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Schedule II - Valuation and Qualifying Accounts (Detail) (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2013	Dec. 31, 2012	Dec. 31, 2011
Valuation And Qualifying Accounts [Abstract]
Balance at beginning of year	$ 624,896	$ 576,030	$ 421,977
Amount charged against operating revenue	4,695,232	3,994,924	3,362,081
Accounts receivable contractual adjustments and write-offs (net of recoveries)	(4,607,843)	(3,946,058)	(3,208,028)
Balance at end of year	$ 712,285	$ 624,896	$ 576,030

X

- Definition

Total of the adjustments in a given period to allowances and reserves, the valuation and qualifying accounts that are either netted against the cost of an asset (in order to value it at its carrying value) or that reflect a liability.

+ References

Reference 1: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Accounting Standards Codification

-Topic 235

-SubTopic 10

-Section S99

-Paragraph 4

-URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e24092-122690



Reference 2: http://www.xbrl.org/2003/role/presentationRef

-Publisher SEC

-Name Regulation S-X (SX)

-Number 210

-Section 09

-Article 12

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X

- Definition

Total of allowances and reserves, the valuation and qualifying accounts that are either netted against the cost of an asset (in order to value it at its carrying value) or that reflect a liability established to represent expected future costs.

+ References

Reference 1: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Accounting Standards Codification

-Topic 235

-SubTopic 10

-Section S99

-Paragraph 4

-URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e24092-122690



Reference 2: http://www.xbrl.org/2003/role/presentationRef

-Publisher SEC

-Name Regulation S-X (SX)

-Number 210

-Section 09

-Article 12

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- Definition

Total of allowances and reserves, the valuation and qualifying accounts that are either netted against the cost of an asset (in order to value it at its carrying value) or that reflect a liability established to represent expected future costs, charged to costs and expenses.

+ References

Reference 1: http://www.xbrl.org/2003/role/presentationRef

-Publisher FASB

-Name Accounting Standards Codification

-Topic 235

-SubTopic 10

-Section S99

-Paragraph 4

-URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e24092-122690



Reference 2: http://www.xbrl.org/2003/role/presentationRef

-Publisher SEC

-Name Regulation S-X (SX)

-Number 210

-Section 09

-Article 12

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