Condensed Consolidated Statements of Cash Flows (USD $) In Thousands, unless otherwise specified	6 Months Ended
	Jun. 30, 2014	Jun. 30, 2013
Cash Flows from Operating Activities:
Net income	$ 318,466	$ 297,738
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	184,050	161,677
Stock-based compensation expense	14,945	13,579
Gains on sales of assets and businesses, net of losses	(10,134)	(2,277)
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(61,865)	(82,224)
Accrued interest	(271)	13,199
Accrued and deferred income taxes	(9,435)	3,280
Other working capital accounts	17,739	32,421
Other assets and deferred charges	10,415	9,069
Other	(4,092)	4,083
Accrued insurance expense, net of commercial premiums paid	38,520	(22,590)
Payments made in settlement of self-insurance claims	(39,922)	(37,038)
Net cash 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)
Net cash (used in) provided by financing activities	(206,187)	(225,178)
Decrease 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
Supplemental Disclosures of Cash Flow Information:
Interest paid	60,078	54,067
Income taxes paid, net of refunds	$ 156,434	$ 152,553