In many countries absent or poorly functioning prepayment mechanisms for health care expose families to the financial risks associated with accidents and sickness. The report exploits a specially designed health governance and accountability module that was added to the 2008 wave of the Albania LSMS to gain additional insight into the determinants of informal payments and household perceptions and experiences of governance in the health sector more generally. This report is structured in four parts. Following the motivation, introduction and summary of the report's findings in part one, part two sets the institutional context for readers not already familiar with Albania's health system, and presents data showing public perceptions of health care and answers to subjective questions included in the health governance and accountability module of the 2008 Albania LSMS. These data have been combined with prior waves of the LSMS to show how the incidence of informal payments has changed in recent years. Part three shows the impact out-of-pocket payments -both formal and informal- have on household consumption and the incidence of poverty. Part fourth presents the results of statistical analysis, using techniques to match like-households over time, in order to identify significant factors at the household level that are associated with informal payments and how these have changed during a period of structural changes in the health system.