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Fair value measurement (Details) - USD ($) $ in Millions	Sep. 30, 2017	Jun. 30, 2017	Dec. 31, 2016	Sep. 30, 2016	Jun. 30, 2016	Dec. 31, 2015
Assets:
Total available-for-sale investments	$ 40,949		$ 37,781
Fair Value, Measurements, Recurring [Member]
Derivatives:
Total assets	41,230		38,025
Derivatives:
Contingent consideration obligations in connection with business combinations	68		179
Total liabilities	560		713
Fair Value, Measurements, Recurring [Member] | Foreign currency contracts [Member]
Derivatives:
Foreign currency and cross-currency swap contracts	7		203
Derivatives:
Foreign currency and cross-currency swap contracts	179		4
Fair Value, Measurements, Recurring [Member] | Cross currency swap contracts [Member]
Derivatives:
Foreign currency and cross-currency swap contracts	224
Derivatives:
Foreign currency and cross-currency swap contracts	308		523
Fair Value, Measurements, Recurring [Member] | Interest rate swap contracts [Member]
Derivatives:
Interest rate contracts	40		41
Derivatives:
Interest rate swap contracts	5		7
Fair Value, Measurements, Recurring [Member] | Forward interest rate contract [Member]
Derivatives:
Interest rate contracts	10
Fair Value, Measurements, Recurring [Member] | U.S. Treasury securities [Member]
Assets:
Total available-for-sale investments	8,018		6,614
Fair Value, Measurements, Recurring [Member] | Other government-related debt securities - U.S. [Member]
Assets:
Total available-for-sale investments	224		299
Fair Value, Measurements, Recurring [Member] | Other government-related debt securities - Foreign and other [Member]
Assets:
Total available-for-sale investments	2,671		1,759
Fair Value, Measurements, Recurring [Member] | Corporate debt securities - Financial [Member]
Assets:
Total available-for-sale investments	10,254		8,460
Fair Value, Measurements, Recurring [Member] | Corporate debt securities - Industrial [Member]
Assets:
Total available-for-sale investments	9,906		8,789
Fair Value, Measurements, Recurring [Member] | Corporate debt securities - Other [Member]
Assets:
Total available-for-sale investments	1,261		1,077
Fair Value, Measurements, Recurring [Member] | Residential mortgage-backed securities [Member]
Assets:
Total available-for-sale investments	2,204		1,940
Fair Value, Measurements, Recurring [Member] | Other mortgage- and asset-backed securities [Member]
Assets:
Total available-for-sale investments	2,067		1,719
Fair Value, Measurements, Recurring [Member] | Money market mutual funds [Member]
Assets:
Total available-for-sale investments	2,455		2,782
Fair Value, Measurements, Recurring [Member] | Other short-term interest-bearing securities [Member]
Assets:
Total available-for-sale investments	1,746		4,188
Fair Value, Measurements, Recurring [Member] | Equity securities [Member]
Assets:
Total available-for-sale investments	143		154
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member]
Derivatives:
Total assets	10,616		9,550
Derivatives:
Contingent consideration obligations in connection with business combinations	0		0
Total liabilities	0		0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Foreign currency contracts [Member]
Derivatives:
Foreign currency and cross-currency swap contracts	0		0
Derivatives:
Foreign currency and cross-currency swap contracts	0		0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Cross currency swap contracts [Member]
Derivatives:
Foreign currency and cross-currency swap contracts	0
Derivatives:
Foreign currency and cross-currency swap contracts	0		0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Interest rate swap contracts [Member]
Derivatives:
Interest rate contracts	0		0
Derivatives:
Interest rate swap contracts	0		0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Forward interest rate contract [Member]
Derivatives:
Interest rate contracts	0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | U.S. Treasury securities [Member]
Assets:
Total available-for-sale investments	8,018		6,614
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Other government-related debt securities - U.S. [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Other government-related debt securities - Foreign and other [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Corporate debt securities - Financial [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Corporate debt securities - Industrial [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Corporate debt securities - Other [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Residential mortgage-backed securities [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Other mortgage- and asset-backed securities [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Money market mutual funds [Member]
Assets:
Total available-for-sale investments	2,455		2,782
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Other short-term interest-bearing securities [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Equity securities [Member]
Assets:
Total available-for-sale investments	143		154
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member]
Derivatives:
Total assets	30,614		28,475
Derivatives:
Contingent consideration obligations in connection with business combinations	0		0
Total liabilities	492		534
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Foreign currency contracts [Member]
Derivatives:
Foreign currency and cross-currency swap contracts	7		203
Derivatives:
Foreign currency and cross-currency swap contracts	179		4
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Cross currency swap contracts [Member]
Derivatives:
Foreign currency and cross-currency swap contracts	224
Derivatives:
Foreign currency and cross-currency swap contracts	308		523
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Interest rate swap contracts [Member]
Derivatives:
Interest rate contracts	40		41
Derivatives:
Interest rate swap contracts	5		7
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Forward interest rate contract [Member]
Derivatives:
Interest rate contracts	10
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | U.S. Treasury securities [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Other government-related debt securities - U.S. [Member]
Assets:
Total available-for-sale investments	224		299
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Other government-related debt securities - Foreign and other [Member]
Assets:
Total available-for-sale investments	2,671		1,759
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Corporate debt securities - Financial [Member]
Assets:
Total available-for-sale investments	10,254		8,460
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Corporate debt securities - Industrial [Member]
Assets:
Total available-for-sale investments	9,906		8,789
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Corporate debt securities - Other [Member]
Assets:
Total available-for-sale investments	1,261		1,077
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Residential mortgage-backed securities [Member]
Assets:
Total available-for-sale investments	2,204		1,940
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Other mortgage- and asset-backed securities [Member]
Assets:
Total available-for-sale investments	2,067		1,719
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Money market mutual funds [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Other short-term interest-bearing securities [Member]
Assets:
Total available-for-sale investments	1,746		4,188
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Equity securities [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member]
Derivatives:
Total assets	0		0
Derivatives:
Contingent consideration obligations in connection with business combinations	68	$ 182	179	$ 176	$ 171	$ 188
Total liabilities	68		179
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Foreign currency contracts [Member]
Derivatives:
Foreign currency and cross-currency swap contracts	0		0
Derivatives:
Foreign currency and cross-currency swap contracts	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Cross currency swap contracts [Member]
Derivatives:
Foreign currency and cross-currency swap contracts	0
Derivatives:
Foreign currency and cross-currency swap contracts	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Interest rate swap contracts [Member]
Derivatives:
Interest rate contracts	0		0
Derivatives:
Interest rate swap contracts	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Forward interest rate contract [Member]
Derivatives:
Interest rate contracts	0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | U.S. Treasury securities [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Other government-related debt securities - U.S. [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Other government-related debt securities - Foreign and other [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Corporate debt securities - Financial [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Corporate debt securities - Industrial [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Corporate debt securities - Other [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Residential mortgage-backed securities [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Other mortgage- and asset-backed securities [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Money market mutual funds [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Other short-term interest-bearing securities [Member]
Assets:
Total available-for-sale investments	0		0
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Equity securities [Member]
Assets:
Total available-for-sale investments	$ 0		$ 0

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