Original Article A Systematic Review of the Impact of Healthcare Reforms on Access to Emergency Department and Elective Surgery Services: 1994–2014 Sandeep Reddy 1 , Peter Jones 2 , Harsha Shanthanna 3 , Raechel Damarell 4 , and John Wakerman 5 Abstract This systematic review sought to identify whether health care reforms led to improvement in the emergency department (ED) length of stay (LOS) and elective surgery (ES) access in Australia, Canada, New Zealand, and the United Kingdom. The review was registered in the PROSPERO database (CRD42015016343), and nine databases were searched for peer-reviewed, English-language reports published between 1994 and 2014. We also searched relevant ‘‘grey’’ literature and websites. Included studies were checked for cited and citing papers. Primary studies corres- ponding to national and provincial ED and ES reforms in the four countries were considered. Only studies from Australia and the United Kingdom were eventually included, as no studies from the other two countries met the inclusion criteria. The reviewers involved in the study extracted the data independently using International Journal of Health Services 0(0) 1–25 ! The Author(s) 2017 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0020731417722089 journals.sagepub.com/home/joh 1 Deakin University Faculty of Health, Waurn Ponds Campus, Geelong, Victoria, Australia 2 Auckland City Hospital, Auckland, New Zealand 3 McMaster University, St Joseph’s Hospital, Hamilton, Ontario, Canada 4 College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia 5 Flinders University, School of Medicine, Adelaide, South Australia, Australia Corresponding Author: Sandeep Reddy, School of Medicine, Waurn Ponds Campus, Deakin University, Geelong, VIC 3220, Australia. Email: sandeep.reddy@deakin.edu.au