Document and Entity Information - shares	3 Months Ended
Document and Entity Information - shares	Mar. 31, 2019	Apr. 30, 2019
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q1
Trading Symbol	UHS
Entity Registrant Name	UNIVERSAL HEALTH SERVICES INC
Entity Central Index Key	0000352915
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Class A
Document Information [Line Items]
Entity Common Stock, Shares Outstanding		6,577,100
Class B
Document Information [Line Items]
Entity Common Stock, Shares Outstanding		82,882,673
Class C
Document Information [Line Items]
Entity Common Stock, Shares Outstanding		661,688
Class D
Document Information [Line Items]
Entity Common Stock, Shares Outstanding		18,573

Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Income Statement [Abstract]
Net revenues	$ 2,804,391	$ 2,687,516
Operating charges:
Salaries, wages and benefits	1,365,546	1,300,148
Other operating expenses	644,780	620,819
Supplies expense	307,463	292,929
Depreciation and amortization	120,040	113,103
Lease and rental expense	26,125	26,703
Operating Expenses, Total	2,463,954	2,353,702
Income from operations	340,437	333,814
Interest expense, net	39,640	37,576
Other (income) expense, net	4,501
Income before income taxes	296,296	296,238
Provision for income taxes	58,898	67,569
Net income	237,398	228,669
Less: Net income attributable to noncontrolling interests	3,230	4,837
Net income attributable to UHS	$ 234,168	$ 223,832
Basic earnings per share attributable to UHS	$ 2.57	$ 2.37
Diluted earnings per share attributable to UHS	$ 2.57	$ 2.36
Weighted average number of common shares - basic	90,776	94,226
Add: Other share equivalents	191	457
Weighted average number of common shares and equivalents - diluted	90,967	94,683

Condensed Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement Of Income And Comprehensive Income [Abstract]
Net income	$ 237,398	$ 228,669
Other comprehensive income (loss):
Unrealized derivative gains (losses) on cash flow hedges	(2,917)	2,124
Foreign currency translation adjustment	(14,262)	(4,341)
Other		2,367
Other comprehensive income (loss) before tax	(17,179)	150
Income tax expense (benefit) related to items of other comprehensive income (loss)	(2,466)	1,077
Total other comprehensive income (loss), net of tax	(14,713)	(927)
Comprehensive income	222,685	227,742
Less: Comprehensive income attributable to noncontrolling interests	3,230	4,837
Comprehensive income attributable to UHS	$ 219,455	$ 222,905

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 62,726	$ 105,220
Accounts receivable, net	1,602,405	1,509,909
Supplies	149,928	148,206
Other current assets	145,382	174,467
Total current assets	1,960,441	1,937,802
Property and equipment	8,733,367	8,563,455
Less: accumulated depreciation	(3,818,529)	(3,715,515)
Property, plant and equipment, net, Total	4,914,838	4,847,940
Other assets:
Goodwill	3,856,664	3,844,628
Deferred income taxes	5,350	5,280
Right of use assets-operating leases	342,032	0
Deferred charges	8,207	8,772
Other	633,745	621,058
Total Assets	11,721,277	11,265,480
Current liabilities:
Current maturities of long-term debt	71,991	63,446
Accounts payable and accrued liabilities	1,355,717	1,253,714
Legal reserves	128,294	129,150
Operating lease liabilities	56,136	0
Federal and state taxes	44,628	2,428
Total current liabilities	1,656,766	1,448,738
Other noncurrent liabilities	364,334	361,809
Operating lease liabilities noncurrent	286,101	0
Long-term debt	3,821,938	3,935,187
Deferred income taxes	35,984	49,661
Redeemable noncontrolling interests	3,843	4,292
Equity:
UHS common stockholders’ equity	5,482,415	5,389,262
Noncontrolling interest	69,896	76,531
Total equity	5,552,311	5,465,793
Total Liabilities and Stockholders’ Equity	$ 11,721,277	$ 11,265,480

Consolidated Statements of Changes in Equity - USD ($) $ in Thousands	Total	Redeemable Noncontrolling Interest	Class A	Class B	Class C	Class D	Cumulative Dividends	Retained Earnings	Accumulated Other Comprehensive Income (Loss)	UHS Common Stockholders' Equity	Noncontrolling Interest
Balance at Dec. 31, 2017	$ 5,051,436		$ 66	$ 869	$ 7	$ 0	$ (371,814)	$ 5,353,209	$ 7,177	$ 4,989,514	$ 61,922
Balance at Dec. 31, 2017		$ 6,702
Common Stock
Issued/(converted)	2,666			2				2,664		2,666
Repurchased	(9,441)			(1)				(9,440)		(9,441)
Restricted share-based compensation expense	545							545		545
Dividends paid	(9,422)						(9,422)			(9,422)
Stock option expense	18,879							18,879		18,879
Distributions to noncontrolling interests	(3,717)	(500)									(3,717)
Purchase of noncontrolling interest	7,213										7,213
Comprehensive income:
Net income to UHS / noncontrolling interests	228,790							223,832		223,832	4,958
Net income attributable to redeemable noncontrolling interest		(121)
Foreign currency translation adjustments, net of income tax	(4,341)								(4,341)	(4,341)
Other, net of income tax	1,795								1,795	1,795
Unrealized derivative losses on cash flow hedges, net of income tax	1,619								1,619	1,619
Subtotal - comprehensive income	227,863							223,832	(927)	222,905	4,958
Subtotal attributable to redeemable noncontrolling interest		(121)
Balance at Mar. 31, 2018	5,286,022		66	870	7		(381,236)	5,589,689	6,250	5,215,646	70,376
Balance at Mar. 31, 2018		6,081
Balance at Dec. 31, 2018	5,465,793		66	841	7	$ 0	(409,156)	5,793,262	4,242	5,389,262	76,531
Balance at Dec. 31, 2018		4,292
Common Stock
Issued/(converted)	2,726			6				2,720		2,726
Repurchased	(137,229)			(10)				(137,219)		(137,229)
Restricted share-based compensation expense	1,523							1,523		1,523
Dividends paid	(9,081)						(9,081)			(9,081)
Stock option expense	15,759							15,759		15,759
Distributions to noncontrolling interests	(9,814)	(500)									(9,814)
Comprehensive income:
Net income to UHS / noncontrolling interests	237,347							234,168		234,168	3,179
Net income attributable to redeemable noncontrolling interest		51
Foreign currency translation adjustments, net of income tax	(12,489)								(12,489)	(12,489)
Unrealized derivative losses on cash flow hedges, net of income tax	(2,224)								(2,224)	(2,224)
Subtotal - comprehensive income	222,634							234,168	(14,713)	219,455	3,179
Subtotal attributable to redeemable noncontrolling interest		51
Balance at Mar. 31, 2019	5,552,311		$ 66	$ 837	$ 7		$ (418,237)	$ 5,910,213	$ (10,471)	$ 5,482,415	$ 69,896
Balance at Mar. 31, 2019	$ 4,000	$ 3,843

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash Flows from Operating Activities:
Net income	$ 237,398	$ 228,669
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	120,040	113,134
Stock-based compensation expense	17,591	19,700
Gain on sale of assets and businesses	0	(703)
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(101,619)	(72,526)
Accrued interest	(2,687)	(6,209)
Accrued and deferred income taxes	52,291	61,674
Other working capital accounts	107,878	59,032
Other assets and deferred charges	(3,771)	(5,438)
Other	(38,298)	8,211
Accrued insurance expense, net of commercial premiums paid	24,398	23,125
Payments made in settlement of self-insurance claims	(22,320)	(18,765)
Net cash provided by operating activities	390,901	409,904
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(169,848)	(189,041)
Acquisition of property and businesses	0	(20,931)
Inflows (outflows) from foreign exchange contracts that hedge our net U.K. investment	12,895	(45,853)
Proceeds received from sales of assets and businesses	0	839
Costs incurred for purchase and implementation of information technology applications	(9,678)	(8,570)
Decrease in capital reserves of commercial insurance subsidiary	0	100
Investment in, and advances to, joint ventures and other	(879)	(8,675)
Net cash used in investing activities	(167,510)	(272,131)
Cash Flows from Financing Activities:
Reduction of long-term debt	(114,540)	(140,676)
Additional borrowings	8,700	20,500
Repurchase of common shares	(143,785)	(9,441)
Dividends paid	(9,081)	(9,422)
Issuance of common stock	2,726	2,545
Profit distributions to noncontrolling interests	(10,314)	(4,217)
Net cash used in financing activities	(266,294)	(140,711)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	794	1,857
Decrease in cash, cash equivalents and restricted cash	(42,109)	(1,081)
Cash, cash equivalents and restricted cash, beginning of period	199,685	167,297
Cash, cash equivalents and restricted cash, end of period	157,576	166,216
Supplemental Disclosures of Cash Flow Information:
Interest paid	41,050	41,539
Income taxes paid, net of refunds	5,087	2,749
Noncash purchases of property and equipment	71,987	$ 84,708
Right-of-use assets obtained in exchange for lease obligations	$ 355,981

General

3 Months Ended

Mar. 31, 2019

Organization Consolidation And Presentation Of Financial Statements [Abstract]

General

(1) General

This Quarterly Report on Form 10-Q is for the quarterly period ended March 31, 2019. In this Quarterly Report, “we,” “us,” “our” “UHS” and the “Company” refer to Universal Health Services, Inc. and its subsidiaries.

The condensed consolidated interim financial statements include the accounts of our majority-owned subsidiaries and partnerships and limited liability companies controlled by us, or our subsidiaries, as managing general partner or managing member. The condensed consolidated interim financial statements included herein have been prepared by us, without audit, pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) and reflect all adjustments (consisting only of normal recurring adjustments) which, in our opinion, are necessary to fairly state results for the interim periods. Certain information and footnote disclosures normally included in audited consolidated financial statements prepared in accordance with accounting principles generally accepted in the United States of America have been condensed or omitted pursuant to such rules and regulations, although we believe that the accompanying disclosures are adequate to make the information presented not misleading. These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements, significant accounting policies and the notes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2018.

Relationship with Universal Health Realty Income Trust and Related Party Transactions

3 Months Ended

Mar. 31, 2019

Relationship with Universal Health Realty Income Trust and Related Party Transactions

(2) Relationship with Universal Health Realty Income Trust and Related Party Transactions

Relationship with Universal Health Realty Income Trust:

At March 31, 2019, we held approximately 5.7% of the outstanding shares of Universal Health Realty Income Trust (the “Trust”). We serve as Advisor to the Trust under an annually renewable advisory agreement, which is scheduled to expire on December 31^st of each year, pursuant to the terms of which we conduct the Trust’s day-to-day affairs, provide administrative services and present investment opportunities. The advisory agreement was Amended and Restated effective January 1, 2019. Among other things, the Amended and Restated Advisory Agreement (the “Agreement”) eliminated the 20% annual incentive fee clause which we were previously entitled to under certain conditions (the incentive fee requirements have never been achieved). The advisory agreement was renewed by the Trust for 2019 at the same rate as the prior three years. During 2018, 2017 and 2016, the advisory fee was computed at 0.70% of the Trust’s average invested real estate assets. During the three-month periods ended March 31, 2019 and 2018, we earned an advisory fee from the Trust, which was computed at 0.70% of the Trust’s average invested real estate assets, and is included in net revenues in the accompanying consolidated statements of income, of approximately $1.0 million and $904,000, respectively.

