Consolidated Statements of Cash Flows (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2013	Dec. 31, 2012	Dec. 31, 2011
Cash Flows from Operating Activities:
Net income	$ 554,023	$ 489,047	$ 448,870
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	337,356	308,690	295,861
Gains on sales of assets and businesses, net of losses	(3,114)	(27,085)	(452)
Stock based compensation expense	27,783	22,518	18,225
Costs related to extinguishment of debt	0	29,170	0
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(49,708)	(71,068)	(134,838)
Accrued interest	(1,197)	152	(3,577)
Accrued and deferred income taxes	34,861	(5,666)	78,224
Other working capital accounts	26,234	28,554	(28,382)
Other assets and deferred charges	8,984	30,976	37,160
Other	23,485	6,367	(1,387)
Accrued insurance expense, net of commercial premiums paid	(3,821)	62,660	83,612
Payments made in settlement of self-insurance claims	(70,645)	(75,084)	(82,633)
Net cash provided by operating activities	884,241	799,231	710,683
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(358,493)	(363,192)	(285,682)
Acquisition of property and businesses	(12,636)	(527,847)	(29,466)
Proceeds received from sales of assets and businesses	37,482	149,311	67,592
Costs incurred for purchase and implementation of electronic health records application	(49,811)	(54,362)	(38,249)
Return of deposit on terminated purchase agreement	0	6,500	0
Net cash provided by (used in) investing activities	(383,458)	(789,590)	(285,805)
Cash Flows from Financing Activities:
Reduction of long-term debt	(440,224)	(849,647)	(381,517)
Additional borrowings	15,761	913,500	98,100
Financing costs	(231)	(8,283)	(23,608)
Repurchase of common shares	(27,201)	(19,154)	(60,482)
Dividends paid	(19,621)	(58,395)	(19,466)
Issuance of common stock	5,708	5,435	4,779
Excess income tax benefits related to stock based compensation	20,121	16,040	7,568
Profit distributions to noncontrolling interests	(61,329)	(26,895)	(38,497)
Net cash (used in) provided by financing activities	(507,016)	(27,399)	(413,123)
Increase (decrease) in cash and cash equivalents	(6,233)	(17,758)	11,755
Cash and cash equivalents, beginning of period	23,471	41,229	29,474
Cash and cash equivalents, end of period	17,238	23,471	41,229
Supplemental Disclosures of Cash Flow Information:
Interest paid	131,259	157,415	176,328
Income taxes paid, net of refunds	$ 259,896	$ 264,824	$ 163,029