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Supplemental Data - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($) $ in Thousands | 3 Months Ended
--- | ---
Mar. 31, 2019 | Mar. 31, 2018
Cash flows from operating activities: |  |
Net income | $ 189,487 | $ 225,229
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | (48,183) | 137,310
Net cash provided by operating activities | 141,304 | 362,539
Cash flows from investing activities: |  |
Additions of property and equipment | (198,878) | (232,443)
Acquisitions | (11,274) |
Proceeds from asset and business sales | 13,903 | 18,535
Investments and other items | (4,109) | 30,362
Net cash used in investing activities | (200,358) | (200,128)
Cash flows from financing activities: |  |
Long-term debt | 357,197 | 104,673
Intercompany | 0 | 0
Other items | (32,246) | (327,220)
Net cash used in financing activities | 324,951 | (222,547)
Effect of exchange rate changes on cash, cash equivalents and restricted cash | (921) | 6,668
Net increase (decrease) in cash, cash equivalents and restricted cash | 264,976 | (53,468)
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 415,420 | 518,920
Cash, cash equivalents and restricted cash of continuing operations at end of the period | 561,434 | 447,618
Physician Groups |  |
Cash flows from operating activities: |  |
Net income | 9,237 |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | 9,696 |
Net cash provided by operating activities | 18,933 |
Cash flows from investing activities: |  |
Additions of property and equipment | (229) |
Acquisitions | 0 |
Proceeds from asset and business sales | 0 |
Investments and other items | (1,355) |
Net cash used in investing activities | (1,584) |
Cash flows from financing activities: |  |
Long-term debt | 0 |
Intercompany | 28,965 |
Other items | 0 |
Net cash used in financing activities | 28,965 |
Effect of exchange rate changes on cash, cash equivalents and restricted cash | 0 |
Net increase (decrease) in cash, cash equivalents and restricted cash | 46,314 |
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 | 463 |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | (463) |
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 increase (decrease) in cash, cash equivalents and restricted cash | 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 | 179,787 |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | (57,416) |
Net cash provided by operating activities | 122,371 |
Cash flows from investing activities: |  |
Additions of property and equipment | (198,649) |
Acquisitions | (11,274) |
Proceeds from asset and business sales | 13,903 |
Investments and other items | (2,754) |
Net cash used in investing activities | (198,774) |
Cash flows from financing activities: |  |
Long-term debt | 357,197 |
Intercompany | (28,965) |
Other items | (32,246) |
Net cash used in financing activities | 295,986 |
Effect of exchange rate changes on cash, cash equivalents and restricted cash | (921) |
Net increase (decrease) in cash, cash equivalents and restricted cash | 218,662 |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 415,420 |
Cash, cash equivalents and restricted cash of continuing operations at end of the period | 561,434 |
Discontinued Operations |  |
Cash flows from financing activities: |  |
Net increase (decrease) in cash, cash equivalents and restricted cash | 118,962 | 17,834
Discontinued Operations | Physician Groups |  |
Cash flows from financing activities: |  |
Net increase (decrease) in cash, cash equivalents and restricted cash | 46,314 |
Discontinued Operations | Unrestricted Subsidiaries |  |
Cash flows from financing activities: |  |
Net increase (decrease) in cash, cash equivalents and restricted cash | 0 |
Discontinued Operations | Company and Restricted Subsidiaries |  |
Cash flows from financing activities: |  |
Net increase (decrease) in cash, cash equivalents and restricted cash | 72,648 |
Continuing Operations |  |
Cash flows from financing activities: |  |
Net increase (decrease) in cash, cash equivalents and restricted cash | 146,014 | $ (71,302)
Continuing Operations | Physician Groups |  |
Cash flows from financing activities: |  |
Net increase (decrease) in cash, cash equivalents and restricted cash | 0 |
Continuing Operations | Unrestricted Subsidiaries |  |
Cash flows from financing activities: |  |
Net increase (decrease) in cash, cash equivalents and restricted cash | 0 |
Continuing Operations | Company and Restricted Subsidiaries |  |
Cash flows from financing activities: |  |
Net increase (decrease) in cash, cash equivalents and restricted cash | $ 146,014 |

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