The health care system in Dagestan has distinctive features that are related both to the peculiarities of the Dagestani society and to post-Soviet reforms of public health system. The phenomenon of medical dynasties limits access to the profession for young specialists and may worsen the quality of the services provided. At the same time it is the family ties that help ordinary citizens to get access to health care services and help young professional to find work. In rural areas, it is also common that the head of local health care institution is appointed by “jamaat” – an informal representative body of power in the community. Despite modernization of the health care system that follows Russia’s overall state model, traditional “tukhum” still serves as a reliable insurance system in Dagestan.