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Supplemental Data (unaudited) - Condensed Consolidating Statements of Cash Flows (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
Cash flows from operating activities:      
Net income $ 830,555 $ 1,033,082 $ 427,410
Changes in operating and intercompany assets and liabilities and non-cash items included in net income 1,076,894 930,362 1,129,790
Net cash provided by operating activities 1,907,449 1,963,444 1,557,200
Cash flows from investing activities:      
Additions of property and equipment (905,250) (829,095) (707,998)
Acquisitions and divestitures, net (803,879)    
Proceeds from asset sales 92,336    
Investments and other items, net 250,062 126,558 (97,032)
Net cash used in investing activities (1,366,731) (1,201,668) (881,784)
Cash flows from financing activities:      
Long-term debt and related financing costs, net 154,848 (124,442) 619,698
Intercompany 0 0 0
Other items (921,105) (1,227,539) (758,668)
Net cash used in financing activities (766,257) (1,351,981) (138,970)
Effect of exchange rate changes on cash 254 4,276 (2,571)
Net (decrease) increase in cash and cash equivalents (225,285) (585,929) 533,875
Less: Net (decrease) increase in cash and cash equivalents from discontinued operations (58,743) (15,788) 25,855
Net (decrease) increase in cash and cash equivalents from continuing operations (166,542) (570,141) 508,020
Cash and cash equivalents of continuing operations at beginning of the year 674,776 1,244,917 736,897
Cash and cash equivalents of continuing operations at end of the year 508,234 674,776 $ 1,244,917
Physician Groups      
Cash flows from operating activities:      
Net income 13,611    
Changes in operating and intercompany assets and liabilities and non-cash items included in net income 27,312    
Net cash provided by operating activities 40,923    
Cash flows from investing activities:      
Additions of property and equipment (5,406)    
Acquisitions and divestitures, net 0    
Proceeds from asset sales 0    
Investments and other items, net (3,800)    
Net cash used in investing activities (9,206)    
Cash flows from financing activities:      
Long-term debt and related financing costs, net 0    
Intercompany (36,220)    
Other items 0    
Net cash used in financing activities (36,220)    
Effect of exchange rate changes on cash 0    
Net (decrease) increase in cash and cash equivalents (4,503)    
Less: Net (decrease) increase in cash and cash equivalents from discontinued operations (4,503)    
Net (decrease) increase in cash and cash equivalents from continuing operations 0    
Cash and cash equivalents of continuing operations at beginning of the year 0    
Cash and cash equivalents of continuing operations at end of the year 0 0  
Unrestricted Subsidiaries      
Cash flows from operating activities:      
Net income 19    
Changes in operating and intercompany assets and liabilities and non-cash items included in net income (19)    
Net cash provided by operating activities 0    
Cash flows from investing activities:      
Additions of property and equipment 0    
Acquisitions and divestitures, net 0    
Proceeds from asset sales 0    
Investments and other items, net 0    
Net cash used in investing activities 0    
Cash flows from financing activities:      
Long-term debt and related financing costs, net 0    
Intercompany 0    
Other items 0    
Net cash used in financing activities 0    
Effect of exchange rate changes on cash 0    
Net (decrease) increase in cash and cash equivalents 0    
Less: Net (decrease) increase in cash and cash equivalents from discontinued operations 0    
Net (decrease) increase in cash and cash equivalents from continuing operations 0    
Cash and cash equivalents of continuing operations at beginning of the year 0    
Cash and cash equivalents of continuing operations at end of the year 0 0  
Company and Restricted Subsidiaries(1)      
Cash flows from operating activities:      
Net income 816,925    
Changes in operating and intercompany assets and liabilities and non-cash items included in net income 1,049,601    
Net cash provided by operating activities 1,866,526    
Cash flows from investing activities:      
Additions of property and equipment (899,844)    
Acquisitions and divestitures, net (803,879)    
Proceeds from asset sales 92,336    
Investments and other items, net 253,862    
Net cash used in investing activities (1,357,525)    
Cash flows from financing activities:      
Long-term debt and related financing costs, net 154,848    
Intercompany 36,220    
Other items (921,105)    
Net cash used in financing activities (730,037)    
Effect of exchange rate changes on cash 254    
Net (decrease) increase in cash and cash equivalents (220,782)    
Less: Net (decrease) increase in cash and cash equivalents from discontinued operations (54,240)    
Net (decrease) increase in cash and cash equivalents from continuing operations (166,542)    
Cash and cash equivalents of continuing operations at beginning of the year 674,776    
Cash and cash equivalents of continuing operations at end of the year $ 508,234 $ 674,776