In addition, certain of our officers and directors are also officers and/or directors of the Trust. Management believes that it has the ability to exercise significant influence over the Trust, therefore we account for our investment in the Trust using the equity method of accounting.

Our pre-tax share of income from the Trust, which is included in other income in the accompanying consolidated statements of income, was approximately $300,000 and $284,000 during the three-month periods ended March 31, 2019 and 2018, respectively. We received dividends from the Trust amounting to $531,000 and $524,000 during the three month periods ended March 31, 2019 and 2018, respectively. The carrying value of our investment in the Trust was approximately $7.3 million and $7.5 million at March 31, 2019 and December 31, 2018, respectively, and is included in other assets in the accompanying consolidated balance sheets. The market value of our investment in the Trust was $59.6 million at March 31, 2019 and $48.3 million at December 31, 2018, based on the closing price of the Trust’s stock on the respective dates.

The Trust commenced operations in 1986 by purchasing certain properties from us and immediately leasing the properties back to our respective subsidiaries. Most of the leases were entered into at the time the Trust commenced operations and provided for initial terms of 13 to 15 years with up to six additional 5-year renewal terms. Each lease also provided for additional or bonus rental, as discussed below. The base rents are paid monthly and the bonus rents are computed and paid on a quarterly basis, based upon a computation that compares current quarter revenue to a corresponding quarter in the base year. The leases with those subsidiaries are unconditionally guaranteed by us and are cross-defaulted with one another.

Total rent expense under the operating leases on the three hospital facilities reflected in the table below was approximately $4 million during each of the three months ended March 31, 2019 and 2018. Pursuant to the terms of the three hospital leases with the Trust, we have the option to renew the leases at the lease terms described above and below by providing notice to the Trust at least 90 days prior to the termination of the then current term. We also have the right to purchase the respective leased hospitals at the end of the lease terms or any renewal terms at their appraised fair market value as well as purchase any or all of the three leased hospital properties at the appraised fair market value upon one month’s notice should a change of control of the Trust occur. In addition, we have rights of first refusal to: (i) purchase the respective leased facilities during and for 180 days after the lease terms at the same price, terms and conditions of any third-party offer, or; (ii) renew the lease on the respective leased facility at the end of, and for 180 days after, the lease term at the same terms and conditions pursuant to any third-party offer.

The table below details the renewal options and terms for each of our three acute care hospital facilities leased from the Trust:

Hospital Name	Annual Minimum Rent		End of Lease Term	Renewal Term (years)
McAllen Medical Center	$	5,485,000	December, 2026	5(a)
Wellington Regional Medical Center	$	3,030,000	December, 2021	10(b)
Southwest Healthcare System, Inland Valley Campus	$	2,648,000	December, 2021	10(b)

(a) We have one 5-year renewal option at existing lease rates (through 2031).

(b)	We have two 5-year renewal options at fair market value lease rates (2022 through 2031).

In addition, certain of our subsidiaries are tenants in several medical office buildings and two FEDs owned by the Trust or by limited liability companies in which the Trust holds 95% to 100% of the ownership interest.

Other Related Party Transactions:

In December, 2010, our Board of Directors approved the Company’s entering into supplemental life insurance plans and agreements on the lives of Alan B. Miller (our chief executive officer (“CEO”) and his wife. As a result of these agreements, as amended in October, 2016, based on actuarial tables and other assumptions, during the life expectancies of the insureds, we would pay approximately $28 million in premiums, and certain trusts owned by our CEO, would pay approximately $9 million in premiums. Based on the projected premiums mentioned above, and assuming the policies remain in effect until the death of the insureds, we will be entitled to receive death benefit proceeds of no less than approximately $37 million representing the $28 million of aggregate premiums paid by us as well as the $9 million of aggregate premiums paid by the trusts. In connection with these policies, we will pay/we paid approximately $1.1 million, net, in premium payments during each of the 2019 and 2018 years.

In August, 2015, Marc D. Miller, our President and member of our Board of Directors, was appointed to the Board of Directors of Premier, Inc. (“Premier”), a healthcare performance improvement alliance. During 2013, we entered into a new group purchasing organization agreement (“GPO”) with Premier. In conjunction with the GPO agreement, we acquired a minority interest in Premier for a nominal amount. During the fourth quarter of 2013, in connection with the completion of an initial public offering of the stock of Premier, we received cash proceeds for the sale of a portion of our ownership interest in the GPO. Also in connection with this GPO agreement, we received shares of restricted stock of Premier which vest ratably over a seven-year period (2014 through 2020), contingent upon our continued participation and minority ownership interest in the GPO. We have elected to retain a portion of the previously vested shares of Premier, the market value of which is included in other assets on our consolidated balance sheet. Based upon the closing price of Premier’s stock on each respective date, the market value of our shares of Premier on which the restrictions have lapsed was $51 million as of March 31, 2019 and $56 million as of December 31, 2018. In connection with our adoption of ASU 2016-01, “Recognition and Measurement of Financial Assets and Financial Liabilities”, since our vested shares of Premier are held for investment and classified as available for sale, the $4 million decrease in market value of these shares since December 31, 2018 was recorded as an unrealized loss and included in “Other (income) expense, net” on our condensed consolidated statements of income for the three-month period ended March 31, 2019.

A member of our Board of Directors and member of the Executive Committee and Finance Committee is a partner in Norton Rose Fulbright US LLP, a law firm engaged by us for a variety of legal services. The Board member and his law firm also provide personal legal services to our CEO and acts as trustee of certain trusts for the benefit of our CEO and his family.

Other Noncurrent liabilities and Redeemable/Noncontrolling Interests

3 Months Ended

Mar. 31, 2019

Noncontrolling Interest [Abstract]

Other Noncurrent liabilities and Redeemable/Noncontrolling Interests

(3) Other Noncurrent liabilities and Redeemable/Noncontrolling Interests

Other noncurrent liabilities include the long-term portion of our professional and general liability, workers’ compensation reserves, pension and deferred compensation liabilities, and liabilities incurred in connection with split-dollar life insurance agreements on the lives of our chief executive officer and his wife.

As of March 31, 2019, outside owners held noncontrolling, minority ownership interests of: (i) 20% in an acute care facility located in Washington, D.C.; (ii) approximately 11% in an acute care facility located in Texas; (iii) 20% and 30% in two behavioral health care facilities located in Pennsylvania and Ohio, respectively; (iv) approximately 5% in an acute care facility located in Nevada, and; (v) approximately 20% in a behavioral health care facility located in Spokane, Washington. The noncontrolling interest and redeemable noncontrolling interest balances of $70 million and $4 million, respectively, as of March 31, 2019, consist primarily of the third-party ownership interests in these hospitals.

In connection with the two behavioral health care facilities located in Pennsylvania and Ohio, the minority ownership interests of which are reflected as redeemable noncontrolling interests on our Condensed Consolidated Balance Sheet, the outside owners have “put options” to put their entire ownership interest to us at any time. If exercised, the put option requires us to purchase the minority member’s interest at fair market value.

Treasury

3 Months Ended

Mar. 31, 2019

Equity [Abstract]

Treasury

(4) Treasury

Credit Facilities and Outstanding Debt Securities:

On October 23, 2018, we entered into a Sixth Amendment (the “Sixth Amendment”) to our credit agreement dated as of November 15, 2010, as amended on March 15, 2011, September 21, 2012, May 16, 2013, August 7, 2014 and June 7, 2016, among UHS, as borrower, the several banks and other financial institutions from time to time parties thereto, as lenders, JPMorgan Chase Bank, N.A., as administrative agent, and the other agents party thereto (the “Senior Credit Agreement”). The Sixth Amendment became effective on October 23, 2018.

The Sixth Amendment amended the Senior Credit Agreement to, among other things: (i) increase the aggregate amount of the revolving credit facility to $1 billion (increase of $200 million over the $800 million previous commitment); (ii) increase the aggregate amount of the tranche A term loan commitments to $2 billion (increase of approximately $290 million over the $1.71 billion of outstanding borrowings prior to the amendment), and; (iii) extended the maturity date of the revolving credit and tranche A term loan facilities to October 23, 2023 from August 7, 2019.

On October 31, 2018, we added a seven-year tranche B term loan facility in the aggregate principal amount of $500 million pursuant to the Senior Credit Agreement. The tranche B term loan matures on October 31, 2025. We used the proceeds to repay borrowings under the revolving credit facility, the Securitization, to redeem our $300 million, 3.75% Senior Notes that were scheduled to mature in 2019 and for general corporate purposes.

As of March 31, 2019, we had no borrowings outstanding pursuant to our $1 billion revolving credit facility and we had $973 million of available borrowing capacity net of $12 million of outstanding letters of credit and $15 million of outstanding borrowings pursuant to a short-term credit facility.

Pursuant to the terms of the Sixth Amendment, the tranche A term loan, which had $1.988 billion of borrowings outstanding as of March 31, 2019, provides for eight installment payments of $12.5 million per quarter, covering the period of March of 2019 through December of 2020, followed by payments of $25 million per quarter, commencing in March of 2021 until maturity in October of 2023, when all outstanding amounts will be due.

The tranche B term loan, which had $499 million of borrowings outstanding as of March 31, 2019, provides for installment payments of $1.25 million per quarter, which commenced on March 31, 2019 until maturity in October of 2025, when all outstanding amounts will be due.

Borrowings under the Senior Credit Agreement bear interest at our election at either (1) the ABR rate which is defined as the rate per annum equal to the greatest of (a) the lender’s prime rate, (b) the weighted average of the federal funds rate, plus 0.5% and (c) one month LIBOR rate plus 1%, in each case, plus an applicable margin based upon our consolidated leverage ratio at the end of each quarter ranging from 0.375% to 0.625% for revolving credit and term loan A borrowings and 0.75% for tranche B borrowings, or (2) the one, two, three or six month LIBOR rate (at our election), plus an applicable margin based upon our consolidated leverage ratio at the end of each quarter ranging from 1.375% to 1.625% for revolving credit and term loan A borrowings and 1.75% for the tranche B term loan. As of March 31, 2019, the applicable margins were 0.50% for ABR-based loans and 1.50% for LIBOR-based loans under the revolving credit and term loan A facilities. The revolving credit facility includes a $125 million sub-limit for letters of credit. The Senior Credit Agreement is secured by certain assets of the Company and our material subsidiaries (which generally excludes asset classes such as substantially all of the patient-related accounts receivable of our acute care hospitals, and certain real estate assets and assets held in joint-ventures with third parties) and is guaranteed by our material subsidiaries.

