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Aggregate Net Purchase Price of Acquisitions Allocated to Assets and Liabilities Based on Preliminary Estimated Fair Values (Detail) (USD $)
In Thousands, unless otherwise specified
 9 Months Ended
Sep. 30, 2014
Dec. 31, 2013
Sep. 30, 2014
2014 Acquisitions of assets and liabilities
Business Acquisition [Line Items]      
Working capital, net     $ (41,547) [1]
Property & equipment     149,914
Goodwill 3,296,358 3,049,016 246,606
Other assets     58,835
Income tax assets, net     4,019
Debt     (16,286)
Other     864
Cash paid during first nine months of 2014     $ 402,405
[1] Includes liability for incurred but unpaid medical claims at date of acquisition of commercial health insurer.