Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Cash Flows from Operating Activities:
Net income	$ 151,021	$ 209,070
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	143,784	131,403
Loss on sale of assets and businesses	1,084
Stock-based compensation expense	19,055	18,022
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(15,073)	56,851
Accrued interest	180	10,133
Accrued and deferred income taxes	47,548	53,769
Other working capital accounts	63,308	82,663
Medicare accelerated payments and deferred CARES Act and other grants	250	(509,448)
Other assets and deferred charges	26,042	(17)
Other	(4,020)	2,623
Accrued insurance expense, net of commercial premiums paid	41,685	35,467
Payments made in settlement of self-insurance claims	(29,431)	(18,741)
Net cash provided by operating activities	445,433	71,795
Cash Flows from Investing Activities:
Property and equipment additions	(200,002)	(247,459)
Proceeds received from sales of assets and businesses	10,232
Inflows (outflows) from foreign exchange contracts that hedge our net U.K. investment	20,710	(14,264)
Decrease in capital reserves of commercial insurance subsidiary	100	100
Costs incurred for purchase of information technology applications, net of refunds		(575)
Investment in, and advances to, joint ventures and other		(129)
Net cash used in investing activities	(168,960)	(262,327)
Cash Flows from Financing Activities:
Repayments of long-term debt	(11,966)	(251,830)
Additional borrowings	117,400
Repurchase of common shares	(365,505)	(7,464)
Dividends paid	(14,875)	(17,018)
Issuance of common stock	3,503	3,357
Profit distributions to noncontrolling interests	(5,289)	(4,525)
Purchase (sale) of ownership interests by (from) minority members	(1,307)	7,603
Net cash used in financing activities	(278,039)	(269,877)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(2,232)	423
Decrease in cash, cash equivalents and restricted cash	(3,798)	(459,986)
Cash, cash equivalents and restricted cash, beginning of period	178,934	1,279,154
Cash, cash equivalents and restricted cash, end of period	175,136	819,168
Supplemental Disclosures of Cash Flow Information:
Interest paid	20,388	11,421
Income taxes paid, net of refunds	4,423	8,654
Noncash purchases of property and equipment	$ 90,730	$ 60,124