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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.