This paper analyzes informal payments in Eastern European and Central Asian (ECA) public healthcare systems. Informal payments comprise any purchase of health services outside of formal payment channels and therefore escape reporting and regulation measures. These payments, which are highly prevalent across the region, impede access, decrease equity and ferment systemic corruption. As a result, patients either consume less health care or sell personal assets to pay for treatment. This paper highlights the policy implications of informal payments and explores potential solutions to this problem.