Supplemental Condensed Consolidating Financial Information (Details 3) (USD $) In Thousands, unless otherwise specified	9 Months Ended
	Sep. 30, 2012	Sep. 30, 2011
Cash Flows from Operating Activities:
Net cash provided by operating activities	$ 535,006	$ 562,502
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(282,191)	(195,404)
Proceeds received from sale of assets and businesses	56,194	23,682
Acquisition of property and businesses	(25,092)	(8,599)
Costs incurred for purchase and implementation of electronic health records application	(41,854)	(27,874)
Return of deposit on terminated purchase agreement	6,500	0
Net cash used in investing activities	(286,443)	(208,195)
Cash Flows from Financing Activities:
Reduction of long-term debt	(1,127,829)	(267,539)
Additional borrowings	906,000	36,000
Financing costs	(8,257)	(23,559)
Repurchase of common shares	(9,676)	(44,532)
Dividends paid	(14,519)	(14,638)
Issuance of common stock	3,828	3,596
Profit distributions to noncontrolling interests	(13,687)	(33,962)
Changes in intercompany balances with affiliates, net	0	0
Net cash used in financing activities	(264,140)	(344,634)
Increase (decrease) in cash and cash equivalents	(15,577)	9,673
Cash and cash equivalents, beginning of period	41,229	29,474
Cash and cash equivalents, end of period	25,652	39,147
Parent [Member]
Cash Flows from Operating Activities:
Net cash provided by operating activities	(7,607)	60,800
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	0	0
Proceeds received from sale of assets and businesses	0	0
Acquisition of property and businesses	0	0
Costs incurred for purchase and implementation of electronic health records application	0	0
Return of deposit on terminated purchase agreement	6,500
Net cash used in investing activities	6,500	0
Cash Flows from Financing Activities:
Reduction of long-term debt	(1,123,140)	(252,289)
Additional borrowings	906,000	36,000
Financing costs	(8,257)	23,559
Repurchase of common shares	(9,676)	44,532
Dividends paid	(14,519)	14,638
Issuance of common stock	3,828	3,596
Profit distributions to noncontrolling interests	0	0
Changes in intercompany balances with affiliates, net	246,871	234,622
Net cash used in financing activities	1,107	(60,800)
Increase (decrease) in cash and cash equivalents	0	0
Cash and cash equivalents, beginning of period	0	0
Cash and cash equivalents, end of period	0	0
Guarantors [Member]
Cash Flows from Operating Activities:
Net cash provided by operating activities	379,574	388,838
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(236,978)	143,953
Proceeds received from sale of assets and businesses	49,984	0
Acquisition of property and businesses	(11,476)	0
Costs incurred for purchase and implementation of electronic health records application	(41,854)	(27,874)
Return of deposit on terminated purchase agreement	0
Net cash used in investing activities	(240,324)	(171,827)
Cash Flows from Financing Activities:
Reduction of long-term debt	(2,567)	(1,156)
Additional borrowings	0	0
Financing costs	0	0
Repurchase of common shares	0	0
Dividends paid	0	0
Issuance of common stock	0	0
Profit distributions to noncontrolling interests	0	0
Changes in intercompany balances with affiliates, net	(151,417)	(205,164)
Net cash used in financing activities	(153,984)	(206,320)
Increase (decrease) in cash and cash equivalents	(14,734)	10,691
Cash and cash equivalents, beginning of period	33,221	21,385
Cash and cash equivalents, end of period	18,487	32,076
Non Guarantors [Member]
Cash Flows from Operating Activities:
Net cash provided by operating activities	163,039	112,864
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(45,213)	51,451
Proceeds received from sale of assets and businesses	6,210	23,682
Acquisition of property and businesses	(13,616)	(8,599)
Costs incurred for purchase and implementation of electronic health records application	0	0
Return of deposit on terminated purchase agreement	0
Net cash used in investing activities	(52,619)	(36,368)
Cash Flows from Financing Activities:
Reduction of long-term debt	(2,122)	(14,094)
Additional borrowings	0	0
Financing costs	0	0
Repurchase of common shares	0	0
Dividends paid	0	0
Issuance of common stock	0	0
Profit distributions to noncontrolling interests	(13,687)	33,962
Changes in intercompany balances with affiliates, net	(95,454)	(29,458)
Net cash used in financing activities	(111,263)	(77,514)
Increase (decrease) in cash and cash equivalents	(843)	(1,018)
Cash and cash equivalents, beginning of period	8,008	8,089
Cash and cash equivalents, end of period	7,165	7,071
Consolidating Adjustments [Member]
Cash Flows from Operating Activities:
Net cash provided by operating activities	0	0
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	0	0
Proceeds received from sale of assets and businesses	0	0
Acquisition of property and businesses		0
Costs incurred for purchase and implementation of electronic health records application	0	0
Return of deposit on terminated purchase agreement	0
Net cash used in investing activities	0	0
Cash Flows from Financing Activities:
Reduction of long-term debt	0	0
Additional borrowings	0	0
Financing costs	0	0
Repurchase of common shares	0	0
Dividends paid	0	0
Issuance of common stock	0	0
Profit distributions to noncontrolling interests	0	0
Changes in intercompany balances with affiliates, net	0
Net cash used in financing activities	0	0
Increase (decrease) in cash and cash equivalents	0	0
Cash and cash equivalents, beginning of period	0	0
Cash and cash equivalents, end of period	$ 0	$ 0