This study aimed to analyze an inter-organizational relation of a dyad of the healthcare area, one being public and the other private. In light of the Transaction Cost Theory and Inter-organizational Relations, establishing the cooperation relationship was necessary to optimize public resources, besides the specificity of the transacted asset, which was health care in emergency situations. Transparency in the negotiations to establish a formal contract, however, proved to be insufficient to solve conflicts that were not predicted, as well as the suspension of payment by the public agent due to the inability to manage the budget.