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Supplemental Data - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014
Cash flows from operating activities: |  |  |  |
Net income |  | $ 1,033,082 | $ 427,410 | $ 863,330
Changes in operating and intercompany assets and liabilities and non-cash items included in net income |  | 930,362 | 1,129,790 | 596,077
Net cash provided by operating activities |  | 1,963,444 | 1,557,200 | 1,459,407
Cash flows from investing activities: |  |  |  |
Additions of property and equipment |  | (829,095) | (707,998) | (641,330)
Acquisitions and divestitures, net |  | (563,856) |  |
Proceeds from asset sales |  | 64,725 |  |
Investments and other items |  | 126,558 | (97,032) | (373,096)
Net cash used in investing activities |  | (1,201,668) | (881,784) | (1,277,729)
Cash flows from financing activities: |  |  |  |
Long-term debt and related financing costs, net |  | (124,442) | 619,698 | (7,989)
Other items |  | (1,227,539) | (758,668) | (156,990)
Net cash used in financing activities |  | (1,351,981) | (138,970) | (164,979)
Effect of exchange rate changes on cash |  | 4,276 | (2,571) | 2,293
Net (decrease) increase in cash and cash equivalents |  | (585,929) | 533,875 | 18,992
Cash and cash equivalents at beginning of the year |  | 1,499,116 | 965,241 | 946,249
Cash and cash equivalents at end of the year |  | 913,187 | 1,499,116 | $ 965,241
Physician Groups |  |  |  |
Cash flows from operating activities: |  |  |  |
Net income |  | 32,301 |  |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income |  | 131,863 |  |
Net cash provided by operating activities |  | 164,164 |  |
Cash flows from investing activities: |  |  |  |
Additions of property and equipment |  | (863) |  |
Investments and other items |  | (3,014) |  |
Net cash used in investing activities |  | (3,877) |  |
Cash flows from financing activities: |  |  |  |
Long-term debt and related financing costs, net |  | (4) |  |
Intercompany |  | (143,837) |  |
Net cash used in financing activities |  | (143,841) |  |
Net (decrease) increase in cash and cash equivalents |  | 16,446 |  |
Cash and cash equivalents at beginning of the year |  | 88,245 |  |
Cash and cash equivalents at end of the year |  | 104,691 | 88,245 |
Unrestricted Subsidiaries |  |  |  |
Cash flows from operating activities: |  |  |  |
Net income |  | (66) |  |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income |  | 66 |  |
Company and Restricted Subsidiaries |  |  |  |
Cash flows from operating activities: |  |  |  |
Net income | [1] | 1,000,847 |  |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | [1] | 798,433 |  |
Net cash provided by operating activities | [1] | 1,799,280 |  |
Cash flows from investing activities: |  |  |  |
Additions of property and equipment | [1] | (828,232) |  |
Acquisitions and divestitures, net | [1] | (563,856) |  |
Proceeds from asset sales | [1] | 64,725 |  |
Investments and other items | [1] | 129,572 |  |
Net cash used in investing activities | [1] | (1,197,791) |  |
Cash flows from financing activities: |  |  |  |
Long-term debt and related financing costs, net | [1] | (124,438) |  |
Intercompany | [1] | 143,837 |  |
Other items | [1] | (1,227,539) |  |
Net cash used in financing activities | [1] | (1,208,140) |  |
Effect of exchange rate changes on cash | [1] | 4,276 |  |
Net (decrease) increase in cash and cash equivalents | [1] | (602,375) |  |
Cash and cash equivalents at beginning of the year | [1] | 1,410,871 |  |
Cash and cash equivalents at end of the year | [1] | $ 808,496 | $ 1,410,871 |
[1] | After the elimination of the unrestricted subsidiaries and the physician groups

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