BACKGROUND: The COVID-19 pandemic posed unprecedented challenges to healthcare systems worldwide, prompting governments to rapidly expand hospital bed capacity to meet the surge in demand for medical care. This study focuses on evaluating Colombia's healthcare system response by examining the expansion of hospital beds during the health crisis. METHODS: In an observational study, we used a national census of all healthcare facilities in Colombia, compiled by the Ministry of Health and Social Protection (MPSP), to analyze changes in hospital bed allocation from 2010 to 2022. Our analysis accounted for the size of each provider, its public or private ownership, and the types of services it was authorized to deliver. We applied interrupted time series models to assess changes at both the hospital and municipal levels over time. RESULTS: Findings reveal a significant reduction in hospital beds in 2020, with adult beds decreasing by 1049 units and pediatric beds by 0.709 units compared to 2019. However, there was an increase in ICU beds for adults across all years, which persisted after the end of the crisis. The expansion mainly targeted small hospitals and the public network of providers. Most of the expansion was restricted to areas of the country that already had a supply of ICU and hospitalization beds. CONCLUSION: Colombia's healthcare system responded dynamically to the COVID-19 pandemic by reallocating resources and expanding hospital bed capacity, despite the complex command and control configuration of its health system. Yet, it shows that the country needs to modify its financial and organizational structures to ensure better preparedness for future health crises.