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Supplemental Condensed Consolidating Statements of Cash flows (Detail) - USD ($) $ in Thousands | 6 Months Ended
--- | ---
Jun. 30, 2015 | Jun. 30, 2014
Condensed Financial Statements, Captions [Line Items] |  |
Net cash (used in) provided by operating activities | $ 531,603 | $ 458,416
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (170,580) | (186,786)
Proceeds received from sale of assets and businesses | 0 | 11,450
Acquisition of property and businesses | (34,500) | (71,000)
Costs incurred for purchase and implementation of electronic health records application | 0 | (8,399)
Net cash used in investing activities | (205,080) | (254,735)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (255,658) | (179,126)
Additional borrowings | 5,200 | 0
Repurchase of common shares | (68,157) | (35,773)
Dividends paid | (19,804) | (9,884)
Issuance of common stock | 4,039 | 3,287
Excess income tax benefits related to stock-based compensation | 28,489 | 28,493
Profit distributions to noncontrolling interests | (23,295) | (13,184)
Proceeds received from sale/leaseback of real property | 12,765 | 0
Changes in intercompany balances with affiliates, net | 0 | 0
Net cash (used in) provided by financing activities | (316,421) | (206,187)
Effect of exchange rate changes on cash and cash equivalents | 293 | 0
(Decrease) increase in cash and cash equivalents | 10,395 | (2,506)
Cash and cash equivalents, beginning of period | 32,069 | 17,238
Cash and cash equivalents, end of period | 42,464 | 14,732
Consolidating Adjustments |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash (used in) provided by operating activities |  | 0
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | 0 | 0
Proceeds received from sale of assets and businesses |  | 0
Acquisition of property and businesses | 0 | 0
Costs incurred for purchase and implementation of electronic health records application |  | 0
Net cash used in investing activities | 0 | 0
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | 0 | 0
Additional borrowings | 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
Proceeds received from sale/leaseback of real property | 0 |
Changes in intercompany balances with affiliates, net | 0 | 0
Net cash (used in) provided by financing activities | 0 | 0
Effect of exchange rate changes on cash and cash equivalents | 0 |
(Decrease) increase 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
Parent |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash (used in) provided by operating activities | (9,690) | 6,497
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | 0 | 0
Proceeds received from sale of assets and businesses |  | 0
Acquisition of property and businesses | 0 | 0
Costs incurred for purchase and implementation of electronic health records application |  | 0
Net cash used in investing activities | 0 | 0
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (252,189) | (167,755)
Additional borrowings | 5,200 |
Repurchase of common shares | (68,157) | (35,773)
Dividends paid | (19,804) | (9,884)
Issuance of common stock | 4,039 | 3,287
Excess income tax benefits related to stock-based compensation | 28,489 | 28,493
Profit distributions to noncontrolling interests | 0 | 0
Proceeds received from sale/leaseback of real property | 0 |
Changes in intercompany balances with affiliates, net | 312,112 | 175,135
Net cash (used in) provided by financing activities | 9,690 | (6,497)
Effect of exchange rate changes on cash and cash equivalents | 0 |
(Decrease) increase 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 | 333,512 | 256,770
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (97,857) | (116,688)
Proceeds received from sale of assets and businesses |  | 11,450
Acquisition of property and businesses | (22,513) | (67,699)
Costs incurred for purchase and implementation of electronic health records application |  | (8,399)
Net cash used in investing activities | (120,370) | (181,336)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (2,865) | (317)
Additional borrowings | 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
Proceeds received from sale/leaseback of real property | 0 |
Changes in intercompany balances with affiliates, net | (202,798) | (78,577)
Net cash (used in) provided by financing activities | (205,663) | (78,894)
Effect of exchange rate changes on cash and cash equivalents | 293 |
(Decrease) increase in cash and cash equivalents | 7,772 | (3,460)
Cash and cash equivalents, beginning of period | 21,784 | 7,990
Cash and cash equivalents, end of period | 29,556 | 4,530
Non Guarantors |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash (used in) provided by operating activities | 207,781 | 195,149
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (72,723) | (70,098)
Proceeds received from sale of assets and businesses |  | 0
Acquisition of property and businesses | (11,987) | (3,301)
Costs incurred for purchase and implementation of electronic health records application |  | 0
Net cash used in investing activities | (84,710) | (73,399)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (604) | (11,054)
Additional borrowings | 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 | (23,295) | (13,184)
Proceeds received from sale/leaseback of real property | 12,765 |
Changes in intercompany balances with affiliates, net | (109,314) | (96,558)
Net cash (used in) provided by financing activities | (120,448) | (120,796)
Effect of exchange rate changes on cash and cash equivalents | 0 |
(Decrease) increase in cash and cash equivalents | 2,623 | 954
Cash and cash equivalents, beginning of period | 10,285 | 9,248
Cash and cash equivalents, end of period | $ 12,908 | $ 10,202

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