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Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 3 Months Ended
Mar. 31, 2018
Mar. 31, 2017
Cash flows from operating activities:    
Net income $ 1,282 $ 777
Increase (decrease) in cash from operating assets and liabilities:    
Accounts receivable (4) 168
Inventories and other assets (218) 3
Accounts payable and accrued expenses (246) (591)
Depreciation and amortization 553 521
Income taxes 246 292
Gains on sales of facilities (405) (1)
Amortization of debt issuance costs 8 8
Share-based compensation 60 73
Other 24 30
Net cash provided by operating activities 1,300 1,280
Cash flows from investing activities:    
Purchase of property and equipment (694) (571)
Acquisition of hospitals and health care entities (379) (90)
Disposal of hospitals and health care entities 767 4
Change in investments 11 (19)
Other (40) 7
Net cash used in investing activities (335) (669)
Cash flows from financing activities:    
Net change in revolving bank credit facilities 270 160
Repayment of long-term debt (50) (43)
Distributions to noncontrolling interests (92) (145)
Payment of debt issuance costs (2) (2)
Payment of cash dividends (123)  
Repurchases of common stock (423) (424)
Other (191) (50)
Net cash used in financing activities (611) (504)
Change in cash and cash equivalents 354 107
Cash and cash equivalents at beginning of period 732 646
Cash and cash equivalents at end of period 1,086 753
Interest payments 549 540
Income tax payments (refunds), net $ 11 $ (3)