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Supplemental Condensed Consolidating Statements of Cash flows (Detail) - USD ($) $ in Thousands | 9 Months Ended
--- | ---
Sep. 30, 2015 | Sep. 30, 2014
Condensed Financial Statements, Captions [Line Items] |  |
Net cash (used in) provided by operating activities | $ 796,499 | $ 689,554
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (269,578) | (309,361)
Proceeds received from sale of assets and businesses | 2,744 | 15,178
Acquisition of property and businesses | (183,103) | (402,405)
Costs incurred for purchase and implementation of electronic health records application | 0 | (11,204)
Net cash used in investing activities | (449,937) | (707,792)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (207,371) | (842,543)
Additional borrowings | 16,300 | 969,800
Financing costs | 0 | (13,413)
Repurchase of common shares | (129,862) | (63,292)
Dividends paid | (29,696) | (19,794)
Issuance of common stock | 6,030 | 4,907
Excess income tax benefits related to stock-based compensation | 29,287 | 30,242
Profit distributions to noncontrolling interests | (35,965) | (25,074)
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 | (338,512) | 40,833
Effect of exchange rate changes on cash and cash equivalents | (596) | (122)
Increase in cash and cash equivalents | 7,454 | 22,473
Cash and cash equivalents, beginning of period | 32,069 | 17,238
Cash and cash equivalents, end of period | 39,523 | 39,711
Parent |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash (used in) provided by operating activities | (51,998) | 8,445
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
Net cash used in investing activities | 0 | 0
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (203,284) | (830,680)
Additional borrowings | 16,300 | 969,800
Financing costs |  | (13,413)
Repurchase of common shares | (129,862) | (63,292)
Dividends paid | (29,696) | (19,794)
Issuance of common stock | 6,030 | 4,907
Excess income tax benefits related to stock-based compensation | 29,287 | 30,242
Profit distributions to noncontrolling interests | 0 | 0
Proceeds received from sale/leaseback of real property | 0 |
Changes in intercompany balances with affiliates, net | 363,223 | (86,215)
Net cash (used in) provided by financing activities | 51,998 | (8,445)
Effect of exchange rate changes on cash and cash equivalents | 0 | 0
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 | 554,650 | 431,986
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (154,460) | (205,455)
Proceeds received from sale of assets and businesses | 0 | 11,450
Acquisition of property and businesses | (171,116) | (394,854)
Costs incurred for purchase and implementation of electronic health records application |  | (11,204)
Net cash used in investing activities | (325,576) | (600,063)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (3,163) | (609)
Additional borrowings | 0 | 0
Financing costs |  | 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 | (219,165) | 190,021
Net cash (used in) provided by financing activities | (222,328) | 189,412
Effect of exchange rate changes on cash and cash equivalents | (596) | (122)
Increase in cash and cash equivalents | 6,150 | 21,213
Cash and cash equivalents, beginning of period | 21,784 | 7,990
Cash and cash equivalents, end of period | 27,934 | 29,203
Non Guarantors |  |
Condensed Financial Statements, Captions [Line Items] |  |
Net cash (used in) provided by operating activities | 293,847 | 249,123
Cash Flows from Investing Activities: |  |
Property and equipment additions, net of disposals | (115,118) | (103,906)
Proceeds received from sale of assets and businesses | 2,744 | 3,728
Acquisition of property and businesses | (11,987) | (7,551)
Costs incurred for purchase and implementation of electronic health records application |  | 0
Net cash used in investing activities | (124,361) | (107,729)
Cash Flows from Financing Activities: |  |
Reduction of long-term debt | (924) | (11,254)
Additional borrowings | 0 | 0
Financing costs |  | 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 | (35,965) | (25,074)
Proceeds received from sale/leaseback of real property | 12,765 |
Changes in intercompany balances with affiliates, net | (144,058) | (103,806)
Net cash (used in) provided by financing activities | (168,182) | (140,134)
Effect of exchange rate changes on cash and cash equivalents | 0 | 0
Increase in cash and cash equivalents | 1,304 | 1,260
Cash and cash equivalents, beginning of period | 10,285 | 9,248
Cash and cash equivalents, end of period | 11,589 | 10,508
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
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 | 0
Financing costs |  | 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 | 0
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

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