The Senior Credit Agreement includes a material adverse change clause that must be represented at each draw. The Senior Credit Agreement contains covenants that include a limitation on sales of assets, mergers, change of ownership, liens and indebtedness, transactions with affiliates, dividends and stock repurchases; and requires compliance with financial covenants including maximum leverage. We were in compliance with all required covenants as of March 31, 2019 and December 31, 2018.

In late April, 2018, we entered into the sixth amendment to our accounts receivable securitization program (“Securitization”) dated as of October 27, 2010 with a group of conduit lenders, liquidity banks, and PNC Bank, National Association, as administrative agent, which provides for borrowings outstanding from time to time by certain of our subsidiaries in exchange for undivided security interests in their respective accounts receivable. The sixth amendment, among other things, extended the term of the Securitization program through April 26, 2021 and increased the borrowing capacity to $450 million (from $440 million previously). Although the program fee and certain other fees were adjusted in connection with the sixth amendment, substantially all other provisions of the Securitization program remained unchanged. Pursuant to the terms of our Securitization program, substantially all of the patient-related accounts receivable of our acute care hospitals (“Receivables”) serve as collateral for the outstanding borrowings. We have accounted for this Securitization as borrowings. We maintain effective control over the Receivables since, pursuant to the terms of the Securitization, the Receivables are sold from certain of our subsidiaries to special purpose entities that are wholly-owned by us. The Receivables, however, are owned by the special purpose entities, can be used only to satisfy the debts of the wholly-owned special purpose entities, and thus are not available to us except through our ownership interest in the special purpose entities. The wholly-owned special purpose entities use the Receivables to collateralize the loans obtained from the group of third-party conduit lenders and liquidity banks. The group of third-party conduit lenders and liquidity banks do not have recourse to us beyond the assets of the wholly-owned special purpose entities that securitize the loans. At March 31, 2019, we had $290 million of outstanding borrowings pursuant to the terms of the Securitization and $160 million of available borrowing capacity.

As of March 31, 2019, we had combined aggregate principal of $1.1 billion from the following senior secured notes:

•

$700 million aggregate principal amount of 4.75% senior secured notes due in August, 2022 (“2022 Notes”) which were issued as follows:

•

$300 million aggregate principal amount issued on August 7, 2014 at par.

•

$400 million aggregate principal amount issued on June 3, 2016 at 101.5% to yield 4.35%.

•

$400 million aggregate principal amount of 5.00% senior secured notes due in June, 2026 (“2026 Notes”) which were issued on June 3, 2016.

Interest on the 2022 Notes is payable on February 1 and August 1 of each year until the maturity date of August 1, 2022. Interest on the 2026 Notes is payable on June 1 and December 1 until the maturity date of June 1, 2026. The 2022 Notes and 2026 Notes were offered only to qualified institutional buyers under Rule 144A and to non-U.S. persons outside the United States in reliance on Regulation S under the Securities Act of 1933, as amended (the “Securities Act”). The 2022 Notes and 2026 Notes have not been registered under the Securities Act and may not be offered or sold in the United States absent registration or an applicable exemption from registration requirements.

On November 26, 2018 we redeemed the $300 million aggregate principal, 3.75% Senior Notes due in 2019. The 2019 Notes were redeemed for an aggregate price equal to 100.485% of the principal amount, resulting in a premium paid of approximately $1 million, plus accrued interest to the redemption date.

At March 31, 2019, the carrying value and fair value of our debt were each approximately $3.9 billion. At December 31, 2018, the carrying value and fair value of our debt were each approximately $4.0 billion. The fair value of our debt was computed based upon quotes received from financial institutions. We consider these to be “level 2” in the fair value hierarchy as outlined in the authoritative guidance for disclosures in connection with debt instruments.

Cash Flow Hedges:

We manage our ratio of fixed and floating rate debt with the objective of achieving a mix that management believes is appropriate. To manage this risk in a cost-effective manner, we, from time to time, enter into interest rate swap agreements in which we agree to exchange various combinations of fixed and/or variable interest rates based on agreed upon notional amounts. We account for our derivative and hedging activities using the Financial Accounting Standard Board’s (“FASB”) guidance which requires all derivative instruments, including certain derivative instruments embedded in other contracts, to be carried at fair value on the balance sheet. For derivative transactions designated as hedges, we formally document all relationships between the hedging instrument and the related hedged item, as well as its risk-management objective and strategy for undertaking each hedge transaction.

Derivative instruments designated in a hedge relationship to mitigate exposure to variability in expected future cash flows, or other types of forecasted transactions, are considered cash flow hedges. Cash flow hedges are accounted for by recording the fair value of the derivative instrument on the balance sheet as either an asset or liability, with a corresponding amount recorded in accumulated other comprehensive income (“AOCI”) within shareholders’ equity. Amounts are reclassified from AOCI to the income statement in the period or periods the hedged transaction affects earnings. We use interest rate derivatives in our cash flow hedge transactions. Such derivatives are designed to be highly effective in offsetting changes in the cash flows related to the hedged liability.

For hedge transactions that do not qualify for the short-cut method, at the hedge’s inception and on a regular basis thereafter, a formal assessment is performed to determine whether changes in the fair values or cash flows of the derivative instruments have been highly effective in offsetting changes in cash flows of the hedged items and whether they are expected to be highly effective in the future.

The fair value of interest rate swap agreements approximates the amount at which they could be settled, based on estimates obtained from the counterparties. We assess the effectiveness of our hedge instruments on a quarterly basis. We performed periodic assessments of the cash flow hedge instruments during the first three months of 2019 and the full year of 2018 and determined the hedges to be highly effective. Although we do not anticipate nonperformance by our counterparties to interest rate swap agreements, the counterparties expose us to credit risk in the event of nonperformance. We do not hold or issue derivative financial instruments for trading purposes.

During 2015, we entered into nine forward starting interest rate swaps whereby we paid a fixed rate on a total notional amount of $1.0 billion and received one-month LIBOR. The average fixed rate payable on these swaps, all of which matured on April 15, 2019, was 1.31%. These interest rates swaps consisted of:

•

Four forward starting interest rate swaps, entered into during the second quarter of 2015, whereby we paid a fixed rate on a total notional amount of $500 million and received one-month LIBOR. Each of the four swaps became effective on July 15, 2015 and matured on April 15, 2019. The average fixed rate payable on these swaps was 1.40%;

•

Four forward starting interest rate swaps, entered into during the third quarter of 2015, whereby we paid a fixed rate on a total notional amount of $400 million and received one-month LIBOR. One swap on a notional amount of $100 million became effective on July 15, 2015, two swaps on a total notional amount of $200 million became effective on September 15, 2015 and another swap on a notional amount of $100 million became effective on December 15, 2015. All of these swaps matured on April 15, 2019 and the average fixed rate payable was 1.23%, and;

•

One interest rate swap, entered into during the fourth quarter of 2015, whereby we paid a fixed rate on a total notional amount of $100 million and received one-month LIBOR. The swap became effective on December 15, 2015 and matured on April 15, 2019. The fixed rate payable on this swap was 1.21%.

Foreign Currency Forward Exchange Contracts:

In August 2017, the FASB issued new guidance on hedge accounting (ASU 2017-12) that is intended to more closely align hedge accounting with companies’ risk management strategies, simplify the application of hedge accounting, and increase transparency as to the scope and results of hedging programs. The new guidance amends the presentation and disclosure requirements, and changes how companies assess effectiveness. The Company adopted this guidance as of January 1, 2019 and applied to all existing hedges as of the adoption date.

We use forward exchange contracts to hedge our net investment in foreign operations against movements in exchange rates. The effective portion of the unrealized gains or losses on these contracts is recorded in foreign currency translation adjustment within accumulated other comprehensive income and remains there until either the sale or liquidation of the subsidiary. In conjunction with the January 1, 2019 adoption of ASU 2017-12, “Targeted Improvements to Accounting for Hedging Activities”, we reclassified our presentation of the net cash inflows or outflows, which were received or paid in connection with foreign exchange contracts that hedge our net investment in foreign operations against movements in exchange rates, to investing cash flows on the consolidated statements of cash flows. As previously disclosed within our footnotes, these cash flows were formerly reported as operating activities. Prior period amounts have been reclassified from net cash provided by operating activities to net cash used in investing activities to conform with the current year presentation on the consolidated statements of cash flows. In connection with these forward exchange contracts, we recorded net cash inflows of $13 million during the three-month period ended March 31, 2019 and net cash outflows of $46 million during the three-month period ended March 31, 2018.

Derivatives Hedging Relationships:

The following table presents the effects of our interest rate swap agreements and our foreign currency foreign exchange contracts on our results of operations for the three month periods ended March 31, 2019 and 2018 (in thousands):

	Gain/(Loss) recognized in AOCI
	March 31,			March 31,
	2019			2018
Cash Flow Hedge relationships
Interest rate swap agreements (a)	$	(2,917	)	$	2,124

Net Investment Hedge relationships
Foreign currency foreign exchange contracts (b)	$	5,221		$	(45,853	)

(a)	The amount of gain reclassified out of AOCI into Interest expense, net was $2.9 million and $709,000 during the three month periods ended March 31, 2019 and 2018, respectively.

(b)

The amount reclassified out of AOCI into Other (income) expense, net includes the net effect of a $3.8 million gain offset by a $3.8 million loss recorded on repatriation of cash related to our net investment in the U.K. for the three month period ended March 31, 2019. There were no amounts reclassified out of AOCI for the three month period ended March 31, 2018.

No other gains or losses were recognized in income related to derivatives in Subtopic 815-20.

Cash, Cash Equivalents and Restricted Cash:

Cash, cash equivalents, and restricted cash as reported in the condensed consolidated statements of cash flows are presented separately on our condensed consolidated balance sheets as follow (in thousands):

	March 31,		December 31,
	2019		2018
Cash and cash equivalents	$	62,726	$	105,220
Restricted cash and cash equivalents (a)		94,850		94,465
Total cash, cash equivalents and restricted cash	$	157,576	$	199,685

(a) Restricted cash and cash equivalents is included in other assets on the accompanying consolidated balance sheet.

Fair Value Measurement

3 Months Ended

Mar. 31, 2019

Fair Value Disclosures [Abstract]

Fair Value Measurement

(5) Fair Value Measurement

Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. The following fair value hierarchy classifies the inputs to valuation techniques used to measure fair value into one of three levels:

•

Level 1: Unadjusted quoted prices in active markets for identical assets or liabilities.

•

Level 2: Inputs other than quoted prices that are observable for the asset or liability, either directly or indirectly. These included quoted prices for similar assets or liabilities in active markets and quoted prices for identical or similar assets or liabilities in markets that are not active.

•

Level 3: Unobservable inputs that reflect the reporting entity’s own assumptions.

