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Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 9 Months Ended
Sep. 30, 2019
Sep. 30, 2018
Cash flows from operating activities:    
Net income $ 2,872 $ 3,144
Increase (decrease) in cash from operating assets and liabilities:    
Accounts receivable (93) (161)
Inventories and other assets (95) (136)
Accounts payable and accrued expenses (118) 150
Depreciation and amortization 1,902 1,697
Income taxes 51  
Gains on sales of facilities (17) (420)
Losses on retirement of debt 211 9
Amortization of debt issuance costs and discounts 23 23
Share-based compensation 263 204
Other 98 76
Net cash provided by (used in) operating activities 5,097 4,586
Cash flows from investing activities:    
Purchase of property and equipment (2,884) (2,420)
Acquisition of hospitals and health care entities (1,592) (1,056)
Disposal of hospitals and health care entities 49 802
Change in investments 35 65
Other 17 (6)
Net cash used in investing activities (4,375) (2,615)
Cash flows from financing activities:    
Issuances of long-term debt 6,451 2,000
Net change in revolving bank credit facilities (30) (330)
Repayment of long-term debt (5,289) (1,652)
Distributions to noncontrolling interests (404) (315)
Payment of debt issuance costs (71) (24)
Payment of cash dividends (414) (366)
Repurchases of common stock (759) (1,195)
Other (145) (232)
Net cash (used in) provided by financing activities (661) (2,114)
Effect of exchange rate changes on cash and cash equivalents (4) (11)
Change in cash and cash equivalents 57 (154)
Cash and cash equivalents at beginning of period 502 732
Cash and cash equivalents at end of period 559 578
Interest payments 1,492 1,422
Income tax payments, net $ 714 $ 702