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Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 3 Months Ended
Mar. 31, 2021
Mar. 31, 2020
Cash flows from operating activities:    
Net income $ 1,580 $ 698
Increase (decrease) in cash from operating assets and liabilities:    
Accounts receivable (371) 464
Inventories and other assets (85) (196)
Accounts payable and accrued expenses (371) (784)
Depreciation and amortization 697 674
Income taxes 406 121
Gains on sales of facilities (2) (7)
Losses on retirement of debt 0 295
Amortization of debt issuance costs and discounts 8 7
Share-based compensation 97 82
Other 29 21
Net cash provided by operating activities 1,988 1,375
Cash flows from investing activities:    
Purchase of property and equipment (654) (853)
Acquisition of hospitals and health care entities (22) (328)
Sales of hospitals and health care entities 20 35
Change in investments (2) (1)
Other 9 2
Net cash used in investing activities (649) (1,145)
Cash flows from financing activities:    
Issuances of long-term debt 0 2,700
Net change in revolving credit facilities 80 1,440
Repayment of long-term debt (47) (3,327)
Distributions to noncontrolling interests (234) (154)
Payment of debt issuance costs 0 (34)
Payment of dividends (169) (152)
Repurchase of common stock (1,527) (441)
Other (207) (141)
Net cash used in financing activities (2,104) (109)
Effect of exchange rate changes on cash and cash equivalents 2 (11)
Change in cash and cash equivalents (763) 110
Cash and cash equivalents at beginning of period 1,793 621
Cash and cash equivalents at end of period 1,030 731
Interest payments 375 468
Income tax refunds, net $ (13) $ (9)