Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2015	Dec. 31, 2014		Dec. 31, 2013
Cash Flows from Operating Activities:
Net income	$ 750,698	$ 604,996		$ 554,023
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	398,618	375,624		337,356
Gains on sales of assets and businesses, net of losses	(3,615)	(7,837)		(3,114)
Stock-based compensation expense	39,971	31,092		27,783
Costs related to extinguishment of debt	0	19,730		0
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(45,814)	(105,708)		(49,708)
Accrued interest	(693)	4,400		(1,197)
Accrued and deferred income taxes	(34,394)	33,920		34,861
Other working capital accounts	(125,556)	73,912		26,234
Other assets and deferred charges	6,631	13,667		8,984
Other	23,295	2,449		23,485
Accrued insurance expense, net of commercial premiums paid	90,895	59,276	[1]	(3,821)	[1]
Payments made in settlement of self-insurance claims	(79,138)	(69,645)		(70,645)
Net cash provided by operating activities	1,020,898	1,035,876		884,241
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(379,321)	(391,150)		(358,493)
Acquisition of property and businesses	(533,655)	(431,386)		(12,636)
Proceeds received from sales of assets and businesses	3,391	15,178		37,482
Costs incurred for purchase and implementation of electronic health records application	0	(13,488)		(49,811)
Increase in insurance subsidiary investments	(3,300)	(12,000)		0
Net cash used in investing activities	(912,885)	(832,846)		(383,458)
Cash Flows from Financing Activities:
Reduction of long-term debt	(68,166)	(879,129)		(440,224)
Additional borrowings	234,400	830,000		15,761
Financing costs	(515)	(14,976)		(231)
Repurchase of common shares	(209,782)	(100,749)		(27,201)
Dividends paid	(39,532)	(29,665)		(19,621)
Issuance of common stock	8,441	6,863		5,708
Excess income tax benefits related to stock based compensation	47,364	33,912		20,121
Profit distributions to noncontrolling interests	(62,220)	(33,680)		(61,329)
Proceeds received from sale/leaseback of real property	12,765	0		0
Net cash used in financing activities	(77,245)	(187,424)		(507,016)
Effect of exchange rate changes on cash and cash equivalents	(1,609)	(775)		0
Increase (decrease) in cash and cash equivalents	29,159	14,831		(6,233)
Cash and cash equivalents, beginning of period	32,069	17,238		23,471
Cash and cash equivalents, end of period	61,228	32,069		17,238
Supplemental Disclosures of Cash Flow Information:
Interest paid, including early redemption premium and original issue discount write-off in 2014	107,054	130,279		131,259
Income taxes paid, net of refunds	380,658	258,612		259,896
Noncash purchases of property and equipment	$ 49,086	$ 35,469		$ 36,212

[1] General and professional liability amounts are net of adjustments recorded during 2014 and 2013, as discussed below.