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Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended
--- | --- | ---
Jun. 30, 2017 | Jun. 30, 2016 | Jun. 30, 2017 | Jun. 30, 2016
Segment Reporting Information [Line Items] |  |  |  |  |
Patient service revenues |  | $ 2,682,467 | $ 2,583,514 | $ 5,283,845 | $ 5,065,448
Less: Provision for uncollectible accounts |  | (115,485) | (111,428) | (228,468) | (220,633)
Net dialysis and related lab services patient service revenues |  | 2,566,982 | 2,472,086 | 5,055,377 | 4,844,815
Other revenues |  | 288,417 | 345,580 | 579,269 | 665,979
Total net operating revenues |  | 3,877,477 | 3,717,651 | 7,574,760 | 7,298,787
Capitated revenues |  | 1,022,078 | 899,985 | 1,940,114 | 1,787,993
Operating income (loss) |  | 378,316 | 329,070 | 1,266,552 | 693,959
Corporate administrative support |  | (11,031) | (5,417) | (21,622) | (12,337)
Debt expense |  | (107,962) | (102,894) | (212,391) | (205,778)
Other income, net |  | 5,253 | 3,215 | 9,496 | 6,191
Consolidated income before income taxes |  | 275,607 | 229,391 | 1,063,657 | 494,372
Operating Segments |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Total net operating revenues |  | 3,914,873 | 3,746,885 | 7,651,277 | 7,354,227
Operating income (loss) |  | 389,347 | 334,487 | 1,288,174 | 706,296
Operating Segments | U.S. dialysis and related lab services |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Patient service revenues |  | 2,429,658 | 2,367,044 | 4,802,319 | 4,695,015
Less: Provision for uncollectible accounts |  | (109,335) | (106,515) | (216,105) | (211,266)
Net dialysis and related lab services patient service revenues |  | 2,320,323 | 2,260,529 | 4,586,214 | 4,483,749
Other revenues | [1] | 4,891 | 4,250 | 10,194 | 8,223
Total net operating revenues |  | 2,325,214 | 2,264,779 | 4,596,408 | 4,491,972
Operating income (loss) | [2] | 450,472 | 449,190 | 1,395,212 | 889,245
Operating Segments | U.S. dialysis and related lab services | External Sources |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Patient service revenues |  | 2,403,222 | 2,352,574 | 4,752,123 | 4,666,236
Operating Segments | U.S. dialysis and related lab services | Intersubsegment Eliminations |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Patient service revenues |  | 26,436 | 14,470 | 50,196 | 28,779
Operating Segments | DMG |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Net dialysis and related lab services patient service revenues |  | 189,529 | 169,167 | 368,501 | 281,601
Other revenues | [3] | 19,070 | 16,235 | 37,339 | 26,569
Total net operating revenues |  | 1,196,066 | 1,059,565 | 2,283,050 | 2,048,423
Capitated revenues |  | 987,420 | 874,119 | 1,877,105 | 1,740,138
Operating income (loss) |  | (12,880) | (102,059) | (572) | (159,204)
Operating Segments | DMG | Intersubsegment Eliminations |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Other revenues |  | 47 | 44 | 105 | 115
Operating Segments | Ancillary services and strategic initiatives |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Net dialysis and related lab services patient service revenues |  | 83,566 | 56,860 | 150,858 | 108,244
Other revenues |  | 264,456 | 325,095 | 531,736 | 631,187
Total net operating revenues |  | 393,593 | 422,541 | 771,819 | 813,832
Capitated revenues |  | 34,658 | 25,866 | 63,009 | 47,855
Operating income (loss) |  | (48,245) | (12,644) | (106,466) | (23,745)
Operating Segments | Ancillary services and strategic initiatives | Intersubsegment Eliminations |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Total net operating revenues |  | 10,913 | 14,720 | 26,216 | 26,546
Intersegment Elimination |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |
Total net operating revenues |  | $ (37,396) | $ (29,234) | $ (76,517) | $ (55,440)
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