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Segment Reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended
--- | --- | ---
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Dialysis and related lab patient service revenues |  |  |  |  |  |  |  |  | $ 10,709,981 | $ 10,093,670 | $ 9,727,360
Provision for uncollectible accounts |  |  |  |  |  |  |  |  | (49,587) | (485,364) | (431,304)
Net dialysis and related lab patient service revenues |  |  |  |  |  |  |  |  | 10,660,394 | 9,608,306 | 9,296,056
Other revenues |  |  |  |  |  |  |  |  | 744,457 | 1,268,328 | 1,411,411
Total revenues | $ 2,821,124 | $ 2,847,330 | $ 2,886,953 | $ 2,849,444 | $ 2,780,913 | $ 2,765,071 | $ 2,699,399 | $ 2,631,251 | 11,404,851 | 10,876,634 | 10,707,467
Operating income | $ 387,908 | $ 289,038 | $ 438,192 | $ 410,686 | $ 150,337 | $ 395,294 | $ 391,196 | $ 875,928 | 1,525,824 | 1,812,755 | 2,029,710
Corporate administrative support |  |  |  |  |  |  |  |  | (90,108) | (44,966) | (13,628)
Debt expense |  |  |  |  |  |  |  |  | (487,435) | (430,634) | (414,116)
Other income |  |  |  |  |  |  |  |  | 10,089 | 17,665 | 7,511
Income from continuing operations before income taxes |  |  |  |  |  |  |  |  | 1,048,478 | 1,399,786 | 1,623,105
U.S. dialysis and related lab services |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Total revenues |  |  |  |  |  |  |  |  | 10,242,999 | 9,304,889 | 9,110,834
Other ancillary services and strategic initiatives |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Total revenues |  |  |  |  |  |  |  |  | 1,161,852 | 1,571,745 | 1,596,633
Operating Segments |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Total revenues |  |  |  |  |  |  |  |  | 11,532,037 | 10,956,413 | 10,759,561
Operating income |  |  |  |  |  |  |  |  | 1,615,932 | 1,857,721 | 2,043,338
Operating Segments | U.S. dialysis and related lab services |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Dialysis and related lab patient service revenues |  |  |  |  |  |  |  |  | 10,366,996 | 9,822,299 | 9,551,422
Provision for uncollectible accounts |  |  |  |  |  |  |  |  | (50,927) | 481,973 | (429,878)
Net dialysis and related lab patient service revenues |  |  |  |  |  |  |  |  | 10,316,069 | 9,340,326 | 9,121,544
Other revenues |  |  |  |  |  |  |  |  | 19,880 | 19,739 | 16,645
Total revenues |  |  |  |  |  |  |  |  | 10,335,949 | 9,360,065 | 9,138,189
Operating income |  |  |  |  |  |  |  |  | 1,709,721 | 2,297,198 | 1,777,014
Operating Segments | U.S. dialysis and related lab services | External Sources |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Dialysis and related lab patient service revenues |  |  |  |  |  |  |  |  | 10,274,046 | 9,767,123 | 9,524,067
Operating Segments | U.S. dialysis and related lab services | Intersubsegment Eliminations |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Dialysis and related lab patient service revenues |  |  |  |  |  |  |  |  | 92,950 | 55,176 | 27,355
Operating Segments | Other ancillary services and strategic initiatives |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Dialysis and related lab patient service revenues |  |  |  |  |  |  |  |  | 437,275 | 323,156 | 201,867
Other revenues |  |  |  |  |  |  |  |  | 724,577 | 1,248,589 | 1,394,766
Total revenues |  |  |  |  |  |  |  |  | 1,196,088 | 1,596,348 | 1,621,372
Operating income |  |  |  |  |  |  |  |  | (93,789) | (439,477) | 266,324
Operating Segments | Other ancillary services and strategic initiatives | Intersubsegment Eliminations |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Dialysis and related lab patient service revenues |  |  |  |  |  |  |  |  | 34,236 | 24,603 | 24,739
Intersegment Elimination |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Total revenues |  |  |  |  |  |  |  |  | (127,186) | (79,779) | (52,094)
Intersegment Elimination | U.S. dialysis and related lab services |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Total revenues |  |  |  |  |  |  |  |  | (92,950) | (55,176) | (27,355)
Intersegment Elimination | Other ancillary services and strategic initiatives |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Total revenues |  |  |  |  |  |  |  |  | $ (34,236) | $ (24,603) | $ (24,739)

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