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Supplemental Data - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended
--- | --- | ---
Jun. 30, 2017 | Jun. 30, 2016 | Jun. 30, 2017 | Jun. 30, 2016
Cash flows from operating activities: |  |  |  |  |
Net income |  | $ 161,625 | $ 94,503 | $ 661,910 | $ 232,662
Changes in operating and intercompany assets and liabilities and non-cash items included in net income |  |  |  | 349,534 | 712,977
Net cash provided by (used in) operating activities |  |  |  | 1,011,444 | 945,639
Cash flows from investing activities: |  |  |  |  |
Additions of property and equipment |  | (184,405) | (185,440) | (398,940) | (358,627)
Acquisitions and divestitures, net |  |  |  | (619,839) |
Proceeds from discontinued operations |  |  |  | 70,236 | 17,393
Investments and other items |  |  |  | 96,895 | 56,319
Net cash used in investing activities |  |  |  | (851,648) | (758,229)
Cash flows from financing activities: |  |  |  |  |
Long-term debt |  |  |  | (64,032) | (61,233)
Intercompany |  |  |  | 0 | 0
Payments For Other Financing Activities |  |  |  | (301,146) | (342,321)
Net cash (used in) provided by financing activities |  |  |  | (365,178) | (403,554)
Effect of exchange rate changes on cash |  |  |  | 4,192 | 444
Net (decrease) increase in cash |  |  |  | (201,190) | (215,700)
Cash and cash equivalents at beginning of period |  |  |  | 913,187 | 1,499,116
Cash and cash equivalents at end of period |  | 711,997 | $ 1,283,416 | 711,997 | $ 1,283,416
Physician Groups |  |  |  |  |
Cash flows from operating activities: |  |  |  |  |
Net income |  |  |  | 2,000 |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income |  |  |  | (37,812) |
Net cash provided by (used in) operating activities |  |  |  | (35,812) |
Cash flows from investing activities: |  |  |  |  |
Additions of property and equipment |  |  |  | (5,603) |
Investments and other items |  |  |  | (1,386) |
Net cash used in investing activities |  |  |  | (6,989) |
Cash flows from financing activities: |  |  |  |  |
Long-term debt |  |  |  | 0 |
Intercompany |  |  |  | 45,342 |
Net cash (used in) provided by financing activities |  |  |  | 45,342 |
Net (decrease) increase in cash |  |  |  | 2,541 |
Cash and cash equivalents at beginning of period |  |  |  | 104,691 |
Cash and cash equivalents at end of period |  | 107,232 |  | 107,232 |
Unrestricted Subsidiaries |  |  |  |  |
Cash flows from operating activities: |  |  |  |  |
Net income |  |  |  | 139 |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income |  |  |  | (139) |
Company and Restricted Subsidiaries(1) |  |  |  |  |
Cash flows from operating activities: |  |  |  |  |
Net income | [1] |  |  | 659,771 |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | [1] |  |  | 387,485 |
Net cash provided by (used in) operating activities | [1] |  |  | 1,047,256 |
Cash flows from investing activities: |  |  |  |  |
Additions of property and equipment | [1] |  |  | (393,337) |
Acquisitions and divestitures, net | [1] |  |  | (619,839) |
Proceeds from discontinued operations | [1] |  |  | 70,236 |
Investments and other items | [1] |  |  | 98,281 |
Net cash used in investing activities | [1] |  |  | (844,659) |
Cash flows from financing activities: |  |  |  |  |
Long-term debt | [1] |  |  | (64,032) |
Intercompany | [1] |  |  | (45,342) |
Payments For Other Financing Activities | [1] |  |  | (301,146) |
Net cash (used in) provided by financing activities | [1] |  |  | (410,520) |
Effect of exchange rate changes on cash | [1] |  |  | 4,192 |
Net (decrease) increase in cash | [1] |  |  | (203,731) |
Cash and cash equivalents at beginning of period | [1] |  |  | 808,496 |
Cash and cash equivalents at end of period | [1] | $ 604,765 |  | $ 604,765 |
[1] | After elimination of the unrestricted subsidiaries and the physician groups.

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