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Revenue Recognition and Accounts Receivable - Additional Information (Detail) | 12 Months Ended
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Dec. 31, 2018 USD ($) | Dec. 31, 2017 USD ($) | Dec. 31, 2016 USD ($)
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] |  |  |
Provision for uncollectible accounts | $ 49,587,000 | $ 485,364,000 | $ 431,304,000
Accounts receivable, net | 1,858,608,000 | 1,714,750,000 |
Medicare bad debt claims |  |  |
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] |  |  |
Accounts receivable, net | $ 1,080,561,000 | $ 874,971,000 |
Accounts Receivable |  |  |
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] |  |  |
Accounts Receivable Period Outstanding | 1 year |  |
Patient Services Customer Concentration Risk | Accounts Receivable |  |  |
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] |  |  |
Number Of Concentration Risk Customers | 0 | 0 |
Percentage of U.S. dialysis service revenues related to government-based programs | 10.00% | 10.00% |
Accounts receivable, net | $ 0 |  |
Percentage Of Accounts Receivable Six Months Or More Past Due | 18.00% | 21.00% |
Accounts Receivable Period Outstanding | 6 months |  |
Difference between Revenue Guidance in Effect before and after Topic 606 |  |  |
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] |  |  |
Contract with Customer, Performance Obligation Satisfied in Previous Period | $ 88,495,000 |  |
New Accounting Pronouncement or Change in Accounting Principle, Effect of Adoption, Quantification | 36,000,000 |  |
Accounts Receivable |  |  |
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] |  |  |
Accounts receivable, allowance | $ 52,924,000 | $ 218,399,000 |

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