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Supplemental Condensed Consolidating Statements of Cash flows (Detail) (USD $) In Thousands, unless otherwise specified | 3 Months Ended
--- | ---
Mar. 31, 2014 | Mar. 31, 2013
Condensed Financial Statements, Captions [Line Items] |  |
Net cash (used in) provided by operating activities | $ 194,639 | $ 178,497
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (92,387) | (95,919)
Proceeds received from sale of assets and businesses | 11,450 | 6,657
Acquisition of property and businesses | (3,301) | 0
Costs incurred for purchase and implementation of electronic health records application | (6,504) | (16,412)
Net cash provided by (used in) investing activities | (90,742) | (105,674)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (109,054) | (69,926)
Additional borrowings | 11,900 | 9,500
Repurchase of common shares | (13,993) | (14,027)
Dividends paid | (4,933) | (4,870)
Issuance of common stock | 1,445 | 1,232
Excess income tax benefits related to stock-based compensation | 11,750 | 9,266
Profit distributions to noncontrolling interests | (1,989) | (10,074)
Changes in intercompany balances with affiliates, net | 0 | 0
Net cash (used in) provided by financing activities | (104,874) | (78,899)
Decrease in cash and cash equivalents | (977) | (6,076)
Cash and cash equivalents, beginning of period | 17,238 | 23,471
Cash and cash equivalents, end of period | 16,261 | 17,395
Parent |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash (used in) provided by operating activities | 70,888 | 64,747
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
Net cash provided by (used in) investing activities | 0 | 0
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (97,975) | (63,612)
Additional borrowings | 11,900 | 9,500
Repurchase of common shares | (13,993) | (14,027)
Dividends paid | (4,933) | (4,870)
Issuance of common stock | 1,445 | 1,232
Excess income tax benefits related to stock-based compensation | 11,750 | 9,266
Profit distributions to noncontrolling interests | 0 | 0
Changes in intercompany balances with affiliates, net | 20,918 | (2,236)
Net cash (used in) provided by financing activities | (70,888) | (64,747)
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 (used in) provided by operating activities | 51,661 | 35,367
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (70,385) | (54,822)
Proceeds received from sale of assets and businesses | 11,450 | 4,178
Acquisition of property and businesses | 0 | 0
Costs incurred for purchase and implementation of electronic health records application | (6,504) | (16,412)
Net cash provided by (used in) investing activities | (65,439) | (67,056)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (228) | (265)
Additional borrowings | 0 | 0
Repurchase of common shares | 0 | 0
Dividends paid | 0 | 0
Issuance of common stock | 0 | 0
Excess income tax benefits related to stock-based compensation | 0 | 0
Profit distributions to noncontrolling interests | 0 | 0
Changes in intercompany balances with affiliates, net | 13,735 | 28,322
Net cash (used in) provided by financing activities | 13,507 | 28,057
Decrease in cash and cash equivalents | (271) | (3,632)
Cash and cash equivalents, beginning of period | 7,990 | 11,949
Cash and cash equivalents, end of period | 7,719 | 8,317
Non Guarantors |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash (used in) provided by operating activities | 72,090 | 78,383
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (22,002) | (41,097)
Proceeds received from sale of assets and businesses | 0 | 2,479
Acquisition of property and businesses | (3,301) | 0
Costs incurred for purchase and implementation of electronic health records application | 0 | 0
Net cash provided by (used in) investing activities | (25,303) | (38,618)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (10,851) | (6,049)
Additional borrowings | 0 | 0
Repurchase of common shares | 0 | 0
Dividends paid | 0 | 0
Issuance of common stock | 0 | 0
Excess income tax benefits related to stock-based compensation | 0 | 0
Profit distributions to noncontrolling interests | (1,989) | (10,074)
Changes in intercompany balances with affiliates, net | (34,653) | (26,086)
Net cash (used in) provided by financing activities | (47,493) | (42,209)
Decrease in cash and cash equivalents | (706) | (2,444)
Cash and cash equivalents, beginning of period | 9,248 | 11,522
Cash and cash equivalents, end of period | 8,542 | 9,078
Consolidating Adjustments |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash (used in) provided by 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
Costs incurred for purchase and implementation of electronic health records application | 0 | 0
Net cash provided by (used in) investing activities | 0 | 0
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | 0 | 0
Additional borrowings | 0 | 0
Repurchase of common shares | 0 | 0
Dividends paid | 0 | 0
Issuance of common stock | 0 | 0
Excess income tax benefits related to stock-based compensation | 0 | 0
Profit distributions to noncontrolling interests | 0 | 0
Changes in intercompany balances with affiliates, net | 0 | 0
Net cash (used in) provided by 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

X
- Definition Amount of currency on hand as well as demand deposits with banks or financial institutions. Includes other kinds of accounts that have the general characteristics of demand deposits. Also includes short-term, highly liquid investments that are both readily convertible to known amounts of cash and so near their maturity that they present insignificant risk of changes in value because of changes in interest rates. Excludes cash and cash equivalents within disposal group and discontinued operation. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Cash -URI http://asc.fasb.org/extlink&oid=6506951 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Cash Equivalents -URI http://asc.fasb.org/extlink&oid=6507016 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher SEC -Name Regulation S-X (SX) -Number 210 -Section 02 -Paragraph 1 -Article 5 Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 210 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.5-02.1) -URI http://asc.fasb.org/extlink&oid=6877327&loc=d3e13212-122682 Reference 5: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 210 -SubTopic 10 -Section 45 -Paragraph 1 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=28358313&loc=d3e6676-107765 Reference 6: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 4 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3044-108585 + Details
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- Definition Amount of cash inflow from realized tax benefit related to deductible compensation cost reported on the entity's tax return for equity instruments in excess of the compensation cost for those instruments recognized for financial reporting purposes. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 718 -SubTopic 20 -Section 55 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=32706628&loc=d3e11374-113907 + Details
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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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