Nonlinear Rank Scaling and Hidden Structure in NHS Expenditure Transparency Data

TL;DR

This study analyzes NHS expenditure transparency data, revealing complex nonlinear scaling patterns and hidden spending structures that are obscured when only larger transactions are considered.

Contribution

It uncovers nonlinear rank scaling and hidden organizational structures in NHS expenditure data, advancing understanding of healthcare spending transparency.

Findings

Multiple scaling regimes in expenditure data

Large transactions conceal significant spending

Patterns similar to word frequency and urban scaling

Abstract

A variety of transparency initiatives have been introduced by governments to reduce corruption and allow citizens to independently evaluate effectiveness and efficiency of spending. In 2010, the UK government mandated transparency for many expenditures exceeding {\pounds}25,000. The resulting data is dispersed across a range of governmental organizations and presents an opportunity to understand expenditure at scale, interrogate organizational structures and develop transparency measures. Here, we focus on data from the top two layers of the National Health Service (NHS) within England, including NHS England (NHSE) and Integrated Care Boards (ICBs). As the one of the largest government run healthcare organizations in the world and potentially the sixth largest employer globally, the NHS provides a distinctive case for studying healthcare delivery, contractor dynamics, and organizational self-organization. We find that limiting transparency to larger transactions conceals a substantial share of spending from scrutiny, including most transactions. The rank-frequency distributions of suppliers, expense types, and spending categories exhibit multiple scaling regimes and these are similar to patterns observed in word frequency and urban scaling studies.