Supplemental Condensed Consolidating Statements of Cash flows (Detail) (USD $) In Thousands, unless otherwise specified	6 Months Ended
	Jun. 30, 2014	Jun. 30, 2013
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	$ 458,416	$ 390,917
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(186,786)	(175,944)
Proceeds received from sale of assets and businesses	11,450	34,008
Cash paid/reserved related to acquisition of property and businesses	(71,000)	(1,320)
Costs incurred for purchase and implementation of electronic health records application	(8,399)	(33,396)
Net cash provided by (used in) investing activities	(254,735)	(176,652)
Cash Flows from Financing Activities:
Reduction of long-term debt	(179,126)	(196,096)
Additional borrowings	0	11,000
Repurchase of common shares	(35,773)	(21,373)
Dividends paid	(9,884)	(9,795)
Issuance of common stock	3,287	2,735
Excess income tax benefits related to stock-based compensation	28,493	15,085
Profit distributions to noncontrolling interests	(13,184)	(26,734)
Changes in intercompany balances with affiliates, net	0	0
Net cash (used in) provided by financing activities	(206,187)	(225,178)
(Decrease) increase in cash and cash equivalents	(2,506)	(10,913)
Cash and cash equivalents, beginning of period	17,238	23,471
Cash and cash equivalents, end of period	14,732	12,558
Parent
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	6,497	929
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	0	0
Proceeds received from sale of assets and businesses	0	0
Cash paid/reserved related to acquisition of property and businesses	0	0
Costs incurred for purchase and implementation of electronic health records application	0	0
Net cash provided by (used in) investing activities	0	0
Cash Flows from Financing Activities:
Reduction of long-term debt	(167,755)	(189,188)
Additional borrowings		11,000
Repurchase of common shares	(35,773)	(21,373)
Dividends paid	(9,884)	(9,795)
Issuance of common stock	3,287	2,735
Excess income tax benefits related to stock-based compensation	28,493	15,085
Profit distributions to noncontrolling interests	0	0
Changes in intercompany balances with affiliates, net	175,135	190,607
Net cash (used in) provided by financing activities	(6,497)	(929)
(Decrease) increase 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
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	256,770	242,016
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(116,688)	(133,607)
Proceeds received from sale of assets and businesses	11,450	7,552
Cash paid/reserved related to acquisition of property and businesses	(67,699)	(1,320)
Costs incurred for purchase and implementation of electronic health records application	(8,399)	(33,396)
Net cash provided by (used in) investing activities	(181,336)	(160,771)
Cash Flows from Financing Activities:
Reduction of long-term debt	(317)	(526)
Additional borrowings		0
Repurchase of common shares	0	0
Dividends paid	0	0
Issuance of common stock	0	0
Excess income tax benefits related to stock-based compensation	0	0
Profit distributions to noncontrolling interests	0	0
Changes in intercompany balances with affiliates, net	(78,577)	(89,098)
Net cash (used in) provided by financing activities	(78,894)	(89,624)
(Decrease) increase in cash and cash equivalents	(3,460)	(8,379)
Cash and cash equivalents, beginning of period	7,990	11,949
Cash and cash equivalents, end of period	4,530	3,570
Non Guarantors
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	195,149	147,972
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(70,098)	(42,337)
Proceeds received from sale of assets and businesses	0	26,456
Cash paid/reserved related to acquisition of property and businesses	(3,301)	0
Costs incurred for purchase and implementation of electronic health records application	0	0
Net cash provided by (used in) investing activities	(73,399)	(15,881)
Cash Flows from Financing Activities:
Reduction of long-term debt	(11,054)	(6,382)
Additional borrowings		0
Repurchase of common shares	0	0
Dividends paid	0	0
Issuance of common stock	0	0
Excess income tax benefits related to stock-based compensation	0	0
Profit distributions to noncontrolling interests	(13,184)	(26,734)
Changes in intercompany balances with affiliates, net	(96,558)	(101,509)
Net cash (used in) provided by financing activities	(120,796)	(134,625)
(Decrease) increase in cash and cash equivalents	954	(2,534)
Cash and cash equivalents, beginning of period	9,248	11,522
Cash and cash equivalents, end of period	10,202	8,988
Consolidating Adjustments
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) 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
Cash paid/reserved related to acquisition of property and businesses	0	0
Costs incurred for purchase and implementation of electronic health records application	0	0
Net cash provided by (used in) investing activities	0	0
Cash Flows from Financing Activities:
Reduction of long-term debt	0	0
Additional borrowings		0
Repurchase of common shares	0	0
Dividends paid	0	0
Issuance of common stock	0	0
Excess income tax benefits related to stock-based compensation	0	0
Profit distributions to noncontrolling interests	0	0
Changes in intercompany balances with affiliates, net	0	0
Net cash (used in) provided by financing activities	0	0
(Decrease) increase 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