Supplemental Condensed Consolidating Statements of Cash flows (Detail) (USD $) In Thousands, unless otherwise specified	9 Months Ended
	Sep. 30, 2014	Sep. 30, 2013
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	$ 689,554	$ 575,923
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(309,361)	(279,751)
Proceeds received from sale of assets and businesses	15,178	37,118
Cash paid/reserved related to acquisition of property and businesses	(402,405)	(1,320)
Costs incurred for purchase and implementation of electronic health records application	(11,204)	(42,353)
Net cash provided by (used in) investing activities	(707,792)	(286,306)
Cash Flows from Financing Activities:
Reduction of long-term debt	(842,543)	(234,231)
Additional borrowings	969,800	1,500
Financing costs	(13,413)	0
Repurchase of common shares	(63,292)	(22,186)
Dividends paid	(19,794)	(14,706)
Issuance of common stock	4,907	4,096
Excess income tax benefits related to stock-based compensation	30,242	15,809
Profit distributions to noncontrolling interests	(25,074)	(51,248)
Changes in intercompany balances with affiliates, net	0	0
Net cash (used in) provided by financing activities	40,833	(300,966)
Effect of exchange rate changes on cash and cash equivalents	(122)	0
Increase (decrease) in cash and cash equivalents	22,473	(11,349)
Cash and cash equivalents, beginning of period	17,238	23,471
Cash and cash equivalents, end of period	39,711	12,122
Parent
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	8,445	(6,371)
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	(830,680)	(226,761)
Additional borrowings	969,800	1,500
Financing costs	(13,413)
Repurchase of common shares	(63,292)	(22,186)
Dividends paid	(19,794)	(14,706)
Issuance of common stock	4,907	4,096
Excess income tax benefits related to stock-based compensation	30,242	15,809
Profit distributions to noncontrolling interests	0	0
Changes in intercompany balances with affiliates, net	(86,215)	248,619
Net cash (used in) provided by financing activities	(8,445)	6,371
Effect of exchange rate changes on cash and cash equivalents	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
Guarantors
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	431,986	341,031
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(205,455)	(202,758)
Proceeds received from sale of assets and businesses	11,450	7,552
Cash paid/reserved related to acquisition of property and businesses	(394,854)	(1,320)
Costs incurred for purchase and implementation of electronic health records application	(11,204)	(42,353)
Net cash provided by (used in) investing activities	(600,063)	(238,879)
Cash Flows from Financing Activities:
Reduction of long-term debt	(609)	(807)
Additional borrowings	0	0
Financing costs	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	190,021	(108,930)
Net cash (used in) provided by financing activities	189,412	(109,737)
Effect of exchange rate changes on cash and cash equivalents	(122)
Increase (decrease) in cash and cash equivalents	21,213	(7,585)
Cash and cash equivalents, beginning of period	7,990	11,949
Cash and cash equivalents, end of period	29,203	4,364
Non Guarantors
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	249,123	241,263
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(103,906)	(76,993)
Proceeds received from sale of assets and businesses	3,728	29,566
Cash paid/reserved related to acquisition of property and businesses	(7,551)	0
Costs incurred for purchase and implementation of electronic health records application	0	0
Net cash provided by (used in) investing activities	(107,729)	(47,427)
Cash Flows from Financing Activities:
Reduction of long-term debt	(11,254)	(6,663)
Additional borrowings	0	0
Financing costs	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	(25,074)	(51,248)
Changes in intercompany balances with affiliates, net	(103,806)	(139,689)
Net cash (used in) provided by financing activities	(140,134)	(197,600)
Effect of exchange rate changes on cash and cash equivalents	0
Increase (decrease) in cash and cash equivalents	1,260	(3,764)
Cash and cash equivalents, beginning of period	9,248	11,522
Cash and cash equivalents, end of period	10,508	7,758
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	0
Financing costs	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
Effect of exchange rate changes on cash and cash equivalents	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