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Long-term debt (Detail) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2025	Jun. 30, 2025	May 23, 2025	Dec. 31, 2024
Debt Instrument [Line Items]
Total debt principal outstanding	$ 10,330,478	$ 10,330,478		$ 9,511,106
Discount Premium And Deferred Financing Costs	(69,231)	(69,231)		(64,336)
Carrying amount of long-term debt, net of unamortized discounts, premiums and deferred financing costs	10,261,247	10,261,247		9,446,770
Less current portion	(182,442)	(182,442)		(270,867)
Total long-term debt	$ 10,078,805	$ 10,078,805		9,175,903
Long-term debt, weighted average interest rate, at point in time	5.73%	5.73%
Revolving line of credit
Debt Instrument [Line Items]
Secured Debt	$ 0	$ 0		0
Revolving line of credit, fair value of amount outstanding	$ 0	$ 0
Debt Instrument, Maturity Date		Apr. 28, 2028
Weighted Average
Debt Instrument [Line Items]
Debt Instrument, Interest Rate During Period	5.71%	5.66%
4.625% Senior Notes
Debt Instrument [Line Items]
Senior Notes	$ 2,750,000	$ 2,750,000		2,750,000
Debt Instrument, Fair Value Disclosure	$ 2,633,125	$ 2,633,125
Debt Instrument, Maturity Date		Jun. 01, 2030
Debt, Interest Rate, at Point in Time	4.625%	4.625%
3.75% Senior Notes
Debt Instrument [Line Items]
Senior Notes	$ 1,500,000	$ 1,500,000		1,500,000
Debt Instrument, Fair Value Disclosure	$ 1,362,225	$ 1,362,225
Debt Instrument, Maturity Date		Feb. 15, 2031
Debt, Interest Rate, at Point in Time	3.75%	3.75%
6.875% Senior Notes
Debt Instrument [Line Items]
Senior Notes	$ 1,000,000	$ 1,000,000		1,000,000
Debt Instrument, Fair Value Disclosure	$ 1,035,000	$ 1,035,000
Debt Instrument, Maturity Date		Sep. 01, 2032
Debt, Interest Rate, at Point in Time	6.875%	6.875%
Acquisition obligations and other notes payable
Debt Instrument [Line Items]
Acquisition obligations and other notes payable	$ 51,276	$ 51,276		56,483
Long-term debt, weighted average interest rate, at point in time	5.41%	5.41%
Acquisition obligations and other notes payable, fair value	$ 51,276	$ 51,276
Debt instrument, maturity date, description		2025-2038
Financing lease obligations
Debt Instrument [Line Items]
Financing lease obligations	$ 201,413	$ 201,413		216,401
Finance lease, weighted average discount rate, percent	4.54%	4.54%
Debt instrument, maturity date, description		2026-2039
Change Healthcare Temporary Funding Assistance
Debt Instrument [Line Items]
CHC Temporary Funding Assistance	$ 0	$ 0		92,777
CHC Temporary Funding Assistance, Fair Value	0	0
6.75% Senior Notes
Debt Instrument [Line Items]
Senior Notes	1,000,000	1,000,000	$ 1,000,000
Debt Instrument, Fair Value Disclosure	$ 1,032,500	$ 1,032,500
Debt Instrument, Maturity Date		Jul. 15, 2033
Debt, Interest Rate, at Point in Time	6.75%	6.75%	6.75%
Term Loan A-1
Debt Instrument [Line Items]
Secured Debt	$ 2,199,840	$ 2,199,840		2,259,295
Debt Instrument, Fair Value Disclosure	2,202,590	2,202,590
Debt Instrument, Periodic Payment, Principal		$ 59,455
Debt Instrument, Maturity Date		Apr. 28, 2028
Term Loan B-1
Debt Instrument [Line Items]
Secured Debt	1,627,949	$ 1,627,949		$ 1,636,150
Debt Instrument, Fair Value Disclosure	$ 1,636,089	1,636,089
Debt Instrument, Periodic Payment, Principal		$ 8,201
Debt Instrument, Maturity Date		May 09, 2031
Term Loan B-1 | SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of Variable Rate Basis	SOFR + 2.00%
Term Loan A-1 and Revolver | SOFR
Debt Instrument [Line Items]
Debt Instrument, Description of Variable Rate Basis		Base +1.75%
Term Loan A-1 and Revolver | Adjusted Rate
Debt Instrument [Line Items]
Debt Instrument, Basis Spread on Variable Rate		0.10%

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