The following tables present the assets and liabilities recorded at fair value on a recurring basis:

	Balance at				Basis of Fair Value Measurement
(in thousands)	March 31, 2019			Balance Sheet Location	Level 1		Level 2			Level 3
Assets:
Money market mutual funds	$	106,916		Other assets	$	106,916		$
Certificates of deposit		5,415		Other assets		5,415
Available for sale securities		51,337		Other assets		51,337
Deferred compensation assets		33,778		Other assets		33,778
Interest rate swap agreements		1,008		Accounts receivable, net				1,008
Foreign currency exchange contracts		(2,579	)	Other current assets				(2,579	)
	$	195,875			$	197,446	$	(1,571	)		-
Liabilities:
Deferred compensation liabilities	$	33,778		Other noncurrent liabilities	$	33,778
	$	33,778			$	33,778		-			-

	Balance at				Basis of Fair Value Measurement
(in thousands)	December 31, 2018			Balance Sheet Location	Level 1		Level 2			Level 3
Assets:
Money market mutual funds	$	106,530		Other assets	$	106,530		$
Certificates of deposit		5,415		Other assets		5,415
Available for sale securities		55,594		Other assets		55,594
Deferred compensation assets		32,998		Other assets		32,998
Interest rate swap agreements		3,925		Accounts Receivable, net				3,925
Foreign currency exchange contracts		8,908		Other current assets				8,908
	$	213,370			$	200,537	$	12,833			-
Liabilities:
Deferred compensation liabilities	$	32,998		Other noncurrent liabilities	$	32,998
	$	32,998			$	32,998		-			-

The fair value of our money market mutual funds, certificates of deposit and available for sale securities are computed based upon quoted market prices in active market. The fair value of deferred compensation assets and offsetting liability are computed based on market prices in an active market held in a rabbi trust. The fair value of our interest rate swaps are based on quotes from our counter parties. The fair value of our foreign currency exchange contracts is valued using quoted forward exchange rates and spot rates at the reporting date.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Commitments and Contingencies

3 Months Ended

Mar. 31, 2019

Commitments And Contingencies Disclosure [Abstract]

Commitments and Contingencies

(6) Commitments and Contingencies

Professional and General Liability, Workers’ Compensation Liability

Effective January, 2017, the vast majority of our subsidiaries are self-insured for professional and general liability exposure up to $5 million and $3 million per occurrence, respectively, subject to certain aggregate limitations. Prior to January, 2017, the vast majority of our subsidiaries were self-insured for professional and general liability exposure up to $10 million and $3 million per occurrence, respectively. These subsidiaries are provided with several excess policies through commercial insurance carriers which provide for coverage in excess of the applicable per occurrence self-insured retention or underlying policy limits up to $250 million per occurrence and in the aggregate for claims incurred after 2013 and up to $200 million per occurrence and in the aggregate for claims incurred from 2011 through 2013. We remain liable for 10%, up to an annual aggregate limitation of $5 million ($8.5 million for facilities located in the U.K.), of the claims paid pursuant to the commercially insured excess coverage. In addition, from time to time based upon marketplace conditions, we may elect to purchase additional commercial coverage for certain of our facilities or businesses. Our behavioral health care facilities located in the U.K. have policies through a commercial insurance carrier located in the U.K. that provides for £10 million of professional liability coverage and £25 million of general liability coverage.

As of March 31, 2019, the total accrual for our professional and general liability claims was $246 million, of which $42 million was included in current liabilities. As of December 31, 2018, the total accrual for our professional and general liability claims was $243 million, of which $42 million was included in current liabilities.

As of March 31, 2019, the total accrual for our workers’ compensation liability claims was $71 million, of which $40 million was included in current liabilities. As of December 31, 2018, the total accrual for our workers’ compensation liability claims was $72 million, of which $40 million was included in current liabilities.

Our estimated liability for self-insured professional and general liability claims is based on a number of factors including, among other things, the number of asserted claims and reported incidents, estimates of losses for these claims based on recent and historical settlement amounts, estimates of incurred but not reported claims based on historical experience, and estimates of amounts recoverable under our commercial insurance policies. While we continuously monitor these factors, our ultimate liability for professional and general liability claims could change materially from our current estimates due to inherent uncertainties involved in making this estimate. Given our significant self-insured exposure for professional and general liability claims, there can be no assurance that a sharp increase in the number and/or severity of claims asserted against us will not have a material adverse effect on our future results of operations. Although we are unable to predict whether or not our future financial statements will include adjustments to our prior year reserves for self-insured general and professional and workers’ compensation claims, given the relatively unpredictable nature of the these potential liabilities and the factors impacting these reserves, as discussed above, it is reasonably likely that our future financial results may include material adjustments to prior period reserves.

Property Insurance:

We have commercial property insurance policies for our properties covering catastrophic losses, including windstorm damage, up to a $1 billion policy limit, subject to a deductible ranging from $50,000 to $250,000 per occurrence. Losses resulting from named windstorms are subject to deductibles between 3% and 5% of the total insurable value of the property. In addition, we have commercial property insurance policies covering catastrophic losses resulting from earthquake and flood damage, each subject to aggregated loss limits (as opposed to per occurrence losses). Commercially insured earthquake coverage for our facilities is subject to various deductibles and limitations including: (i) $500 million limitation for our facilities located in Nevada; (ii) $130 million limitation for our facilities located in California; (iii) $100 million limitation for our facilities located in fault zones within the United States; (iv) $40 million limitation for our facility located in Puerto Rico, and; (v) $250 million limitation for many of our facilities located in other states. Deductibles for flood losses vary in amount, up to a maximum of $500,000, based upon location of the facility. Since certain of our facilities have been designated by our insurer as flood prone, we have elected to purchase policies from The National Flood Insurance Program. Property insurance for our behavioral health facilities located in the U.K. are provided on an all risk basis up to a £1.29 billion policy limit, with coverage caps per location, that includes coverage for real and personal property as well as business interruption losses.

Other

Our accounts receivable as of March 31, 2019 and December 31, 2018 include amounts due from Illinois of approximately $34 million and $32 million, respectively. Collection of the outstanding receivables continues to be delayed due to state budgetary and funding pressures. Approximately $19 million as of March 31, 2019 and $18 million as of December 31, 2018, of the receivables due from Illinois were outstanding in excess of 60 days, as of each respective date. Although the accounts receivable due from Illinois could remain outstanding for the foreseeable future, since we expect to eventually collect all amounts due to us, no related reserves have been established in our consolidated financial statements. However, we can provide no assurance that we will eventually collect all amounts due to us from Illinois. Failure to ultimately collect all outstanding amounts due to us from Illinois would have an adverse impact on our future consolidated results of operations and cash flows.

Legal Proceedings

We operate in a highly regulated and litigious industry which subjects us to various claims and lawsuits in the ordinary course of business as well as regulatory proceedings and government investigations. These claims or suits include claims for damages for personal injuries, medical malpractice, commercial/contractual disputes, wrongful restriction of, or interference with, physicians’ staff privileges, and employment related claims. In addition, health care companies are subject to investigations and/or actions by various state and federal governmental agencies or those bringing claims on their behalf. Government action has increased with respect to investigations and/or allegations against healthcare providers concerning possible violations of fraud and abuse and false claims statutes as well as compliance with clinical and operational regulations. Currently, and from time to time, we and some of our facilities are subjected to inquiries in the form of subpoenas, Civil Investigative Demands, audits and other document requests from various federal and state agencies. These inquiries can lead to notices and/or actions including repayment obligations from state and federal government agencies associated with potential non-compliance with laws and regulations. Further, the federal False Claim Act allows private individuals to bring lawsuits (qui tam actions) against healthcare providers that submit claims for payments to the government. Various states have also adopted similar statutes. When such a claim is filed, the government will investigate the matter and decide if they are going to intervene in the pending case. These qui tam lawsuits are placed under seal by the court to comply with the False Claims Act’s requirements. If the government chooses not to intervene, the private individual(s) can proceed independently on behalf of the government. Health care providers that are found to violate the False Claims Act may be subject to substantial monetary fines/penalties as well as face potential exclusion from participating in government health care programs or be required to comply with Corporate Integrity Agreements as a condition of a settlement of a False Claim Act matter. In September 2014, the Criminal Division of the Department of Justice (“DOJ”) announced that all qui tam cases will be shared with their Division to determine if a parallel criminal investigation should be opened. The DOJ has also announced an intention to pursue civil and criminal actions against individuals within a company as well as the corporate entity or entities. In addition, health care facilities are subject to monitoring by state and federal surveyors to ensure compliance with program Conditions of Participation. In the event a facility is found to be out of compliance with a Condition of Participation and unable to remedy the alleged deficiency(s), the facility faces termination from the Medicare and Medicaid programs or compliance with a System Improvement Agreement to remedy deficiencies and ensure compliance.

The laws and regulations governing the healthcare industry are complex covering, among other things, government healthcare participation requirements, licensure, certification and accreditation, privacy of patient information, reimbursement for patient services as well as fraud and abuse compliance. These laws and regulations are constantly evolving and expanding. Further, the Affordable Care Act has added additional obligations on healthcare providers to report and refund overpayments by government healthcare programs and authorizes the suspension of Medicare and Medicaid payments “pending an investigation of a credible allegation of fraud.” We monitor our business and have developed an ethics and compliance program with respect to these complex laws, rules and regulations. Although we believe our policies, procedures and practices comply with government regulations, there is no assurance that we will not be faced with the sanctions referenced above which include fines, penalties and/or substantial damages, repayment obligations, payment suspensions, licensure revocation, and expulsion from government healthcare programs. Even if we were to ultimately prevail in any action brought against us or our facilities or in responding to any inquiry, such action or inquiry could have a material adverse effect on us.

Certain legal matters are described below:

Government Investigations:

UHS Behavioral Health

In February, 2013, the Office of Inspector General for the United States Department of Health and Human Services (“OIG”) served a subpoena requesting various documents from January, 2008 to the date of the subpoena directed at Universal Health Services, Inc. (“UHS”) concerning it and UHS of Delaware, Inc., and certain UHS owned behavioral health facilities including: Keys of Carolina, Old Vineyard Behavioral Health, The Meadows Psychiatric Center, Streamwood Behavioral Health, Hartgrove Hospital, Rock River Academy and Residential Treatment Center, Roxbury Treatment Center, Harbor Point Behavioral Health Center, f/k/a The Pines Residential Treatment Center, including the Crawford, Brighton and Kempsville campuses, Wekiva Springs Center and River Point Behavioral Health. Prior to receipt of this subpoena, some of these facilities had received independent subpoenas from state or federal agencies. Subsequent to the February 2013 subpoenas, some of the facilities above have received additional, specific subpoenas or other document and information requests. In addition to the OIG, the DOJ and various U.S. Attorneys’ and state Attorneys’ General Offices are also involved in this matter. Since February 2013, additional facilities have also received subpoenas and/or document and information requests or we have been notified are included in the omnibus investigation. Those facilities include: National Deaf Academy, Arbour-HRI Hospital, Behavioral Hospital of Bellaire, St. Simons By the Sea, Turning Point Care Center, Salt Lake Behavioral Health, Central Florida Behavioral Hospital, University Behavioral Center, Arbour Hospital, Arbour-Fuller Hospital, Pembroke Hospital, Westwood Lodge, Coastal Harbor Health System, Shadow Mountain Behavioral Health, Cedar Hills Hospital, Mayhill Hospital, Southern Crescent Behavioral Health (Anchor Hospital and Crescent Pines campuses), Valley Hospital (AZ), Peachford Behavioral Health System of Atlanta, University Behavioral Health of Denton, El Paso Behavioral Health System, Newport News Behavioral Health Center, The Hughes Center and Forest View Hospital.

