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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (USD $)
In Thousands, unless otherwise specified
 3 Months Ended
Mar. 31, 2013
Mar. 31, 2012
Cash Flows from Operating Activities:    
Net income $ 129,935 $ 142,570
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation & amortization 79,923 73,820
Gain on sales of assets and businesses, net of losses (2,092) 0
Stock-based compensation expense 7,111 5,486
Changes in assets & liabilities, net of effects from acquisitions and dispositions:    
Accounts receivable (81,859) (146,670)
Accrued interest 11,497 13,280
Accrued and deferred income taxes 68,890 75,471
Other working capital accounts (39,785) (48,074)
Other assets and deferred charges 6,662 7,120
Other 1,604 (2,082)
Accrued insurance expense, net of commercial premiums paid 22,962 24,581
Payments made in settlement of self-insurance claims (17,085) (18,279)
Net cash provided by operating activities 187,763 127,223
Cash Flows from Investing Activities:    
Property and equipment additions, net of disposals (95,919) (92,563)
Proceeds received from sale of assets and businesses 6,657 53,461
Costs incurred for purchase and implementation of electronic health records application (16,412) (14,501)
Return of deposit on terminated purchase agreement 0 6,500
Net cash used in investing activities (105,674) (47,103)
Cash Flows from Financing Activities:    
Reduction of long-term debt (69,926) (70,942)
Additional borrowings 9,500 0
Repurchase of common shares (14,027) (2,017)
Dividends paid (4,870) (4,832)
Issuance of common stock 1,232 1,016
Profit distributions to noncontrolling interests (10,074) (2,575)
Net cash (used in) provided by financing activities (88,165) (79,350)
(Decrease) increase in cash and cash equivalents (6,076) 770
Cash and cash equivalents, beginning of period 23,471 41,229
Cash and cash equivalents, end of period 17,395 41,999
Supplemental Disclosures of Cash Flow Information:    
Interest paid 22,982 25,945
Income taxes paid, net of refunds $ 4,908 $ 3,419