In the current political climate of evidence-based research, GIS has emerged as a powerful research tool as it allows spatial and social health inequality to be explored efficiently. This article explores the impact health reforms had on geographical accessibility to hospital emergency department (ED) services in New Zealand from 1991 to 2001. Travel time was calculated using least-cost path analysis, which identified the shortest travel time from each census enumeration district through a road network to the nearest ED. This research found that the population further than 60 minutes from an ED has increased with some areas being affected more than others. Some of this increase is attributed to increases in population rather than the closing of hospitals. The findings will be discussed within the context of the health policy reform era and changes to health service provision.