In October, 2013, we were advised that the DOJ’s Criminal Frauds Section had opened an investigation of River Point Behavioral Health and Wekiva Springs Center. Since that time, we have been notified that the Criminal Frauds section has opened investigations of National Deaf Academy, Hartgrove Hospital and UHS as a corporate entity. In April 2017, the DOJ’s Criminal Division issued a subpoena requesting documentation from Shadow Mountain Behavioral Health. In August 2017, Kempsville Center of Behavioral Health (a part of Harbor Point Behavioral Health previously identified above) received a subpoena requesting documentation.

In April, 2014, the Centers for Medicare and Medicaid Services (“CMS”) instituted a Medicare payment suspension at River Point Behavioral Health in accordance with federal regulations regarding suspension of payments during certain investigations. The Florida Agency for Health Care Administration (“AHCA”) subsequently issued a Medicaid payment suspension for the facility. River Point Behavioral Health submitted a rebuttal statement disputing the basis of the suspension and requesting revocation of the suspension. Notwithstanding, CMS continued the payment suspension. River Point Behavioral Health provided additional information to CMS in an effort to obtain relief from the payment suspension but the Medicare suspension remains in effect. In June 2017, AHCA advised that while they were maintaining the suspension for dual eligible and cross-over Medicare beneficiaries, the Medicaid payment suspension was lifted effective June 27, 2017. We cannot predict if and/or when the facility’s remaining suspended payments will resume in total. From inception through March 31, 2019, the aggregate funds withheld from us in connection with the River Point Behavioral Health payment suspension amounted to approximately $9 million. Although the operating results of River Point Behavioral Health did not have a material impact on our consolidated results of operations during the three-month period ended March 31, 2019 or the year ended December 31, 2018, the payment suspension has had a material adverse effect on the facility’s results of operations and financial condition.

The DOJ has advised us that the civil aspect of the coordinated investigation referenced above is a False Claims Act investigation focused on billings submitted to government payers in relation to services provided at those facilities. While there have been various matters raised by DOJ during the pendency of this investigation, DOJ Civil has advised that the focus of their investigation is on medical necessity issues and billing for services not eligible for payment due to non-compliance with regulatory requirements relating to, among other things, admission eligibility, discharge decisions, length of stay and patient care issues. It is our understanding that the DOJ Criminal Fraud Section is investigating issues similar to those focused on by the DOJ Civil Division and the other related agencies involved in this matter. UHS denies any fraudulent billings were submitted to government payers; however, we are involved in settlement discussions with the DOJ Civil Division in an attempt to resolve this matter. During 2018, we recorded pre-tax increases to the reserve established in connection with the civil aspects of these matters amounting to $102 million (including $13 million recorded during the first quarter of 2018) increasing the aggregate pre-tax reserve to $123 million as of December 31, 2018 from $22 million as of December 31, 2017. The aggregate pre-tax reserve remained at $123 million as of March 31, 2019. Changes in the reserve may be required in future periods as discussions with the DOJ continue and additional information becomes available. We cannot predict the ultimate resolution of these matters and therefore can provide no assurance that final amounts paid in settlement or otherwise, if any, or associated costs, as well as the income tax deductibility of payments, will not differ materially from our established reserve and assumptions related to income tax deductibility.

DOJ investigation of Turning Point Hospital.

During the fourth quarter of 2018, we were notified that the DOJ Civil Division in conjunction with the U.S. Attorney’s Office for the Northern District of Georgia and the Georgia Attorney General’s Office have opened an investigation of Turning Point Hospital in Moultrie, GA. The DOJ Civil Division has advised us that they are primarily investigating transportation and housing financial assistance provided to patients receiving treatment at the facility. The DOJ issued a civil investigative demand to the facility requesting various documents and other information. At this time, we are unable to assess potential liability or damages, if any.

Litigation:

U.S. ex rel Escobar v. Universal Health Services, Inc. et.al.

This is a False Claims Act case filed against Universal Health Services, Inc., UHS of Delaware, Inc. and HRI Clinics, Inc. d/b/a Arbour Counseling Services in U.S. District Court for the District of Massachusetts. This qui tam action primarily alleges that Arbour Counseling Services failed to appropriately supervise certain clinical providers in contravention of regulatory requirements and the submission of claims to Medicaid were subsequently improper. Relators make other claims of improper billing to Medicaid associated with alleged failures of Arbour Counseling to comply with state regulations. The U.S. Attorney’s Office and the Massachusetts Attorney General’s Office initially declined to intervene. UHS filed a motion to dismiss and the trial court originally granted the motion dismissing the case. The First Circuit Court of Appeals (“First Circuit”) reversed the trial court’s dismissal of the case. The United States Supreme Court subsequently vacated the First Circuit’s opinion and remanded the case for further consideration under the new legal standards established by the Supreme Court for False Claims Act cases. During the 4^th quarter of 2016, the First Circuit issued a revised opinion upholding their reversal of the trial court’s dismissal. The case was then remanded to the trial court for further proceedings. In January 2017, the U.S. Attorney’s Office and Massachusetts Attorney General’s Office advised of the potential for intervention in the case. The Massachusetts Attorney General’s Office subsequently filed its motion to intervene which was granted and, in April 2017, filed their Complaint in Intervention. We are defending this case vigorously. At this time, we are uncertain as to potential liability or financial exposure, if any, which may be associated with this matter.

Shareholder Class Action

In December 2016 a purported shareholder class action lawsuit was filed in U.S. District Court for the Central District of California against UHS and certain UHS officers alleging violations of the federal securities laws. The case was originally filed as Heed v. Universal Health Services, Inc. et. al. (Case No. 2:16-CV-09499-PSG-JC). The court subsequently appointed Teamsters Local 456 Pension Fund and Teamsters Local 456 Annuity Fund to serve as lead plaintiffs. The case has been transferred to the U.S. District Court for the Eastern District of Pennsylvania and the style of the case has been changed to Teamsters Local 456 Pension Fund, et. al. v. Universal Health Services, Inc. et. al. (Case No. 2:17-CV-02817-LS). In September, 2017, Teamsters Local 456 Pension Fund filed an amended complaint. The amended class action complaint alleges violations of federal securities laws relating to disclosures made in public filings associated with alleged practices and operations at our behavioral health facilities. Plaintiffs seek monetary damages for shareholders during the defined class period as a result of the decrease in share price following various public disclosures or reports. In December 2017, we filed a motion to dismiss the amended complaint. We deny liability and intend to defend ourselves vigorously. At this time, we are uncertain as to potential liability or financial exposure, if any, which may be associated with this matter.

Shareholder Derivative Cases

In March 2017, a shareholder derivative suit was filed by plaintiff David Heed in the Court of Common Pleas of Philadelphia County. A notice of removal to the United States District Court for the Eastern District of Pennsylvania was filed (Case No. 2:17-cv-01476-LS). Plaintiff filed a motion to remand. In December 2017, the Court denied plaintiff’s motion to remand and has retained the case in federal court. In May, June and July 2017, additional shareholder derivative suits were filed in the United States District Court for the Eastern District of Pennsylvania. The plaintiffs in those cases are: Central Laborers’ Pension Fund (Case No. 17-cv-02187-LS); Firemen’s Retirement System of St. Louis (Case No. 17—cv-02317-LS); Waterford Township Police & Fire Retirement System (Case No. 17-cv-02595-LS); and Amalgamated Bank Longview Funds (Case No. 17-cv-03404-LS). The Fireman’s Retirement System case has since been voluntarily dismissed. The federal court has consolidated all of the cases pending in the Eastern District of Pennsylvania and has appointed co-lead plaintiffs and co-lead counsel. Lead Plaintiffs have filed a consolidated, amended complaint. We have filed a motion to dismiss the amended complaint. In addition, a shareholder derivative case was filed in Chancery Court in Delaware by the Delaware County Employees’ Retirement Fund (Case No. 2017-0475-JTL). In December 2017, the Chancery Court stayed this case pending resolution of other contemporaneous matters. Each of these cases have named certain current and former members of the Board of Directors individually and certain officers of Universal Health Services, Inc. as defendants. UHS has also been named as a nominal defendant in these cases. The derivative cases make substantially similar allegations and claims as the shareholder class action relating to practices at our behavioral health facilities and board and corporate oversight of these facilities as well as claims relating to the stock trading by the individual defendants and company repurchase of shares during the relevant time period. The cases make claims of breaches of fiduciary duties by the named board members and officers; alleged violations of federal securities laws; and common law causes of action against the individual defendants including unjust enrichment, corporate waste, abuse of control, constructive fraud and gross mismanagement. The cases seek monetary damages allegedly incurred by the company; restitution and disgorgement of profits, benefits and other compensation from the individual defendants and various forms of equitable relief relating to corporate governance matters. The defendants deny liability and intend to defend these cases vigorously. At this time, we are uncertain as to potential liability or financial exposure, if any, which may be associated with these matters.

Disproportionate Share Hospital Payment Matter:

In late September, 2015, many hospitals in Pennsylvania, including seven of our behavioral health care hospitals located in the state, received letters from the Pennsylvania Department of Human Services (the “Department”) demanding repayment of allegedly excess Medicaid Disproportionate Share Hospital payments (“DSH”) for the federal fiscal year (“FFY”) 2011 amounting to approximately $4 million in the aggregate. Since that time, we have received similar requests for repayment for alleged DSH overpayments for FFYs 2012, 2013 and 2014. For FFY 2012, the claimed overpayment amounts to approximately $4 million. For FFY 2013, the claimed overpayments were initially approximately $7 million but have since been reduced to approximately $2 million due to a change in the Department’s calculations of the hospital specific DSH upper payment limit. For FFY 2014, the claimed overpayments were approximately $7 million. We filed administrative appeals for all of our facilities contesting the recoupment efforts for FFYs 2011 through 2014 as we believe the Department’s calculation methodology is inaccurate and conflicts with applicable federal and state laws and regulations. The Department has agreed to postpone the recoupment of the state’s share of the DSH payments until all hospital appeals are resolved but started recoupment of the federal share. Due to a change in the Pennsylvania Medicaid State Plan and implementation of a CMS-approved Medicaid Section 1115 Waiver, we do not believe the methodology applied by the Department to FFYs 2011 through 2014 is applicable to reimbursements received for Medicaid services provided after January 1, 2015 by our behavioral health care facilities located in Pennsylvania. We can provide no assurance that we will ultimately be successful in our legal and administrative appeals related to the Department’s repayment demands. If our legal and administrative appeals are unsuccessful, our future consolidated results of operations and financial condition could be adversely impacted by these repayments.

