CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (USD $) In Thousands, unless otherwise specified	9 Months Ended
	Sep. 30, 2013	Sep. 30, 2012
Cash Flows from Operating Activities:
Net income	$ 420,837	$ 341,387
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	248,648	227,641
Stock-based compensation expense	20,072	16,189
Gains on sales of assets and businesses, net of losses	(2,973)	(945)
Costs related to extinguishment of debt	0	29,170
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(99,261)	(86,821)
Accrued interest	10,376	11,901
Accrued and deferred income taxes	20,918	(260)
Other working capital accounts	10,313	(42,916)
Other assets and deferred charges	13,425	25,959
Other	5,792	5,833
Accrued insurance expense, net of commercial premiums paid	(1,406)	66,752
Payments made in settlement of self-insurance claims	(55,009)	(58,884)
Net cash provided by operating activities	591,732	535,006
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(279,751)	(282,191)
Proceeds received from sale of assets and businesses	37,118	56,194
Acquisition of property and businesses	(1,320)	(25,092)
Costs incurred for purchase and implementation of electronic health records application	(42,353)	(41,854)
Return of deposit on terminated purchase agreement	0	6,500
Net cash used in investing activities	(286,306)	(286,443)
Cash Flows from Financing Activities:
Reduction of long-term debt	(234,231)	(1,127,829)
Additional borrowings	1,500	906,000
Financing costs	0	(8,257)
Repurchase of common shares	(22,186)	(9,676)
Dividends paid	(14,706)	(14,519)
Issuance of common stock	4,096	3,828
Profit distributions to noncontrolling interests	(51,248)	(13,687)
Net cash provided by (used in) financing activities	(316,775)	(264,140)
Decrease in cash and cash equivalents	(11,349)	(15,577)
Cash and cash equivalents, beginning of period	23,471	41,229
Cash and cash equivalents, end of period	12,122	25,652
Supplemental Disclosures of Cash Flow Information:
Interest paid	88,430	104,560
Income taxes paid, net of refunds	$ 218,290	$ 187,899