Healthcare facility construction activity by state

Hospital and healthcare construction projects expand and improve facilities to better serve patients and the healthcare providers who work there. And new healthcare facilities help increase services and capabilities in the local communities.

How is healthcare construction activity tracked?

In the Definitive Healthcare HospitalView product, we collect Certificates of Need (CONs) and Requests for Proposals (RFPs) from federal, state, local and healthcare system websites. The “new hospitals/units/services” and “hospital/facility relocation/renovation” CON categories and “construction - new building/relocation/design” RFP category track new hospital buildings, hospital construction projects and healthcare facility renovations to inform the market on planned projects.

Which states have the most healthcare construction activity?

Between 2018 and February 2022, we collected over 11,500 healthcare construction CONs and RFPs. This list below ranks states by their total number of construction related CONs and RFPs over the last few years.

Number of healthcare construction CONs and RFPs by state

Rank State Number of CONs and RFPs 2018-2020
1 New York 2,420
2 Texas 674
3 Georgia 589
4 California 578
5 North Carolina 446
6 Florida 433
7 Virginia 414
8 Michigan 370
9 South Carolina 631
10 Washington 341
11 Illinois 340
12 Pennsylvania 295
13 Massachusetts 263
14 Maryland 263
15 Kentucky 256
16 Ohio 256
17 Alabama 222
18 District of Columbia 217
19 Missouri 179
20 Tennessee 178
21 Louisiana 145
22 West Virginia 133
23 Mississippi 133
24 Wisconsin 130
25 Colorado 118
26 Connecticut 117
27 Iowa 115
28 Arkansas 112
29 Oklahoma 103
30 Hawaii 101
31 New Jersey 101
32 Kansas 94
33 Indiana 91
34 Utah 84
35 Arizona 83
36 Rhode Island 81
37 Nevada 76
38 Alaska 67
39 Minnesota 66
40 Maine 63
41 Oregon 54
42 Montana 52
43 Delaware 49
44 New Mexico 48
45 South Dakota 44
46 Wyoming 40
47 Vermont 38
48 Nebraska 36
49 Idaho 33
50 New Hampshire 23
51 North Dakota 23


Fig. 1 Data is from the Definitive Healthcare HospitalView product. News and intelligence data is proprietary and updated daily. Data accessed March 2022.

New York had the most construction CONs and RFPs from 2018 through February 2022 with over 2,400. The state’s large population and number of healthcare facilities likely contribute to this number. Texas had nearly 700 CONs and RFPs while Georgia had almost 600.

What is a healthcare certificate of need?

Certificates of Need (CONs) are legal documents required by the District of Columbia and many states for the approval of capital expenditures and projects. The goal of CON programs is to help reduce healthcare spending by ensuring new expenses fit the community and the healthcare system need.

Definitive Healthcare collects CONs by monitoring the websites of the 36 states/federal jurisdictions with participating programs and makes the information available in our HospitalView product.

Which states require certificates of need?

Tracked by the National Conference of State Legislatures (NCSL), the 36 states and federal jurisdictions that have CON laws include:

  • Alabama
  • Alaska
  • Arkansas
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Illinois
  • Indiana
  • Iowa
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Jersey
  • New York
  • North Carolina
  • Ohio
  • Oklahoma
  • Oregon
  • Rhode Island
  • South Carolina
  • Tennessee
  • Vermont
  • Virginia
  • Washington
  • West Virginia

The states without CON laws are:

  • Arizona
  • California
  • Colorado
  • Idaho
  • Kansas
  • Minnesota
  • New Hampshire
  • New Mexico
  • North Dakota
  • Pennsylvania
  • South Dakota
  • Texas
  • Utah
  • Wisconsin
  • Wyoming

What is a healthcare request for proposal?

Requests for Proposals (RFPs) are documents that announce and outline the specifics of a project that a hospital or healthcare system plans to undertake. These formal requests solicit bids from suppliers and contractors to complete the proposed project.

The Definitive Healthcare HospitalView product tracks federal healthcare RFPs from the System for Award Management website and collects non-federal RFPs by monitoring state, local and healthcare entity websites for RFPs and purchasing requests.

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