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Fair value measurement (Details) - USD ($)
$ in Millions
Jun. 30, 2017
Mar. 31, 2017
Dec. 31, 2016
Jun. 30, 2016
Mar. 31, 2016
Dec. 31, 2015
Assets:            
Total available-for-sale investments $ 38,922   $ 37,781      
Fair Value, Measurements, Recurring [Member]            
Derivatives:            
Total assets 39,145   38,025      
Derivatives:            
Contingent consideration obligations in connection with business combinations 182   179      
Total liabilities 673   713      
Fair Value, Measurements, Recurring [Member] | Foreign currency contracts [Member]            
Derivatives:            
Foreign currency and cross-currency swap contracts 18   203      
Derivatives:            
Foreign currency and cross-currency swap contracts 93   4      
Fair Value, Measurements, Recurring [Member] | Cross currency swap contracts [Member]            
Derivatives:            
Foreign currency and cross-currency swap contracts 153          
Derivatives:            
Foreign currency and cross-currency swap contracts 398   523      
Fair Value, Measurements, Recurring [Member] | Interest rate swap contracts [Member]            
Derivatives:            
Interest rate contracts 52   41      
Derivatives:            
Interest rate swap contracts     7      
Fair Value, Measurements, Recurring [Member] | U.S. Treasury securities [Member]            
Assets:            
Total available-for-sale investments 7,661   6,614      
Fair Value, Measurements, Recurring [Member] | Other government-related debt securities - U.S. [Member]            
Assets:            
Total available-for-sale investments 226   299      
Fair Value, Measurements, Recurring [Member] | Other government-related debt securities - Foreign and other [Member]            
Assets:            
Total available-for-sale investments 2,353   1,759      
Fair Value, Measurements, Recurring [Member] | Corporate debt securities - Financial [Member]            
Assets:            
Total available-for-sale investments 9,637   8,460      
Fair Value, Measurements, Recurring [Member] | Corporate debt securities - Industrial [Member]            
Assets:            
Total available-for-sale investments 9,569   8,789      
Fair Value, Measurements, Recurring [Member] | Corporate debt securities - Other [Member]            
Assets:            
Total available-for-sale investments 1,235   1,077      
Fair Value, Measurements, Recurring [Member] | Residential mortgage-backed securities [Member]            
Assets:            
Total available-for-sale investments 1,682   1,940      
Fair Value, Measurements, Recurring [Member] | Other mortgage- and asset-backed securities [Member]            
Assets:            
Total available-for-sale investments 1,853   1,719      
Fair Value, Measurements, Recurring [Member] | Money market mutual funds [Member]            
Assets:            
Total available-for-sale investments 2,165   2,782      
Fair Value, Measurements, Recurring [Member] | Other short-term interest-bearing securities [Member]            
Assets:            
Total available-for-sale investments 2,382   4,188      
Fair Value, Measurements, Recurring [Member] | Equity securities [Member]            
Assets:            
Total available-for-sale investments 159   154      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member]            
Derivatives:            
Total assets 9,985   9,550      
Derivatives:            
Contingent consideration obligations in connection with business combinations 0   0      
Total liabilities 0   0      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Foreign currency contracts [Member]            
Derivatives:            
Foreign currency and cross-currency swap contracts 0   0      
Derivatives:            
Foreign currency and cross-currency swap contracts 0   0      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Cross currency swap contracts [Member]            
Derivatives:            
Foreign currency and cross-currency swap contracts 0          
Derivatives:            
Foreign currency and cross-currency swap contracts 0   0      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Interest rate swap contracts [Member]            
Derivatives:            
Interest rate contracts 0   0      
Derivatives:            
Interest rate swap contracts     0      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | U.S. Treasury securities [Member]            
Assets:            
Total available-for-sale investments 7,661   6,614      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Other government-related debt securities - U.S. [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Other government-related debt securities - Foreign and other [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Corporate debt securities - Financial [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Corporate debt securities - Industrial [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Corporate debt securities - Other [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Residential mortgage-backed securities [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Other mortgage- and asset-backed securities [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Money market mutual funds [Member]            
Assets:            
Total available-for-sale investments 2,165   2,782      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Other short-term interest-bearing securities [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Equity securities [Member]            
Assets:            
Total available-for-sale investments 159   154      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member]            
Derivatives:            
Total assets 29,160   28,475      
Derivatives:            
Contingent consideration obligations in connection with business combinations 0   0      
Total liabilities 491   534      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Foreign currency contracts [Member]            
Derivatives:            
Foreign currency and cross-currency swap contracts 18   203      
Derivatives:            
Foreign currency and cross-currency swap contracts 93   4      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Cross currency swap contracts [Member]            
Derivatives:            
Foreign currency and cross-currency swap contracts 153          
Derivatives:            
Foreign currency and cross-currency swap contracts 398   523      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Interest rate swap contracts [Member]            
Derivatives:            
Interest rate contracts 52   41      
Derivatives:            
Interest rate swap contracts     7      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | U.S. Treasury securities [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Other government-related debt securities - U.S. [Member]            
Assets:            
Total available-for-sale investments 226   299      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Other government-related debt securities - Foreign and other [Member]            
Assets:            
Total available-for-sale investments 2,353   1,759      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Corporate debt securities - Financial [Member]            
Assets:            
Total available-for-sale investments 9,637   8,460      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Corporate debt securities - Industrial [Member]            
Assets:            
Total available-for-sale investments 9,569   8,789      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Corporate debt securities - Other [Member]            
Assets:            
Total available-for-sale investments 1,235   1,077      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Residential mortgage-backed securities [Member]            
Assets:            
Total available-for-sale investments 1,682   1,940      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Other mortgage- and asset-backed securities [Member]            
Assets:            
Total available-for-sale investments 1,853   1,719      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Money market mutual funds [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Other short-term interest-bearing securities [Member]            
Assets:            
Total available-for-sale investments 2,382   4,188      
Fair Value, Measurements, Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Equity securities [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member]            
Derivatives:            
Total assets 0   0      
Derivatives:            
Contingent consideration obligations in connection with business combinations 182 $ 184 179 $ 171 $ 194 $ 188
Total liabilities 182   179      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Foreign currency contracts [Member]            
Derivatives:            
Foreign currency and cross-currency swap contracts 0   0      
Derivatives:            
Foreign currency and cross-currency swap contracts 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Cross currency swap contracts [Member]            
Derivatives:            
Foreign currency and cross-currency swap contracts 0          
Derivatives:            
Foreign currency and cross-currency swap contracts 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Interest rate swap contracts [Member]            
Derivatives:            
Interest rate contracts 0   0      
Derivatives:            
Interest rate swap contracts     0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | U.S. Treasury securities [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Other government-related debt securities - U.S. [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Other government-related debt securities - Foreign and other [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Corporate debt securities - Financial [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Corporate debt securities - Industrial [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Corporate debt securities - Other [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Residential mortgage-backed securities [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Other mortgage- and asset-backed securities [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Money market mutual funds [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Other short-term interest-bearing securities [Member]            
Assets:            
Total available-for-sale investments 0   0      
Fair Value, Measurements, Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Equity securities [Member]            
Assets:            
Total available-for-sale investments $ 0   $ 0