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Condensed Consolidated Statements of Cash Flows (USD $)
In Thousands
 6 Months Ended
Jun. 30, 2011
Jun. 30, 2010
Cash Flows from Operating Activities:    
Net income $ 246,021 $ 159,177
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation & amortization 144,949 107,536
Net gain on sale of assets 0 (1,993)
Stock-based compensation expense 8,665 8,327
Changes in assets & liabilities, net of effects from acquisitions and dispositions:    
Accounts receivable (77,661) (16,523)
Accrued interest (2,309) (1,757)
Accrued and deferred income taxes 55,420 3,946
Other working capital accounts (48,417) (15,753)
Other assets and deferred charges 11,525 1,484
Other 3,468 (4,513)
Accrued insurance expense, net of commercial premiums paid 47,480 15,491
Payments made in settlement of self-insurance claims (33,365) (27,698)
Net cash provided by operating activities 355,776 227,724
Cash Flows from Investing Activities:    
Property and equipment additions, net of disposals (116,240) (121,640)
Proceeds received from sale of assets and businesses 2,041 5,000
Costs incurred for purchase and implementation of electronic health records application (11,416) (8,354)
Net cash used in investing activities (125,615) (124,994)
Cash Flows from Financing Activities:    
Reduction of long-term debt (200,566) (77,974)
Additional borrowings 36,000 0
Financing costs (23,534) 0
Repurchase of common shares (6,163) (3,703)
Dividends paid (9,763) (9,693)
Issuance of common stock 2,408 3,833
Profit distributions to noncontrolling interests (23,201) (12,336)
Proceeds from sale of noncontrolling interest in majority owned business 0 300
Net cash used in financing activities (224,819) (99,573)
Increase (decrease) in cash and cash equivalents 5,342 3,157
Cash and cash equivalents, beginning of period 29,474 9,180
Cash and cash equivalents, end of period 34,816 12,337
Supplemental Disclosures of Cash Flow Information:    
Interest paid 102,213 29,783
Income taxes paid, net of refunds $ 83,532 $ 79,943