Other Matters:

Various other suits, claims and investigations, including government subpoenas, arising against, or issued to, us are pending and additional such matters may arise in the future. Management will consider additional disclosure from time to time to the extent it believes such matters may be or become material. The outcome of any current or future litigation or governmental or internal investigations, including the matters described above, cannot be accurately predicted, nor can we predict any resulting penalties, fines or other sanctions that may be imposed at the discretion of federal or state regulatory authorities. We record accruals for such contingencies to the extent that we conclude it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. No estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made at this time regarding the matters described above or that are otherwise pending because the inherently unpredictable nature of legal proceedings may be exacerbated by various factors, including, but not limited to: (i) the damages sought in the proceedings are unsubstantiated or indeterminate; (ii) discovery is not complete; (iii) the matter is in its early stages; (iv) the matters present legal uncertainties; (v) there are significant facts in dispute; (vi) there are a large number of parties, or; (vii) there is a wide range of potential outcomes. It is possible that the outcome of these matters could have a material adverse impact on our future results of operations, financial position, cash flows and, potentially, our reputation.

Segment Reporting

3 Months Ended

Mar. 31, 2019

Segment Reporting [Abstract]

Segment Reporting

(7) Segment Reporting

Our reportable operating segments consist of acute care hospital services and behavioral health care services. The “Other” segment column below includes centralized services including, but not limited to, information technology, purchasing, reimbursement, accounting and finance, taxation, legal, advertising and design and construction. The chief operating decision making group for our acute care services and behavioral health care services is comprised of our Chief Executive Officer, the President and the Presidents of each operating segment. The Presidents for each operating segment also manage the profitability of each respective segment’s various facilities. The operating segments are managed separately because each operating segment represents a business unit that offers different types of healthcare services or operates in different healthcare environments. The accounting policies of the operating segments are the same as those described in the summary of significant accounting policies included in our Annual Report on Form 10-K for the year ended December 31, 2018. The corporate overhead allocations, as reflected below, are utilized for internal reporting purposes and are comprised of each period’s projected corporate-level operating expenses (excluding interest expense). The overhead expenses are captured and allocated directly to each segment to the extent possible, and overhead expenses incurred on behalf of both segments are captured and allocated to each segment based upon each segment’s respective percentage of total operating expenses.

	Three months ended March 31, 2019
	Acute Care Hospital Services			Behavioral Health Services (a)			Other			Total Consolidated
	(Amounts in thousands)
Gross inpatient revenues	$	7,163,714		$	2,483,999		$	0		$	9,647,713
Gross outpatient revenues	$	4,257,614		$	266,546		$	0		$	4,524,160
Total net revenues	$	1,514,844		$	1,286,383		$	3,164		$	2,804,391
Income/(loss) before allocation of corporate overhead and income taxes	$	192,213		$	244,168		$	(140,085	)	$	296,296
Allocation of corporate overhead	$	(57,500	)	$	(41,647	)	$	99,147		$	0
Income/(loss) after allocation of corporate overhead and before income taxes	$	134,713		$	202,521		$	(40,938	)	$	296,296
Total assets as of March 31, 2019	$	4,372,628		$	6,972,929		$	375,720		$	11,721,277

	Three months ended March 31, 2018
	Acute Care Hospital Services			Behavioral Health Services (a)			Other			Total Consolidated
	(Amounts in thousands)
Gross inpatient revenues	$	6,361,766		$	2,402,258		$	0		$	8,764,024
Gross outpatient revenues	$	3,714,661		$	255,181		$	0		$	3,969,842
Total net revenues	$	1,445,632		$	1,237,996		$	3,888		$	2,687,516
Income/(loss) before allocation of corporate overhead and income taxes	$	203,711		$	238,748		$	(146,221	)	$	296,238
Allocation of corporate overhead	$	(49,891	)	$	(40,332	)	$	90,223		$	0
Income/(loss) after allocation of corporate overhead and before income taxes	$	153,820		$	198,416		$	(55,998	)	$	296,238
Total assets as of March 31, 2018	$	3,924,302		$	6,649,732		$	449,483		$	11,023,517

(a)

Includes net revenues generated from our behavioral health care facilities located in the U.K. amounting to approximately $137 million and $115 million for the three-month periods ended March 31, 2019 and 2018, respectively. Total assets at our U.K. behavioral health care facilities were approximately $1.237 billion and $1.176 billion as of March 31, 2019 and 2018, respectively.

Earnings Per Share Data ("EPS") and Stock Based Compensation

3 Months Ended

Mar. 31, 2019

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Earnings Per Share Data ("EPS") and Stock Based Compensation

(8) Earnings Per Share Data (“EPS”) and Stock Based Compensation

Basic earnings per share are based on the weighted average number of common shares outstanding during the period. Diluted earnings per share are based on the weighted average number of common shares outstanding during the period adjusted to give effect to common stock equivalents.

The following table sets forth the computation of basic and diluted earnings per share for the periods indicated (in thousands, except per share data):

	Three months ended March 31,
	2019			2018
Basic and Diluted:
Net income attributable to UHS	$	234,168		$	223,832
Less: Net income attributable to unvested restricted share grants		(515	)		(104	)
Net income attributable to UHS – basic and diluted	$	233,653		$	223,728

Weighted average number of common shares - basic		90,776			94,226
Net effect of dilutive stock options and grants based on the treasury stock method		191			457
Weighted average number of common shares and equivalents - diluted		90,967			94,683
Earnings per basic share attributable to UHS:	$	2.57		$	2.37
Earnings per diluted share attributable to UHS:	$	2.57		$	2.36

The “Net effect of dilutive stock options and grants based on the treasury stock method”, for all periods presented above, excludes certain outstanding stock options applicable to each period since the effect would have been anti-dilutive. The excluded weighted-average stock options totaled 7.0 million for the three months ended March 31, 2019 and 2.9 million for the three months ended March 31, 2018. All classes of our common stock have the same dividend rights.

The decrease in our basic and diluted weighted number of common shares outstanding for the three months ended March 31, 2019, as compared to the comparable prior year quarter, was due primarily to the impact of shares repurchased by us since January 1, 2018.

Stock-Based Compensation:

During the three-month periods ended March 31, 2019 and 2018, pre-tax compensation cost of $15.8 million and $18.9 million, respectively, was recognized related to outstanding stock options. In addition, during the three-month periods ended March 31, 2019 and 2018, pre-tax compensation cost of approximately $1.5 million and $545,000 (net of cancellations), respectively, was recognized related to restricted stock. As of March 31, 2019 there was approximately $175.7 million of unrecognized compensation cost related to unvested options and restricted stock which is expected to be recognized over the remaining weighted average vesting period of 3.1 years. There were 2,390,390 stock options granted during the first three months of 2019 with a weighted-average grant date fair value of $30.43 per share. There were 142,288 shares of restricted shares granted during the first three months of 2019 with a weighted-average grant date fair value of $134.23 per share.

The expense associated with stock-based compensation arrangements is a non-cash charge. In the Condensed Consolidated Statements of Cash Flows, stock-based compensation expense is an adjustment to reconcile net income to cash provided by operating activities and aggregated to $17.6 million and $19.7 million during the three-month periods ended March 31, 2019 and 2018, respectively.

Dispositions and acquisitions

3 Months Ended

Mar. 31, 2019

Business Combinations [Abstract]

Dispositions and acquisitions

(9) Dispositions and acquisitions

Three-month period ended March 31, 2019:

Acquisitions:

During the first quarter of 2019, there were no acquisitions.

Divestitures:

During the first quarter of 2019, there were no divestitures.

Three-month period ended March 31, 2018:

Acquisitions:

During the first quarter of 2018, we paid approximately $21 million to acquire businesses and property consisting primarily of the acquisition of a 109-bed behavioral health care facility located in Gulfport, Mississippi.

Divestitures:

During the first quarter of 2018, there were no divestitures.

Income Taxes

3 Months Ended

Mar. 31, 2019

Income Tax Disclosure [Abstract]

Income Taxes

(11) Income Taxes

Our effective income tax rate was 19.9% for the three months ended March 31, 2019, compared with 22.8% for the three months ended March 31, 2018. The decrease in the effective tax rate during the three months ended March 31, 2019, compared with the same period in 2018, was primarily due to a $9 million decrease in our provision for income taxes attributable to employee share-based payment accounting, which decreased our provision for income taxes by $11 million during the first quarter of 2019 as compared to $2 million during the first quarter of 2018.

The global intangible low-taxed income (“GILTI”) provisions from the TCJA-17 require the inclusion of the earnings of certain foreign subsidiaries in excess of an acceptable rate of return on certain assets of the respective subsidiaries in our U.S. tax return for tax years beginning after December 31, 2017. An accounting policy election was made during 2018 to treat taxes related to GILTI as a period cost when the tax is incurred. We recorded a GILTI tax provision of less than $1 million for the three months ended March 31, 2019 and 2018, respectively.

As of January 1, 2019, our unrecognized tax benefits were approximately $2 million. The amount, if recognized, that would favorably affect the effective tax rate is approximately $1 million. During the three months ended March 31, 2019, changes to the estimated liabilities for uncertain tax positions (including accrued interest) relating to tax positions taken during prior and current periods did not have a material impact on our financial statements.

We recognize accrued interest and penalties associated with uncertain tax positions as part of the tax provision. As of March 31, 2019, we have less than $1 million of accrued interest and penalties. The U.S. federal statute of limitations remains open for 2015 and subsequent years. Foreign and U.S. state and local jurisdictions have statutes of limitations generally ranging from 3 to 4 years. The statute of limitations on certain jurisdictions could expire within the next twelve months. It is reasonably possible that the amount of uncertain tax benefits will change during the next 12 months, however, it is anticipated that any such change, if it were to occur, would not have a material impact on our results of operations.

We operate in multiple jurisdictions with varying tax laws. We are subject to audits by any of these taxing authorities. Our tax returns have been examined by the Internal Revenue Service (“IRS”) through the year ended December 31, 2006. We believe that adequate accruals have been provided for federal, foreign and state taxes.

Revenue

3 Months Ended

Mar. 31, 2019

Revenue From Contract With Customer [Abstract]

Revenue

(12) Revenue

In May 2014 and March 2016, the FASB issued ASU 2014-09 and ASU 2016-08, “Revenue from Contracts with Customers (Topic 606)” and “Revenue from Contracts with Customers: Principal versus Agent Considerations (Reporting Revenue Gross versus Net)”, respectively, which provides guidance for revenue recognition. The standard’s core principle is that a company will recognize revenue when it transfers promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. Under the new standards, our estimate for amounts not expected to be collected based on historical experience will continue to be recognized as a reduction to net revenue. However, subsequent changes in estimate of collectability due to a change in the financial status of a payer, for example a bankruptcy, will be recognized as bad debt expense in operating charges.

