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Accrued Professional Liability - Schedule of Accrued Professional Liability (Detail) (USD $)
In Thousands, unless otherwise specified
 12 Months Ended
Dec. 31, 2013
Dec. 31, 2012
Dec. 31, 2011
Payables And Accruals [Abstract]      
Balance at beginning of year $ 137,036 $ 122,847 $ 111,662
Provision (adjustment) for losses related to Current year 41,235 35,441 33,031
Provision (adjustment) for losses related to Prior years (8,100) (8,119) (10,099)
Total provision for losses 33,135 27,322 22,932
Claim payments related to Current year (741) (569) (221)
Claim payments related to Prior years (10,739) (12,564) (11,526)
Total payments (11,480) (13,133) (11,747)
Balance at end of year $ 158,691 $ 137,036 $ 122,847