systemically conditioned mechanism for compensating for the reproduction of human capital. Repressive measures to combat the shadow sector will be ineffective without addressing the mathematically proven imbalance in wages.

informal employment, healthcare economics, correlation coefficient, staff shortage, VMP quotas, occupational deformation, shadow payments, status monetization, remuneration.