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Goodwill and Other Intangible Assets
12 Months Ended
Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill and Intangible Assets Disclosure [Text Block] Goodwill and Other Intangible Assets
The changes in the carrying amounts of goodwill by segment were as follows:
(In thousands)DomesticInternationalTotal
Balance at the end of 2019$819,735 $63,423 $883,158 
Purchase price allocation adjustments for the AbleVets acquisition744 — 744 
Goodwill recorded in connection with 2020 business acquisitions33,709 — 33,709 
Goodwill reduction in connection with divestiture transactions— (7,692)(7,692)
Foreign currency translation adjustment and other— 4,601 4,601 
Balance at the end of 2020854,188 60,332 914,520 
Goodwill recorded in connection with the Kantar Health acquisition119,709 106,523 226,232 
Foreign currency translation adjustment and other— (9,631)(9,631)
Balance at the end of 2021$973,897 $157,224 $1,131,121 

A summary of net intangible assets is as follows:
20212020
(In thousands)Gross Carrying AmountAccumulated AmortizationGross Carrying AmountAccumulated Amortization
Customer lists$636,410 $360,598 $494,615 $312,044 
Purchased software396,508 346,381 354,228 337,811 
Internal use software233,438 150,356 207,696 123,280 
Trade names52,883 33,719 42,951 28,961 
Other52,179 21,882 50,535 18,680 
Total$1,371,418 $912,936 $1,150,025 $820,776 
Intangible assets, net$458,482 $329,249 

Amortization expense for 2021, 2020 and 2019 was $95 million, $85 million and $114 million, respectively.

Estimated aggregate amortization expense for each of the next five years is as follows:
(In thousands)
2022$96,281 
202386,863 
202479,985 
202538,916 
202620,769