Condensed Consolidated Statements Of Cash Flows (USD $) In Thousands	9 Months Ended
	Sep. 30, 2011	Sep. 30, 2010
Cash Flows from Operating Activities:
Net income	$ 340,863	$ 224,979
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	220,208	163,066
Loss (gain) on sale of assets	164	(1,993)
Stock-based compensation expense	13,434	12,678
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(103,700)	(6,751)
Accrued interest	13,143	8,437
Accrued and deferred income taxes	102,949	(2,656)
Other working capital accounts	(74,342)	26,697
Other assets and deferred charges	20,215	(2,526)
Other	4,146	(4,556)
Accrued insurance expense, net of commercial premiums paid	71,186	32,770
Payments made in settlement of self-insurance claims	(45,764)	(37,330)
Net cash provided by operating activities	562,502	412,815
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(195,404)	(177,750)
Proceeds received from sale of assets and businesses	23,682	21,460
Restricted cash related to bond issuance held in escrow pending completion of PSI acquisition	0	(256,972)
Acquisition of property and businesses	(8,599)	0
Costs incurred for purchase and implementation of electronic health records application	(27,874)	(13,216)
Net cash used in investing activities	(208,195)	(426,478)
Cash Flows from Financing Activities:
Reduction of long-term debt	(267,539)	(194,600)
Additional borrowings	36,000	250,000
Financing costs	(23,559)	(5,016)
Repurchase of common shares	(44,532)	(3,963)
Dividends paid	(14,638)	(14,555)
Issuance of common stock	3,596	5,204
Profit distributions to noncontrolling interests	(33,962)	(23,558)
Proceeds from sale of noncontrolling interest in majority owned business	0	600
Net cash (used in) provided by financing activities	(344,634)	14,112
Increase in cash and cash equivalents	9,673	449
Cash and cash equivalents, beginning of period	29,474	9,180
Cash and cash equivalents, end of period	39,147	9,629
Supplemental Disclosures of Cash Flow Information:
Interest paid	120,712	33,584
Income taxes paid, net of refunds	$ 89,268	$ 113,521