Self-Insurance Reserves (Details) (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2013	Dec. 31, 2012
Liability for Future Policy Benefit, by Product Segment [Line Items]
Balance	$ 50,883	$ 44,273
Current year provisions	31,705	34,714
Claims paid and direct expenses	(33,546)	(28,509)
Long-term insurance losses recoverable	61	405
Balance	49,103	50,883
Professional Malpractice Liability Insurance [Member]
Liability for Future Policy Benefit, by Product Segment [Line Items]
Balance	35,108	32,010
Current year provisions	7,879	13,226
Claims paid and direct expenses	(11,890)	(9,207)
Long-term insurance losses recoverable	(648)	(921)
Balance	30,449	35,108
Workers' Compensation [Member]
Liability for Future Policy Benefit, by Product Segment [Line Items]
Balance	13,308	9,827
Current year provisions	6,656	7,186
Claims paid and direct expenses	(4,755)	(5,031)
Long-term insurance losses recoverable	709	1,326
Balance	15,918	13,308
Health Insurance Product Line [Member]
Liability for Future Policy Benefit, by Product Segment [Line Items]
Balance	2,467	2,436
Current year provisions	17,170	14,302
Claims paid and direct expenses	(16,901)	(14,271)
Long-term insurance losses recoverable	0	0
Balance	$ 2,736	$ 2,467