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Supplemental Data - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2017
Sep. 30, 2016
Sep. 30, 2017
Sep. 30, 2016
Cash flows from operating activities:        
Net (loss) income $ (172,034) $ 612,150 $ 489,876 $ 844,812
Changes in operating and intercompany assets and liabilities and non-cash items included in net income     1,074,663 636,450
Net cash provided by operating activities     1,564,539 1,481,262
Cash flows from investing activities:        
Additions of property and equipment (240,889) (216,616) (639,829) (575,243)
Acquisitions     (726,538)  
Proceeds from asset and business sales     92,529 18,991
Investments and other items     166,605 (203,659)
Net cash used in investing activities     (1,107,233) (1,257,242)
Cash flows from financing activities:        
Long-term debt     (108,463) (98,724)
Intercompany     0 0
Other items     (421,369) (709,252)
Net cash used in financing activities     (529,832) (807,976)
Effect of exchange rate changes on cash and cash equivalents     5,449 (1,664)
Net decrease in cash and cash equivalents     (67,077) (585,620)
Cash and cash equivalents at beginning of period     913,187 1,499,116
Cash and cash equivalents at end of period 846,110 $ 913,496 846,110 $ 913,496
Physician Groups        
Cash flows from operating activities:        
Net (loss) income     7,544  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income     29,753  
Net cash provided by operating activities     37,297  
Cash flows from investing activities:        
Additions of property and equipment     (5,903)  
Acquisitions     0  
Proceeds from asset and business sales     0  
Investments and other items     (2,378)  
Net cash used in investing activities     (8,281)  
Cash flows from financing activities:        
Long-term debt     0  
Intercompany     28,829  
Other items     0  
Net cash used in financing activities     28,829  
Effect of exchange rate changes on cash and cash equivalents     0  
Net decrease in cash and cash equivalents     57,845  
Cash and cash equivalents at beginning of period     104,691  
Cash and cash equivalents at end of period 162,536   162,536  
Unrestricted Subsidiaries        
Cash flows from operating activities:        
Net (loss) income     88  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income     (88)  
Net cash provided by operating activities     0  
Cash flows from investing activities:        
Additions of property and equipment     0  
Acquisitions     0  
Proceeds from asset and business sales     0  
Investments and other items     0  
Net cash used in investing activities     0  
Cash flows from financing activities:        
Long-term debt     0  
Intercompany     0  
Other items     0  
Net cash used in financing activities     0  
Effect of exchange rate changes on cash and cash equivalents     0  
Net decrease in cash and cash equivalents     0  
Cash and cash equivalents at end of period 0   0  
Company and Restricted Subsidiaries        
Cash flows from operating activities:        
Net (loss) income     482,244  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income     1,044,998  
Net cash provided by operating activities     1,527,242  
Cash flows from investing activities:        
Additions of property and equipment     (633,926)  
Acquisitions     (726,538)  
Proceeds from asset and business sales     92,529  
Investments and other items     168,983  
Net cash used in investing activities     (1,098,952)  
Cash flows from financing activities:        
Long-term debt     (108,463)  
Intercompany     (28,829)  
Other items     (421,369)  
Net cash used in financing activities     (558,661)  
Effect of exchange rate changes on cash and cash equivalents     5,449  
Net decrease in cash and cash equivalents     (124,922)  
Cash and cash equivalents at beginning of period     808,496  
Cash and cash equivalents at end of period $ 683,574   $ 683,574