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Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash flows from operating activities:
Net income	$ 1,181	$ 1,282
Decrease in cash from operating assets and liabilities:
Accounts receivable	(369)	(4)
Inventories and other assets	(174)	(218)
Accounts payable and accrued expenses	(651)	(263)
Depreciation and amortization	619	553
Income taxes	269	246
Losses (gains) on sales of facilities	1	(405)
Amortization of debt issuance costs	8	8
Share-based compensation	62	60
Other	28	24
Net cash provided by (used in) operating activities	974	1,283
Cash flows from investing activities:
Purchase of property and equipment	(781)	(694)
Acquisition of hospitals and health care entities	(1,474)	(379)
Disposal of hospitals and health care entities	30	767
Change in investments	36	11
Other	24	(40)
Net cash used in investing activities	(2,165)	(335)
Cash flows from financing activities:
Issuances of long-term debt	1,500
Net change in revolving bank credit facilities	460	270
Repayment of long-term debt	(49)	(50)
Distributions to noncontrolling interests	(136)	(92)
Payment of debt issuance costs	(22)	(2)
Payment of cash dividends	(141)	(123)
Repurchases of common stock	(278)	(423)
Other	(118)	(191)
Net cash provided by (used in) financing activities	1,216	(611)
Effect of exchange rate changes on cash and cash equivalents	4	17
Change in cash and cash equivalents	29	354
Cash and cash equivalents at beginning of period	502	732
Cash and cash equivalents at end of period	531	1,086
Interest payments	580	549
Income tax payments, net	$ 10	$ 11

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