Self-Insurance Reserves (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2015	Dec. 31, 2014
Schedule of Self-Insurance Reserves [Line Items]
Balance January 1	$ 49,960	$ 49,103
Current year provisions	40,957	33,875
Claims paid and direct expenses	(35,381)	(31,995)
Change in long-term insurance losses recoverable	(467)	(1,023)
Balance December 31	56,003	49,960
Professional Malpractice Liability Insurance [Member]
Schedule of Self-Insurance Reserves [Line Items]
Balance January 1	30,401	30,449
Current year provisions	12,528	9,746
Claims paid and direct expenses	(11,911)	(9,638)
Change in long-term insurance losses recoverable	(308)	(156)
Balance December 31	30,710	30,401
Workers' Compensation [Member]
Schedule of Self-Insurance Reserves [Line Items]
Balance January 1	15,758	15,918
Current year provisions	12,508	6,083
Claims paid and direct expenses	(8,822)	(5,376)
Change in long-term insurance losses recoverable	(775)	(867)
Balance December 31	20,219	15,758
Health Insurance Product Line [Member]
Schedule of Self-Insurance Reserves [Line Items]
Balance January 1	3,801	2,736
Current year provisions	15,921	18,046
Claims paid and direct expenses	(14,648)	(16,981)
Change in long-term insurance losses recoverable	0	0
Balance December 31	$ 5,074	$ 3,801