The performance obligation is separately identifiable from other promises in the customer contract. As the performance obligations are met (i.e.: room, board, ancillary services, level of care), revenue is recognized based upon allocated transaction price. The transaction price is allocated to separate performance obligations based upon the relative standalone selling price. In instances where we determine there are multiple performance obligations across multiple months, the transaction price will be allocated by applying an estimated implicit and explicit rate to gross charges based on the separate performance obligations.

In assessing collectability, we have elected the portfolio approach. This portfolio approach is being used as we have large volume of similar contracts with similar classes of customers. We reasonably expect that the effect of applying a portfolio approach to a group of contracts would not differ materially from considering each contract separately. Management’s judgment to group the contracts by portfolio is based on the payment behavior expected in each portfolio category. As a result, aggregating all of the contracts (which are at the patient level) by the particular payer or group of payers, will result in the recognition of the same amount of revenue as applying the analysis at the individual patient level.

We group our revenues into categories based on payment behaviors. Each component has its own reimbursement structure which allows us to disaggregate the revenue into categories that share the nature and timing of payments. The other patient revenue consists primarily of self-pay, government-funded non-Medicaid, and other.

The following table disaggregates our revenue by major source for the three month periods ended March 31, 2019 and 2018 (in thousands):

	For the three months ended March 31, 2019
	Acute Care				Behavioral Health				Other		Total
Medicare	$	335,909	22	%	$	137,456	11	%			$	473,365	17	%
Managed Medicare		209,103	14	%		52,259	4	%				261,362	9	%
Medicaid		104,510	7	%		172,916	13	%				277,426	10	%
Managed Medicaid		133,731	9	%		267,273	21	%				401,004	14	%
Managed Care (HMO and PPOs)		570,383	38	%		347,882	27	%				918,265	33	%
UK Revenue		0	0	%		136,702	11	%				136,702	5	%
Other patient revenue and adjustments, net		51,883	3	%		123,478	10	%				175,361	6	%
Other non-patient revenue		109,325	7	%		48,417	4	%		3,164		160,906	6	%
Total Net Revenue	$	1,514,844	100	%	$	1,286,383	100	%	$	3,164		2,804,391	100	%

	For the three months ended March 31, 2018
	Acute Care				Behavioral Health				Other		Total
Medicare	$	342,718	24	%	$	142,527	12	%			$	485,245	18	%
Managed Medicare		176,957	12	%		44,995	4	%				221,952	8	%
Medicaid		105,966	7	%		177,336	14	%				283,302	11	%
Managed Medicaid		111,277	8	%		230,776	19	%				342,053	13	%
Managed Care (HMO and PPOs)		497,780	34	%		358,062	29	%				855,842	32	%
UK Revenue		0	0	%		114,741	9	%				114,741	4	%
Other patient revenue and adjustments, net		112,570	8	%		116,985	9	%				229,555	9	%
Other non-patient revenue		98,364	7	%		52,574	4	%		3,888		154,826	6	%
Total Net Revenue	$	1,445,632	100	%	$	1,237,996	100	%	$	3,888		2,687,516	100	%

Lease Accounting

3 Months Ended

Mar. 31, 2019

Leases [Abstract]

Lease Accounting

(13) Lease Accounting

In February 2016, the FASB issued ASU 2016-02 (Topic 842) "Leases." Topic 842 supersedes the lease requirements in Accounting Standards Codification Topic 840, "Leases." Under Topic 842, lessees are required to recognize assets and liabilities on the balance sheet for most leases and provide enhanced disclosures. Leases will be classified as either finance or operating.

We adopted Topic 842 effective January 1, 2019. We applied Topic 842 to all leases as of January 1, 2019 with comparative periods continuing to be reported under Topic 840. We have elected the practical expedient package to not reassess at adoption (i) expired or existing contracts for whether they are or contain a lease, (ii) the lease classification of any existing leases or (iii) initial indirect costs for existing leases. We have also elected the policy exemption that allows lessees to choose to not separate lease and non-lease components by class of underlying asset and are applying this expedient to all relevant asset classes.

We determine if an arrangement is or contains a lease at inception of the contract. Our right-of-use assets represent our right to use the underlying assets for the lease term and our lease liabilities represent our obligation to make lease payments arising from the leases. Right-of-use assets and lease liabilities are recognized at commencement date based on the present value of lease payments over the lease term. We use the implicit rate noted within the contract. If not readily available, we use our estimated incremental borrowing rate, which is derived using a collateralized borrowing rate for the same currency and term as the associated lease. A right-of-use asset and lease liability is not recognized for leases with an initial term of 12 months or less and we recognize lease expense for these leases on a straight-line basis over the lease term within lease and rental expense.

Our operating leases are primarily for real estate, including certain acute care facilities, off-campus outpatient facilities, medical office buildings, and corporate and other administrative offices. Our real estate lease agreements typically have initial terms of five to 10 years. These real estate leases may include one or more options to renew, with renewals that can extend the lease term from five to 10 years. The exercise of lease renewal options is at our sole discretion. When determining the lease term, we included options to extend or terminate the lease when it is reasonably certain that we will exercise that option.

The components of lease expense for the three month period ended March 31, 2019 are as follows (in thousands):

	Three months ended March 31,
	2019

Operating lease cost	$	18,079
Variable and short term lease cost (a)		8,046
Total lease cost	$	26,125

Finance lease cost:
Amortization of right-of-use-assets	$	481
Interest on lease liabilities		484
Total finance lease cost	$	965

(a)

Includes equipment, month-to-month and leases with a maturity of less than 12 months.

Supplemental cash flow information related to leases for the three month period ended March 31, 2019 are as follows (in thousands):

	Three months ended March 31,
	2019

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	25,884
Operating cash flows from finance leases	$	575
Financing cash flows from finance leases	$	433

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	355,981
Finance leases	0

Included in the $356 million of right-of-use assets obtained in exchange for operating lease obligations is $6 million of new operating leases entered into during the three month period ended March 31, 2019.

Supplemental balance sheet information related to leases as of March 31, 2019 are as follows (in thousands):

	March 31,
	2019

Operating Leases
Right of use assets-operating leases	$	342,032

Operating lease liabilities	$	56,136
Operating lease liabilities noncurrent		286,101
Total operating lease liabilities	$	342,237

Finance Leases
Property and equipment	$	23,250
Accumulated depreciation		(9,882	)
Property and equipment, net	$	13,368

Current maturities of long-term debt	$	1,737
Long-term debt		17,612
Total finance lease liabilities	$	19,349

Weighted Average remaining lease term, years
Operating leases		10.4
Finance leases		7.8

Weighted Average discount rate
Operating leases		4.7	%
Finance leases		10.5	%

Future maturities of lease liabilities are as follows (in thousands):

	Operating Leases			Finance Leases
Year ending December 31,
2019 (remaining 9 months)	$	52,447		$	2,842
2020		62,920			3,375
2021		55,817			3,257
2022		45,404			3,559
2023		41,277			3,654
Later years		183,572			12,096
Total lease payments		441,437			28,783
less imputed interest		(99,200	)		(9,434	)
Total	$	342,237		$	19,349

Future minimum rental payments under lease commitments with a term of more than one year as of December 31, 2018, prior to our adoption of ASU 2016-02 are as follows (amounts in thousands):

Year	Capital Leases			Operating Leases
2019	$	3,996		$	72,353
2020		3,345			59,492
2021		3,227			48,891
2022		3,508			35,233
2023		3,624			28,839
Later years		12,070			123,039
Total minimum rental	$	29,770		$	367,847
Less: Amount representing interest		(9,829	)
Present value of minimum rental commitments		19,941
Less: Current portion of capital lease obligations		(2,128	)
Long-term portion of capital lease obligations	$	17,813

Recent Accounting Standards

3 Months Ended

Mar. 31, 2019

Accounting Changes And Error Corrections [Abstract]

Recent Accounting Standards

(14) Recent Accounting Standards

In January, 2017, the FASB issued ASU No. 2017-04, “Intangibles-Goodwill and Other (Topic 350): Simplifying the Accounting for Goodwill Impairment” (“ASU 2017-04”), which removes the requirement to perform a hypothetical purchase price allocation to measure goodwill impairment. A goodwill impairment will now be the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the carrying amount of goodwill. ASU 2017-04 is effective for the annual and interim periods beginning January 1, 2020 with early adoption permitted, and applied prospectively. We do not expect ASU 2017-04 to have a material impact on our financial statements.

From time to time, new accounting guidance is issued by the FASB or other standard setting bodies that is adopted by the Company as of the effective date or, in some cases where early adoption is permitted, in advance of the effective date. The Company has assessed the recently issued guidance that is not yet effective and, unless otherwise indicated above, believes the new guidance will not have a material impact on our results of operations, cash flows or financial position.

Relationship with Universal Health Realty Income Trust and Related Party Transactions (Tables)

3 Months Ended

Mar. 31, 2019

Remaining Renewal Options and Terms for Each of Three Hospital Facilities Leased from Trust

The table below details the renewal options and terms for each of our three acute care hospital facilities leased from the Trust:

Hospital Name	Annual Minimum Rent		End of Lease Term	Renewal Term (years)
McAllen Medical Center	$	5,485,000	December, 2026	5(a)
Wellington Regional Medical Center	$	3,030,000	December, 2021	10(b)
Southwest Healthcare System, Inland Valley Campus	$	2,648,000	December, 2021	10(b)

(a) We have one 5-year renewal option at existing lease rates (through 2031).

(b)	We have two 5-year renewal options at fair market value lease rates (2022 through 2031).

Treasury (Tables)

3 Months Ended

Mar. 31, 2019

Equity [Abstract]

Summary of Effects of Interest Rate Swap Agreements and Foreign Currency Foreign Exchange Contracts on Result of Operations

	Gain/(Loss) recognized in AOCI
	March 31,			March 31,
	2019			2018
Cash Flow Hedge relationships
Interest rate swap agreements (a)	$	(2,917	)	$	2,124

Net Investment Hedge relationships
Foreign currency foreign exchange contracts (b)	$	5,221		$	(45,853	)

(a)	The amount of gain reclassified out of AOCI into Interest expense, net was $2.9 million and $709,000 during the three month periods ended March 31, 2019 and 2018, respectively.

(b)

Summary of Cash, Cash Equivalents and Restricted Cash Reported In Condensed Consolidated Statements of Cash Flows

	March 31,		December 31,
	2019		2018
Cash and cash equivalents	$	62,726	$	105,220
Restricted cash and cash equivalents (a)		94,850		94,465
Total cash, cash equivalents and restricted cash	$	157,576	$	199,685

(a) Restricted cash and cash equivalents is included in other assets on the accompanying consolidated balance sheet.

