Condensed Consolidated Statements of Cash Flows (USD $) In Thousands, unless otherwise specified	9 Months Ended
	Sep. 30, 2014	Sep. 30, 2013
Cash Flows from Operating Activities:
Net income	$ 414,504	$ 420,837
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	277,506	248,648
Stock-based compensation expense	22,713	20,072
Gains on sales of assets and businesses, net of losses	(7,837)	(2,973)
Write-off of deferred financing costs related to extinguishment of debt	19,730	0
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(98,193)	(99,261)
Accrued interest	6,547	10,376
Accrued and deferred income taxes	(18,392)	5,109
Other working capital accounts	59,613	10,313
Other assets and deferred charges	15,868	13,425
Other	(7,000)	5,792
Accrued insurance expense, net of commercial premiums paid	57,729	(1,406)
Payments made in settlement of self-insurance claims	(53,234)	(55,009)
Net cash 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)
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
Supplemental Disclosures of Cash Flow Information:
Interest paid, including early redemption premium and original issue discount write-off in 2014	98,670	88,430
Income taxes paid, net of refunds	$ 212,148	$ 218,290