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Supplemental Data - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($)
$ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2018
Jun. 30, 2017
Jun. 30, 2018
Jun. 30, 2017
Cash flows from operating activities:        
Net income $ 306,322 $ 161,625 $ 531,551 $ 661,910
Changes in operating and intercompany assets and liabilities and non-cash items included in net income     393,024 353,147
Net cash provided by operating activities     924,575 1,015,057
Cash flows from investing activities:        
Additions of property and equipment (241,534) (184,405) (473,977) (398,940)
Acquisitions     (89,465)  
Proceeds from asset and business sales     116,241 70,236
Investments and other items     23,137 96,936
Net cash used in investing activities     (424,064) (851,607)
Cash flows from financing activities:        
Long-term debt     573,981 (64,032)
Intercompany     0 0
Other items     (879,890) (301,146)
Net cash used in financing activities     (305,909) (365,178)
Effect of exchange rate changes on cash, cash equivalents and restricted cash     (3,473) 4,192
Net decrease in cash, cash equivalents and restricted cash from continuing operations     191,129 (197,536)
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 480,148 $ 453,207 480,148 453,207
Physician Groups        
Cash flows from operating activities:        
Net income     16,466  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income     101,201  
Net cash provided by operating activities     117,667  
Cash flows from investing activities:        
Additions of property and equipment     (2,097)  
Acquisitions     0  
Proceeds from asset and business sales     0  
Investments and other items     (1,021)  
Net cash used in investing activities     (3,118)  
Cash flows from financing activities:        
Long-term debt     0  
Intercompany     57,783  
Other items     0  
Net cash used in financing activities     57,783  
Effect of exchange rate changes on cash, cash equivalents and restricted cash     0  
Net decrease in cash, cash equivalents and restricted cash from continuing operations     172,332  
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   0  
Unrestricted Subsidiaries        
Cash flows from operating activities:        
Net income     323  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income     (323)  
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 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   0  
Company and Restricted Subsidiaries        
Cash flows from operating activities:        
Net income     514,762  
Changes in operating and intercompany assets and liabilities and non-cash items included in net income     292,146  
Net cash provided by operating activities     806,908  
Cash flows from investing activities:        
Additions of property and equipment     (471,880)  
Acquisitions     (89,465)  
Proceeds from asset and business sales     116,241  
Investments and other items     24,158  
Net cash used in investing activities     (420,946)  
Cash flows from financing activities:        
Long-term debt     573,981  
Intercompany     (57,783)  
Other items     (879,890)  
Net cash used in financing activities     (363,692)  
Effect of exchange rate changes on cash, cash equivalents and restricted cash     (3,473)  
Net decrease in cash, cash equivalents and restricted cash from continuing operations     18,797  
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 $ 480,148   480,148  
Discontinued Operations        
Cash flows from financing activities:        
Net decrease in cash, cash equivalents and restricted cash from continuing operations     229,901 32,720
Discontinued Operations | Physician Groups        
Cash flows from financing activities:        
Net decrease in cash, cash equivalents and restricted cash from continuing operations     172,332  
Discontinued Operations | Unrestricted Subsidiaries        
Cash flows from financing activities:        
Net decrease in cash, cash equivalents and restricted cash from continuing operations     0  
Discontinued Operations | Company and Restricted Subsidiaries        
Cash flows from financing activities:        
Net decrease in cash, cash equivalents and restricted cash from continuing operations     57,569  
Continuing Operations        
Cash flows from financing activities:        
Net decrease in cash, cash equivalents and restricted cash from continuing operations     (38,772) $ (230,256)
Continuing Operations | Physician Groups        
Cash flows from financing activities:        
Net decrease in cash, cash equivalents and restricted cash from continuing operations     0  
Continuing Operations | Unrestricted Subsidiaries        
Cash flows from financing activities:        
Net decrease in cash, cash equivalents and restricted cash from continuing operations     0  
Continuing Operations | Company and Restricted Subsidiaries        
Cash flows from financing activities:        
Net decrease in cash, cash equivalents and restricted cash from continuing operations     $ (38,772)