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Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 6 Months Ended
Jun. 30, 2019
Jun. 30, 2018
Cash flows from operating activities:    
Net income $ 2,108 $ 2,248
Increase (decrease) in cash from operating assets and liabilities:    
Accounts receivable (174) (233)
Inventories and other assets (231) (200)
Accounts payable and accrued expenses (238) 31
Depreciation and amortization 1,255 1,115
Income taxes 27 118
Gains on sales of facilities (17) (414)
Amortization of debt issuance costs and discounts 16 15
Share-based compensation 158 134
Other 67 51
Net cash provided by (used in) operating activities 2,971 2,865
Cash flows from investing activities:    
Purchase of property and equipment (1,745) (1,574)
Acquisition of hospitals and health care entities (1,504) (538)
Disposal of hospitals and health care entities 41 799
Change in investments 59 23
Other 36 (25)
Net cash used in investing activities (3,113) (1,315)
Cash flows from financing activities:    
Issuances of long-term debt 6,451  
Net change in revolving bank credit facilities (3,040) 210
Repayment of long-term debt (98) (101)
Distributions to noncontrolling interests (247) (185)
Payment of debt issuance costs (63) (2)
Payment of cash dividends (278) (245)
Repurchases of common stock (520) (893)
Other (135) (192)
Net cash provided by (used in) financing activities 2,070 (1,408)
Effect of exchange rate changes on cash and cash equivalents   (6)
Change in cash and cash equivalents 1,928 136
Cash and cash equivalents at beginning of period 502 732
Cash and cash equivalents at end of period 2,430 868
Interest payments 910 873
Income tax payments, net $ 523 $ 411