Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014
Cash Flows from Operating Activities:
Net income	$ 559,381	$ 414,504
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	295,697	277,506
Stock-based compensation expense	30,145	22,713
Gains on sales of assets and businesses, net of losses	(1,037)	(7,837)
Write-off of deferred financing costs related to extinguishment of debt	0	19,730
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(60,877)	(98,193)
Accrued interest	(297)	6,547
Accrued and deferred income taxes	(12,568)	(18,392)
Other working capital accounts	(54,018)	59,613
Other assets and deferred charges	6,629	15,868
Other	13,140	(7,000)
Accrued insurance expense, net of commercial premiums paid	75,715	57,729
Payments made in settlement of self-insurance claims	(55,411)	(53,234)
Net cash provided by operating activities	796,499	689,554
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(269,578)	(309,361)
Proceeds received from sale of assets and businesses	2,744	15,178
Acquisition of property and businesses	(183,103)	(402,405)
Costs incurred for purchase and implementation of electronic health records application	0	(11,204)
Net cash used in investing activities	(449,937)	(707,792)
Cash Flows from Financing Activities:
Reduction of long-term debt	(207,371)	(842,543)
Additional borrowings	16,300	969,800
Financing costs	0	(13,413)
Repurchase of common shares	(129,862)	(63,292)
Dividends paid	(29,696)	(19,794)
Issuance of common stock	6,030	4,907
Excess income tax benefits related to stock-based compensation	29,287	30,242
Profit distributions to noncontrolling interests	(35,965)	(25,074)
Proceeds received from sale/leaseback of real property	12,765	0
Net cash (used in) provided by financing activities	(338,512)	40,833
Effect of exchange rate changes on cash and cash equivalents	(596)	(122)
Increase in cash and cash equivalents	7,454	22,473
Cash and cash equivalents, beginning of period	32,069	17,238
Cash and cash equivalents, end of period	39,523	39,711
Supplemental Disclosures of Cash Flow Information:
Interest paid, including early redemption premium and original issue discount write-off in 2014	79,866	98,670
Income taxes paid, net of refunds	274,124	212,148
Noncash purchases of property and equipment	$ 37,228	$ 25,326