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Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Cash flows from operating activities:    
Net income $ 1,914 $ 2,108
Increase (decrease) in cash from operating assets and liabilities:    
Accounts receivable 1,215 (174)
Inventories and other assets (57) (231)
Accounts payable and accrued expenses (336) (238)
Contract liabilities-deferred revenues 4,999 0
Depreciation and amortization 1,365 1,255
Income taxes 472 27
Losses (gains) on sales of facilities 20 (17)
Losses on retirement of debt 295 0
Amortization of debt issuance costs and discounts 14 16
Share-based compensation 148 158
Other 49 67
Net cash provided by operating activities 10,098 2,971
Cash flows from investing activities:    
Purchase of property and equipment (1,598) (1,745)
Acquisition of hospitals and health care entities (346) (1,504)
Sales of hospitals and health care entities 39 41
Change in investments (11) 59
Other (37) 36
Net cash used in investing activities (1,953) (3,113)
Cash flows from financing activities:    
Issuances of long-term debt 2,700 6,451
Net change in revolving bank credit facilities (2,480) (3,040)
Repayment of long-term debt (3,364) (98)
Distributions to noncontrolling interests (199) (247)
Payment of debt issuance costs (35) (63)
Payment of dividends (153) (278)
Repurchases of common stock (441) (520)
Other (144) (135)
Net cash (used in) provided by financing activities (4,116) 2,070
Effect of exchange rate changes on cash and cash equivalents (12) 0
Change in cash and cash equivalents 4,017 1,928
Cash and cash equivalents at beginning of period 621 502
Cash and cash equivalents at end of period 4,638 2,430
Interest payments 854 910
Income tax (refunds) payments, net $ (16) $ 523