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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