New report finds Puerto Rico’s certificate-of-need laws restrict healthcare

San Juan, Puerto Rico; August 21, 2026: A new report finds that Puerto Rico’s certificate-of-need laws delay and restrict investment in healthcare facilities, even as the island faces a growing shortage of doctors and providers. The Institute for Economic Liberty and Pacific Legal Foundation published the study, authored by Dr. Ángel Carrión-Tavárez and Jaimie Cavanaugh, which identifies 80 types of actions requiring government authorization before providers can open, expand, or invest in healthcare services.

“Puerto Rico’s certificate-of-need laws are reducing access to care and increasing health-care costs,” said Jaimie Cavanaugh, report author and senior state policy counsel at Pacific Legal Foundation. “Patients deserve more options, and laws that shield incumbent providers from competition serve only those providers.”

Puerto Rico’s Certificate of Need and Convenience program requires providers to demonstrate a government-defined “need” before opening a facility, expanding services, purchasing specialized equipment, or investing $2 million or more in an existing operation. Between 365 and 500 physicians left the island each year over the past decade, and federal data show dozens of primary care, dental, and mental health shortage areas across Puerto Rico. Nationally, more than 128 studies examining certificate-of-need laws have linked them to higher healthcare costs, reduced access, and mixed or worse quality of care. Twelve states have repealed their certificate-of-need programs outright, and at least 12 more have narrowed them.

The report recommends that Puerto Rico repeal its certificate-of-need law or substantially narrow its scope. The full report is available at institutodelibertadeconomica.org and is part of PLF’s broader effort to repeal CON laws nationwide.