Like many island communities with limited resources, most municipalities in Puerto Rico lack adequate medical services. However, there is little information on variations in hospital capacity and regional disparities in the availability of hospital services in Puerto Rico, especially after the multiple public health emergencies that the island has faced in recent years (for example, hurricanes, earthquakes and COVID-19). This study describes trends in hospital capacity and utilization in Puerto Rico and its health regions from 2010 to 2020. We analyzed the Area Health Resources Archive (AHRF) 2021—22 and grouped the data according to seven health regions, which correspond to clusters of municipalities defined by the Puerto Rico Department of Health. The ten-year estimates of hospital utilization were adjusted according to the population size of each region. During the last five years, there have been decreases in the number of hospitals, hospital beds and surgeries, which represents a change compared to the previous five years. Over the course of the decade analyzed, population-adjusted measures of hospital utilization in Puerto Rico decreased, despite multiple catastrophes that, theoretically, would have increased the need for health services. We also detected variations in hospital capacity and utilization between health regions, indicating that the exchange rate was not uniform across the island. The capacity of the Puerto Rican hospital system has shrunk over the past decade, which could make it difficult to respond to new recurrent health emergencies, especially in specific regions.