Healthcare costs worldwide continue to increase at an alarming rate. Within healthcare, supply chain costs are becoming one of the most critical areas of expense. Some firms have attempted to mitigate supply chain expenses and risks through strategic partnerships and outsourcing. One way to view these strategic relationships, and the risks they bring, is through the lens of transaction cost economics (TCE). Specifically in the United States, dynamic changes from reform efforts to healthcare delivery systems, and the industry as a whole, require a systematic re-thinking of all aspects of partnerships and outsourcing. The purpose of his article is to apply the lessons learned from Williamson’s 2008 article on TCE and the supply chain as they directly relate to healthcare. Additional insight is provided based on the authors’ unique professional background in the discipline.