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Supplemental Data - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2016
Sep. 30, 2015
Sep. 30, 2016
Sep. 30, 2015
Cash flows from operating activities:        
Net income $ 612,150 $ 261,307 $ 844,812 $ 392,936
Changes in operating and intercompany assets and liabilities and non-cash items included in net income     636,450 727,591
Net cash provided by operating activities     1,481,262 1,120,527
Cash flows from investing activities:        
Additions of property and equipment (216,616) (171,340) (575,243) (462,213)
Acquisitions and divestitures, net     (497,331)  
Proceeds from discontinued operations     18,991 6,865
Investments and other items     (203,659) (604,327)
Net cash used in investing activities     (1,257,242) (1,150,384)
Cash flows from financing activities:        
Long-term debt     (98,724) 639,317
Other items     (709,252) (525,438)
Net cash (used in) provided by financing activities     (807,976) 113,879
Effect of exchange rate changes on cash     (1,664) (1,844)
Net (decrease) increase in cash and cash equivalents     (585,620) 82,178
Cash and cash equivalents at beginning of the year     1,499,116 965,241
Cash and cash equivalents at end of the period 913,496 $ 1,047,419 913,496 $ 1,047,419
Physician Groups        
Cash flows from operating activities:        
Net income     (15,545)  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income     152,461  
Net cash provided by operating activities     136,916  
Cash flows from investing activities:        
Additions of property and equipment     (592)  
Investments and other items     (2,124)  
Net cash used in investing activities     (2,716)  
Cash flows from financing activities:        
Long-term debt     (4)  
Intercompany     (117,805)  
Net cash (used in) provided by financing activities     (117,809)  
Net (decrease) increase in cash and cash equivalents     16,391  
Cash and cash equivalents at beginning of the year     88,245  
Cash and cash equivalents at end of the period 104,636   104,636  
Unrestricted Subsidiaries        
Cash flows from operating activities:        
Net income     77  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income     (77)  
Company and Restricted Subsidiaries        
Cash flows from operating activities:        
Net income [1]     860,280  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income [1]     484,066  
Net cash provided by operating activities [1]     1,344,346  
Cash flows from investing activities:        
Additions of property and equipment [1]     (574,651)  
Acquisitions and divestitures, net [1]     (497,331)  
Proceeds from discontinued operations [1]     18,991  
Investments and other items [1]     (201,535)  
Net cash used in investing activities [1]     (1,254,526)  
Cash flows from financing activities:        
Long-term debt [1]     (98,720)  
Intercompany [1]     117,805  
Other items [1]     (709,252)  
Net cash (used in) provided by financing activities [1]     (690,167)  
Effect of exchange rate changes on cash [1]     (1,664)  
Net (decrease) increase in cash and cash equivalents [1]     (602,011)  
Cash and cash equivalents at beginning of the year [1]     1,410,871  
Cash and cash equivalents at end of the period [1] $ 808,860   $ 808,860  
[1] After elimination of the unrestricted subsidiaries and the physician groups.