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Supplemental Condensed Consolidating Statements of Cash flows (Detail) (USD $) In Thousands, unless otherwise specified | 9 Months Ended
--- | ---
Sep. 30, 2013 | Sep. 30, 2012
Condensed Financial Statements, Captions [Line Items] |  |
Net cash provided by (used in) operating activities | $ 591,732 | $ 535,006
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (279,751) | (282,191)
Proceeds received from sale of assets and businesses | 37,118 | 56,194
Acquisition of property and businesses | (1,320) | (25,092)
Costs incurred for purchase and implementation of electronic health records application | (42,353) | (41,854)
Return of deposit on terminated purchase agreement | 0 | 6,500
Net cash used in investing activities | (286,306) | (286,443)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (234,231) | (1,127,829)
Additional borrowings | 1,500 | 906,000
Financing costs | 0 | (8,257)
Repurchase of common shares | (22,186) | (9,676)
Dividends paid | (14,706) | (14,519)
Issuance of common stock | 4,096 | 3,828
Profit distributions to noncontrolling interests | (51,248) | (13,687)
Changes in intercompany balances with affiliates, net | 0 | 0
Net cash provided by (used in) financing activities | (316,775) | (264,140)
Decrease in cash and cash equivalents | (11,349) | (15,577)
Cash and cash equivalents, beginning of period | 23,471 | 41,229
Cash and cash equivalents, end of period | 12,122 | 25,652
Parent |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash provided by (used in) operating activities | 9,438 | (7,607)
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | 0 | 0
Proceeds received from sale of assets and businesses | 0 | 0
Acquisition of property and businesses | 0 | 0
Costs incurred for purchase and implementation of electronic health records application | 0 | 0
Return of deposit on terminated purchase agreement |  | 6,500
Net cash used in investing activities | 0 | 6,500
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (226,761) | (1,123,140)
Additional borrowings | 1,500 | 906,000
Financing costs |  | (8,257)
Repurchase of common shares | (22,186) | (9,676)
Dividends paid | (14,706) | (14,519)
Issuance of common stock | 4,096 | 3,828
Profit distributions to noncontrolling interests | 0 | 0
Changes in intercompany balances with affiliates, net | 248,619 | 246,871
Net cash provided by (used in) financing activities | (9,438) | 1,107
Decrease in cash and cash equivalents | 0 | 0
Cash and cash equivalents, beginning of period | 0 | 0
Cash and cash equivalents, end of period | 0 | 0
Guarantors |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash provided by (used in) operating activities | 341,031 | 379,574
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (202,758) | (236,978)
Proceeds received from sale of assets and businesses | 7,552 | 49,984
Acquisition of property and businesses | (1,320) | (11,476)
Costs incurred for purchase and implementation of electronic health records application | (42,353) | (41,854)
Return of deposit on terminated purchase agreement |  | 0
Net cash used in investing activities | (238,879) | (240,324)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (807) | (2,567)
Additional borrowings | 0 | 0
Financing costs |  | 0
Repurchase of common shares | 0 | 0
Dividends paid | 0 | 0
Issuance of common stock | 0 | 0
Profit distributions to noncontrolling interests | 0 | 0
Changes in intercompany balances with affiliates, net | (108,930) | (151,417)
Net cash provided by (used in) financing activities | (109,737) | (153,984)
Decrease in cash and cash equivalents | (7,585) | (14,734)
Cash and cash equivalents, beginning of period | 11,949 | 33,221
Cash and cash equivalents, end of period | 4,364 | 18,487
Non Guarantors |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash provided by (used in) operating activities | 241,263 | 163,039
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (76,993) | (45,213)
Proceeds received from sale of assets and businesses | 29,566 | 6,210
Acquisition of property and businesses | 0 | (13,616)
Costs incurred for purchase and implementation of electronic health records application | 0 | 0
Return of deposit on terminated purchase agreement |  | 0
Net cash used in investing activities | (47,427) | (52,619)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (6,663) | (2,122)
Additional borrowings | 0 | 0
Financing costs |  | 0
Repurchase of common shares | 0 | 0
Dividends paid | 0 | 0
Issuance of common stock | 0 | 0
Profit distributions to noncontrolling interests | (51,248) | (13,687)
Changes in intercompany balances with affiliates, net | (139,689) | (95,454)
Net cash provided by (used in) financing activities | (197,600) | (111,263)
Decrease in cash and cash equivalents | (3,764) | (843)
Cash and cash equivalents, beginning of period | 11,522 | 8,008
Cash and cash equivalents, end of period | 7,758 | 7,165
Consolidating Adjustments |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash provided by (used in) operating activities | 0 | 0
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | 0 | 0
Proceeds received from sale of assets and businesses | 0 | 0
Acquisition of property and businesses | 0 | 0
Costs incurred for purchase and implementation of electronic health records application | 0 | 0
Return of deposit on terminated purchase agreement |  | 0
Net cash used in investing activities | 0 | 0
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | 0 | 0
Additional borrowings | 0 | 0
Financing costs |  | 0
Repurchase of common shares | 0 | 0
Dividends paid | 0 | 0
Issuance of common stock | 0 | 0
Profit distributions to noncontrolling interests | 0 | 0
Changes in intercompany balances with affiliates, net | 0 | 0
Net cash provided by (used in) financing activities | 0 | 0
Decrease in cash and cash equivalents | 0 | 0
Cash and cash equivalents, beginning of period | 0 | 0
Cash and cash equivalents, end of period | $ 0 | $ 0

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- Definition Amount of cash inflow (outflow) from financing activities, including discontinued operations. Financing activity cash flows include obtaining resources from owners and providing them with a return on, and a return of, their investment; borrowing money and repaying amounts borrowed, or settling the obligation; and obtaining and paying for other resources obtained from creditors on long-term credit. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3521-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3574-108585 + Details
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- Definition Amount of cash inflow (outflow) from investing activities, including discontinued operations. Investing activity cash flows include making and collecting loans and acquiring and disposing of debt or equity instruments and property, plant, and equipment and other productive assets. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3521-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3574-108585 + Details
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- Definition Amount of cash inflow (outflow) from operating activities, including discontinued operations. Operating activity cash flows include transactions, adjustments, and changes in value not defined as investing or financing activities. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3602-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3521-108585 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 25 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3536-108585 + Details
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