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Supplemental Data - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2018
Mar. 31, 2017
Cash flows from operating activities:    
Net income $ 225,229 $ 500,285
Changes in operating and intercompany assets and liabilities and non-cash items included in net income 137,310 364,886
Net cash provided by operating activities 362,539 865,171
Cash flows from investing activities:    
Additions of property and equipment (232,443) (214,535)
Acquisitions (16,582)  
Proceeds from asset and business sales 18,535 46,612
Investments and other items 30,362 (4,828)
Net cash used in investing activities (200,128) (249,987)
Cash flows from financing activities:    
Long-term debt 104,673 (36,141)
Intercompany 0 0
Other items (327,220) (22,796)
Net cash used in financing activities (222,547) (58,937)
Effect of exchange rate changes on cash, cash equivalents and restricted cash 6,668 2,820
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (53,468) 559,067
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year 518,920 683,463
Cash, cash equivalents and restricted cash of continuing operations at end of the period 447,618 1,218,037
Physician Groups    
Cash flows from operating activities:    
Net income 7,397  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income (20,189)  
Net cash provided by operating activities (12,792)  
Cash flows from investing activities:    
Additions of property and equipment (1,165)  
Acquisitions 0  
Proceeds from asset and business sales 0  
Investments and other items (541)  
Net cash used in investing activities (1,706)  
Cash flows from financing activities:    
Long-term debt 0  
Intercompany 1,082  
Other items 0  
Net cash used in financing activities 1,082  
Effect of exchange rate changes on cash, cash equivalents and restricted cash 0  
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (13,416)  
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year 0  
Cash, cash equivalents and restricted cash of continuing operations at end of the period 0  
Unrestricted Subsidiaries    
Cash flows from operating activities:    
Net income 490  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income (490)  
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, cash equivalents and restricted cash 0  
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations 0  
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year 0  
Cash, cash equivalents and restricted cash of continuing operations at end of the period 0  
Company and Restricted Subsidiaries    
Cash flows from operating activities:    
Net income 217,342  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income 157,989  
Net cash provided by operating activities 375,331  
Cash flows from investing activities:    
Additions of property and equipment (231,278)  
Acquisitions (16,582)  
Proceeds from asset and business sales 18,535  
Investments and other items 30,903  
Net cash used in investing activities (198,422)  
Cash flows from financing activities:    
Long-term debt 104,673  
Intercompany (1,082)  
Other items (327,220)  
Net cash used in financing activities (223,629)  
Effect of exchange rate changes on cash, cash equivalents and restricted cash 6,668  
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (40,052)  
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year 518,920  
Cash, cash equivalents and restricted cash of continuing operations at end of the period 447,618  
Discontinued Operations    
Cash flows from financing activities:    
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations 17,834 24,493
Discontinued Operations | Physician Groups    
Cash flows from financing activities:    
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (13,416)  
Discontinued Operations | Unrestricted Subsidiaries    
Cash flows from financing activities:    
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations 0  
Discontinued Operations | Company and Restricted Subsidiaries    
Cash flows from financing activities:    
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations 31,250  
Continuing Operations    
Cash flows from financing activities:    
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (71,302) $ 534,574
Continuing Operations | Physician Groups    
Cash flows from financing activities:    
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations 0  
Continuing Operations | Unrestricted Subsidiaries    
Cash flows from financing activities:    
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations 0  
Continuing Operations | Company and Restricted Subsidiaries    
Cash flows from financing activities:    
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations $ (71,302)