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Accrued Professional Liability - Schedule of Accrued Professional Liability (Detail) (USD $)
In Thousands, unless otherwise specified
 12 Months Ended
Dec. 31, 2012
Dec. 31, 2011
Dec. 31, 2010
Malpractice Loss Contingency [Line Items]      
Balance at beginning of year $ 122,847 $ 111,662 $ 109,628
Provision (adjustment) for losses related to Current year 35,441 33,031 27,086
Provision (adjustment) for losses related to Prior years (8,119) (10,099) (11,142)
Total provision for losses 27,322 22,932 15,944
Claim payments related to Current year (569) (221) (553)
Claim payments related to Prior years (12,564) (11,526) (13,357)
Total payments (13,133) (11,747) (13,910)
Balance at end of year $ 137,036 $ 122,847 $ 111,662