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Supplemental Data - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended
--- | --- | ---
Jun. 30, 2016 | Jun. 30, 2015 | Jun. 30, 2016 | Jun. 30, 2015
Cash flows from operating activities: |  |  |  |  |
Net income |  | $ 94,503 | $ 207,777 | $ 232,662 | $ 131,629
Changes in operating and intercompany assets and liabilities and non-cash items included in net income |  |  |  | 712,977 | 309,902
Net cash provided by operating activities |  |  |  | 945,639 | 441,531
Cash flows from investing activities: |  |  |  |  |
Additions of property and equipment |  | (185,440) | (169,452) | (358,627) | (290,873)
Acquisitions and divestitures, net |  |  |  | (473,314) |
Proceeds from discontinued operations |  |  |  | 17,393 | 3,415
Investments and other items |  |  |  | 56,319 | (614,820)
Net cash used in investing activities |  |  |  | (758,229) | (947,337)
Cash flows from financing activities: |  |  |  |  |
Long-term debt |  |  |  | (61,233) | 667,992
Other items |  |  |  | (342,321) | (192,899)
Net cash (used in) provided by financing activities |  |  |  | (403,554) | 475,093
Effect of exchange rate changes on cash |  |  |  | 444 | (793)
Net decrease in cash and cash equivalents |  |  |  | (215,700) | (31,506)
Cash and cash equivalents at beginning of the year |  |  |  | 1,499,116 | 965,241
Cash and cash equivalents at end of the period |  | 1,283,416 | $ 933,735 | 1,283,416 | $ 933,735
Physician Groups |  |  |  |  |
Cash flows from operating activities: |  |  |  |  |
Net income |  |  |  | (13,891) |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income |  |  |  | 144,876 |
Net cash provided by operating activities |  |  |  | 130,985 |
Cash flows from investing activities: |  |  |  |  |
Additions of property and equipment |  |  |  | (350) |
Investments and other items |  |  |  | (1,465) |
Net cash used in investing activities |  |  |  | (1,815) |
Cash flows from financing activities: |  |  |  |  |
Long-term debt |  |  |  | (4) |
Intercompany |  |  |  | (135,791) |
Net cash (used in) provided by financing activities |  |  |  | (135,795) |
Net decrease in cash and cash equivalents |  |  |  | (6,625) |
Cash and cash equivalents at beginning of the year |  |  |  | 88,245 |
Cash and cash equivalents at end of the period |  | 81,620 |  | 81,620 |
Unrestricted Subsidiaries |  |  |  |  |
Cash flows from operating activities: |  |  |  |  |
Net income |  |  |  | 17 |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income |  |  |  | (17) |
Company and Restricted Subsidiaries |  |  |  |  |
Cash flows from operating activities: |  |  |  |  |
Net income | [1] |  |  | 246,536 |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | [1] |  |  | 568,118 |
Net cash provided by operating activities | [1] |  |  | 814,654 |
Cash flows from investing activities: |  |  |  |  |
Additions of property and equipment | [1] |  |  | (358,277) |
Acquisitions and divestitures, net | [1] |  |  | (473,314) |
Proceeds from discontinued operations | [1] |  |  | 17,393 |
Investments and other items | [1] |  |  | 57,784 |
Net cash used in investing activities | [1] |  |  | (756,414) |
Cash flows from financing activities: |  |  |  |  |
Long-term debt | [1] |  |  | (61,229) |
Intercompany | [1] |  |  | 135,791 |
Other items | [1] |  |  | (342,321) |
Net cash (used in) provided by financing activities | [1] |  |  | (267,759) |
Effect of exchange rate changes on cash | [1] |  |  | 444 |
Net decrease in cash and cash equivalents | [1] |  |  | (209,075) |
Cash and cash equivalents at beginning of the year | [1] |  |  | 1,410,871 |
Cash and cash equivalents at end of the period | [1] | $ 1,201,796 |  | $ 1,201,796 |
[1] | After elimination of the unrestricted subsidiaries and the physician groups.

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