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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.