Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Cash Flows from Operating Activities:
Net income	$ 265,822	$ 162,375
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	141,003	141,621
Gain on sale of assets and businesses	(3,725)	(295)
Stock-based compensation expense	19,630	20,964
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(74,446)	(15,723)
Accrued interest	3,453	(662)
Accrued and deferred income taxes	72,193	46,576
Other working capital accounts	(33,291)	(119,605)
Medicare accelerated payments and deferred CARES Act and other grants		136
Other assets and deferred charges	(20,307)	24,727
Other	8,897	7,030
Accrued insurance expense, net of commercial premiums paid	51,112	42,545
Payments made in settlement of self-insurance claims	(33,935)	(18,936)
Net cash provided by operating activities	396,406	290,753
Cash Flows from Investing Activities:
Property and equipment additions	(208,539)	(168,752)
Proceeds received from sales of assets and businesses	5,428	9,259
Inflows (outflows) from foreign exchange contracts that hedge our net U.K. investment	8,319	(18,818)
Decrease in capital reserves of commercial insurance subsidiary	155
Net cash used in investing activities	(194,637)	(178,311)
Cash Flows from Financing Activities:
Repayments of long-term debt	(63,905)	(16,489)
Additional borrowings, net	12,038	11,300
Financing costs		(292)
Repurchase of common shares	(142,084)	(85,039)
Dividends paid	(13,601)	(14,214)
Issuance of common stock	3,241	2,988
Profit distributions to noncontrolling interests	(4,480)	(4,145)
(Purchase) sale of ownership interests by (from) minority members	(156)
Net cash used in financing activities	(208,947)	(105,891)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(492)	1,650
(Decrease) increase in cash, cash equivalents and restricted cash	(7,670)	8,201
Cash, cash equivalents and restricted cash, beginning of period	214,470	200,837
Cash, cash equivalents and restricted cash, end of period	206,800	209,038
Supplemental Disclosures of Cash Flow Information:
Interest paid	48,116	50,279
Income taxes paid, net of refunds	2,671	2,360
Noncash purchases of property and equipment	$ 60,125	$ 61,341