This article approaches informal relations in post-socialist settings from a political economy perspective. Taking as a case study informal exchanges in the Romanian healthcare system, the article addresses the question of their continuity in the face of both divergent claims and increased monetarization of exchanges. It contends that informal exchanges are individual responses to the increased inequalities that followed the post-socialist redesign of the state. However, by further heightening social inequalities and competition, contemporary neoliberal reforms exacerbate the predatory side of informal exchanges, thus threatening to disrupt their fragile accommodation with post-socialist transformations. © Royal Anthropological Institute 2012.