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Medical payables - Components of Changes in Medical Payables (Detail)
$ in Thousands
 9 Months Ended
Sep. 30, 2017
USD ($)
Health Care Costs Payable [Roll Forward]  
Healthcare costs payables, beginning of the period $ 336,381
Less: Claims paid  
Healthcare costs payables, end of the period 400,259
Healthcare Cost  
Health Care Costs Payable [Roll Forward]  
Healthcare costs payables, beginning of the period 214,275
Add: Components of incurred health care costs  
Current year 1,509,433
Prior years (12,597)
Acquired balance 3,218
Total incurred health care costs 1,500,054
Less: Claims paid  
Current year 1,226,953
Prior years 194,285
Total claims paid 1,421,238
Healthcare costs payables, end of the period $ 293,091