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Contingencies - Additional Information (Detail) - USD ($)
$ in Thousands
1 Months Ended 3 Months Ended
Dec. 31, 2017
Mar. 31, 2018
Mar. 31, 2017
Other Commitments [Line Items]      
Gain on litigation settlement   $ 0 $ 526,827
2016 U.S. Attorney Prescription Drug Investigation      
Other Commitments [Line Items]      
Litigation Settlement, Amount Awarded to Other Party $ 63,700    
Loss Contingency Accrual, Payments 41,500    
Loss Contingency Accrual, Partial Payment $ 22,200    
US Department Of Veterans Affairs Suit      
Other Commitments [Line Items]      
Litigation Settlement, Amount Awarded from Other Party   538,000  
Gain on litigation settlement   527,000  
Noncontrolling Interest | US Department Of Veterans Affairs Suit      
Other Commitments [Line Items]      
Gain on litigation settlement   9,000  
Operating Income (Loss) | US Department Of Veterans Affairs Suit      
Other Commitments [Line Items]      
Gain on litigation settlement   530,000  
Equity Method Investments | Noncontrolling Interest | US Department Of Veterans Affairs Suit      
Other Commitments [Line Items]      
Gain on litigation settlement   $ 3,000