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Commitments and Contingencies - Schedule of Changes in General and Professional Liability and Workers Compensation Reserves (Detail) - USD ($) $ in Thousands | 12 Months Ended
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Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
Commitments and Contingencies Disclosure [Line Items] |  |  |
Beginning balance | $ 298,222 | $ 274,815 | $ 271,476
Liabilities assumed in acquisition |  |  | 661
Plus: Accrued insurance expense, net of commercial premiums paid | 92,863 | 102,595 | 84,638
Less: Payments made in settlement of self-insured claims | (76,144) | (79,188) | (81,960)
Ending balance | 314,941 | 298,222 | 274,815
General and Professional Liability |  |  |
Commitments and Contingencies Disclosure [Line Items] |  |  |
Beginning balance | 228,691 | 207,459 | 203,973
Liabilities assumed in acquisition |  |  | 0
Plus: Accrued insurance expense, net of commercial premiums paid | 54,387 | 65,049 | 54,671
Less: Payments made in settlement of self-insured claims | (40,027) | (43,817) | (51,185)
Ending balance | 243,051 | 228,691 | 207,459
Workers’ Compensation |  |  |
Commitments and Contingencies Disclosure [Line Items] |  |  |
Beginning balance | 69,531 | 67,356 | 67,503
Liabilities assumed in acquisition |  |  | 661
Plus: Accrued insurance expense, net of commercial premiums paid | 38,476 | 37,546 | 29,967
Less: Payments made in settlement of self-insured claims | (36,117) | (35,371) | (30,775)
Ending balance | $ 71,890 | $ 69,531 | $ 67,356

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- Definition The increase (decrease) during the period in the carrying amount of accrued known and estimated losses incurred for which no insurance coverage exists, and for which a claim has been made or is probable of being asserted, typically arising from workmen's' compensation-type of incidents and personal injury to nonemployees from accidents on the entity's property. + References Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3602-108585 + Details
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- Definition Carrying amount (including both current and noncurrent portions) of accrued known and estimated losses incurred as of the balance sheet date for which no insurance coverage exists, and for which a claim has been made or is probable of being asserted, typically arising from workmen's compensation-type of incidents and personal injury to nonemployees from accidents on the entity's property. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 210 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.5-02.24) -URI http://asc.fasb.org/extlink&oid=6877327&loc=d3e13212-122682 + Details
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