Segments - Depreciation and Amortization Expense (Detail) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 32,041	$ 30,011	$ 63,765	$ 60,340
Operating Segments [Member] | Product Development [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	26,752	23,553	52,982	47,429
Operating Segments [Member] | Integrated Healthcare Services [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	4,272	5,171	8,529	10,379
Corporate, Non-Segment [Member]
Segment Reporting Information [Line Items]
Depreciation and amortization	$ 1,017	$ 1,287	$ 2,254	$ 2,532