Business and Summary of Significant Accounting Policies (Details 1) (USD $) In Thousands, unless otherwise specified	3 Months Ended								12 Months Ended
	Dec. 31, 2011	Sep. 30, 2011	Jun. 30, 2011	Mar. 31, 2011	Dec. 31, 2010	Sep. 30, 2010	Jun. 30, 2010	Mar. 31, 2010	Dec. 31, 2011	Dec. 31, 2010	Dec. 31, 2009
Summary of changes in net revenue
Net operating revenues (net of contractual allowances and discounts)	$ 3,442,514	$ 3,395,773	$ 3,433,829	$ 3,354,052	$ 3,314,193	$ 3,159,823	$ 3,080,646	$ 3,068,612	$ 13,626,168	$ 12,623,274	$ 11,742,454
Provision for bad debts									(1,719,956)	(1,530,852)	(1,408,953)
Net operating revenues, less provision for bad debts									$ 11,906,212	$ 11,092,422	$ 10,333,501