Fair Value Measurement (Tables)

3 Months Ended

Mar. 31, 2019

Fair Value Disclosures [Abstract]

Summary of Assets and Liabilities Recorded at Fair Value on Recurring Basis

The following tables present the assets and liabilities recorded at fair value on a recurring basis:

	Balance at				Basis of Fair Value Measurement
(in thousands)	March 31, 2019			Balance Sheet Location	Level 1		Level 2			Level 3
Assets:
Money market mutual funds	$	106,916		Other assets	$	106,916		$
Certificates of deposit		5,415		Other assets		5,415
Available for sale securities		51,337		Other assets		51,337
Deferred compensation assets		33,778		Other assets		33,778
Interest rate swap agreements		1,008		Accounts receivable, net				1,008
Foreign currency exchange contracts		(2,579	)	Other current assets				(2,579	)
	$	195,875			$	197,446	$	(1,571	)		-
Liabilities:
Deferred compensation liabilities	$	33,778		Other noncurrent liabilities	$	33,778
	$	33,778			$	33,778		-			-

	Balance at				Basis of Fair Value Measurement
(in thousands)	December 31, 2018			Balance Sheet Location	Level 1		Level 2			Level 3
Assets:
Money market mutual funds	$	106,530		Other assets	$	106,530		$
Certificates of deposit		5,415		Other assets		5,415
Available for sale securities		55,594		Other assets		55,594
Deferred compensation assets		32,998		Other assets		32,998
Interest rate swap agreements		3,925		Accounts Receivable, net				3,925
Foreign currency exchange contracts		8,908		Other current assets				8,908
	$	213,370			$	200,537	$	12,833			-
Liabilities:
Deferred compensation liabilities	$	32,998		Other noncurrent liabilities	$	32,998
	$	32,998			$	32,998		-			-

Segment Reporting (Tables)

3 Months Ended

Mar. 31, 2019

Segment Reporting [Abstract]

Segment Reporting

	Three months ended March 31, 2019
	Acute Care Hospital Services			Behavioral Health Services (a)			Other			Total Consolidated
	(Amounts in thousands)
Gross inpatient revenues	$	7,163,714		$	2,483,999		$	0		$	9,647,713
Gross outpatient revenues	$	4,257,614		$	266,546		$	0		$	4,524,160
Total net revenues	$	1,514,844		$	1,286,383		$	3,164		$	2,804,391
Income/(loss) before allocation of corporate overhead and income taxes	$	192,213		$	244,168		$	(140,085	)	$	296,296
Allocation of corporate overhead	$	(57,500	)	$	(41,647	)	$	99,147		$	0
Income/(loss) after allocation of corporate overhead and before income taxes	$	134,713		$	202,521		$	(40,938	)	$	296,296
Total assets as of March 31, 2019	$	4,372,628		$	6,972,929		$	375,720		$	11,721,277

	Three months ended March 31, 2018
	Acute Care Hospital Services			Behavioral Health Services (a)			Other			Total Consolidated
	(Amounts in thousands)
Gross inpatient revenues	$	6,361,766		$	2,402,258		$	0		$	8,764,024
Gross outpatient revenues	$	3,714,661		$	255,181		$	0		$	3,969,842
Total net revenues	$	1,445,632		$	1,237,996		$	3,888		$	2,687,516
Income/(loss) before allocation of corporate overhead and income taxes	$	203,711		$	238,748		$	(146,221	)	$	296,238
Allocation of corporate overhead	$	(49,891	)	$	(40,332	)	$	90,223		$	0
Income/(loss) after allocation of corporate overhead and before income taxes	$	153,820		$	198,416		$	(55,998	)	$	296,238
Total assets as of March 31, 2018	$	3,924,302		$	6,649,732		$	449,483		$	11,023,517

(a)

Earnings Per Share Data ("EPS") and Stock Based Compensation (Tables)

3 Months Ended

Mar. 31, 2019

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Computation of Basic and Diluted Earnings per Share

The following table sets forth the computation of basic and diluted earnings per share for the periods indicated (in thousands, except per share data):

	Three months ended March 31,
	2019			2018
Basic and Diluted:
Net income attributable to UHS	$	234,168		$	223,832
Less: Net income attributable to unvested restricted share grants		(515	)		(104	)
Net income attributable to UHS – basic and diluted	$	233,653		$	223,728

Weighted average number of common shares - basic		90,776			94,226
Net effect of dilutive stock options and grants based on the treasury stock method		191			457
Weighted average number of common shares and equivalents - diluted		90,967			94,683
Earnings per basic share attributable to UHS:	$	2.57		$	2.37
Earnings per diluted share attributable to UHS:	$	2.57		$	2.36

Revenue (Tables)

3 Months Ended

Mar. 31, 2019

Revenue From Contract With Customer [Abstract]

Schedule of Disaggregates Revenue by Major Source

The following table disaggregates our revenue by major source for the three month periods ended March 31, 2019 and 2018 (in thousands):

	For the three months ended March 31, 2019
	Acute Care				Behavioral Health				Other		Total
Medicare	$	335,909	22	%	$	137,456	11	%			$	473,365	17	%
Managed Medicare		209,103	14	%		52,259	4	%				261,362	9	%
Medicaid		104,510	7	%		172,916	13	%				277,426	10	%
Managed Medicaid		133,731	9	%		267,273	21	%				401,004	14	%
Managed Care (HMO and PPOs)		570,383	38	%		347,882	27	%				918,265	33	%
UK Revenue		0	0	%		136,702	11	%				136,702	5	%
Other patient revenue and adjustments, net		51,883	3	%		123,478	10	%				175,361	6	%
Other non-patient revenue		109,325	7	%		48,417	4	%		3,164		160,906	6	%
Total Net Revenue	$	1,514,844	100	%	$	1,286,383	100	%	$	3,164		2,804,391	100	%

	For the three months ended March 31, 2018
	Acute Care				Behavioral Health				Other		Total
Medicare	$	342,718	24	%	$	142,527	12	%			$	485,245	18	%
Managed Medicare		176,957	12	%		44,995	4	%				221,952	8	%
Medicaid		105,966	7	%		177,336	14	%				283,302	11	%
Managed Medicaid		111,277	8	%		230,776	19	%				342,053	13	%
Managed Care (HMO and PPOs)		497,780	34	%		358,062	29	%				855,842	32	%
UK Revenue		0	0	%		114,741	9	%				114,741	4	%
Other patient revenue and adjustments, net		112,570	8	%		116,985	9	%				229,555	9	%
Other non-patient revenue		98,364	7	%		52,574	4	%		3,888		154,826	6	%
Total Net Revenue	$	1,445,632	100	%	$	1,237,996	100	%	$	3,888		2,687,516	100	%

Lease Accounting (Tables)

3 Months Ended

Mar. 31, 2019

Leases [Abstract]

Components of Lease Expense

The components of lease expense for the three month period ended March 31, 2019 are as follows (in thousands):

	Three months ended March 31,
	2019

Operating lease cost	$	18,079
Variable and short term lease cost (a)		8,046
Total lease cost	$	26,125

Finance lease cost:
Amortization of right-of-use-assets	$	481
Interest on lease liabilities		484
Total finance lease cost	$	965

(a)

Includes equipment, month-to-month and leases with a maturity of less than 12 months.

Supplemental Cash Flow Information Related to Leases

Supplemental cash flow information related to leases for the three month period ended March 31, 2019 are as follows (in thousands):

	Three months ended March 31,
	2019

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	25,884
Operating cash flows from finance leases	$	575
Financing cash flows from finance leases	$	433

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	355,981
Finance leases	0

Supplemental Balance Sheet Information Related to Leases

Supplemental balance sheet information related to leases as of March 31, 2019 are as follows (in thousands):

	March 31,
	2019

Operating Leases
Right of use assets-operating leases	$	342,032

Operating lease liabilities	$	56,136
Operating lease liabilities noncurrent		286,101
Total operating lease liabilities	$	342,237

Finance Leases
Property and equipment	$	23,250
Accumulated depreciation		(9,882	)
Property and equipment, net	$	13,368

Current maturities of long-term debt	$	1,737
Long-term debt		17,612
Total finance lease liabilities	$	19,349

Weighted Average remaining lease term, years
Operating leases		10.4
Finance leases		7.8

Weighted Average discount rate
Operating leases		4.7	%
Finance leases		10.5	%

Future Maturities of Lease Liabilities

Future maturities of lease liabilities are as follows (in thousands):

	Operating Leases			Finance Leases
Year ending December 31,
2019 (remaining 9 months)	$	52,447		$	2,842
2020		62,920			3,375
2021		55,817			3,257
2022		45,404			3,559
2023		41,277			3,654
Later years		183,572			12,096
Total lease payments		441,437			28,783
less imputed interest		(99,200	)		(9,434	)
Total	$	342,237		$	19,349

Future Minimum Rental Payments Under Lease Commitments

Future minimum rental payments under lease commitments with a term of more than one year as of December 31, 2018, prior to our adoption of ASU 2016-02 are as follows (amounts in thousands):

Year	Capital Leases			Operating Leases
2019	$	3,996		$	72,353
2020		3,345			59,492
2021		3,227			48,891
2022		3,508			35,233
2023		3,624			28,839
Later years		12,070			123,039
Total minimum rental	$	29,770		$	367,847
Less: Amount representing interest		(9,829	)
Present value of minimum rental commitments		19,941
Less: Current portion of capital lease obligations		(2,128	)
Long-term portion of capital lease obligations	$	17,813

Relationship with Universal Health Realty Income Trust and Related Party Transactions - Additional Information (Detail)	3 Months Ended			12 Months Ended
	Mar. 31, 2019 USD ($) Hospital Facility	Mar. 31, 2018 USD ($) Hospital	Dec. 31, 2013	Dec. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)	Dec. 31, 2017	Dec. 31, 2016
Related Party Transaction [Line Items]
Net revenues	$ 2,804,391,000	$ 2,687,516,000
Chief Executive Officer
Related Party Transaction [Line Items]
Estimated payments to acquire life insurance policies	28,000,000
Payments to acquire life insurance policies, net					$ 1,100,000
Chief Executive Officer \| Scenario Forecast
Related Party Transaction [Line Items]
Payments to acquire life insurance policies, net				$ 1,100,000
Chief Executive Officer \| Trust Owned by CEO
Related Party Transaction [Line Items]
Estimated payments to acquire life insurance policies	9,000,000
Minimum \| Chief Executive Officer
Related Party Transaction [Line Items]
Estimated death benefit proceeds	$ 37,000,000
Relationship with Universal Health Realty Income Trust
Related Party Transaction [Line Items]
Trust outstanding shares held, percentage	5.70%
Percentage of annual incentive fee	20.00%
Percentage of advisory fee on average invested real estate assets	0.70%	0.70%			0.70%	0.70%	0.70%
Pre-tax share of income from the Trust	$ 300,000	$ 284,000
Dividends received from the Trust	531,000	524,000
Carrying value of investment in Trust	7,300,000				$ 7,500,000
Market value of investment in Trust	$ 59,600,000				48,300,000
Lease renewal period, years	5 years
Rent expense under operating leases	$ 4,000,000	$ 4,000,000
Notice period on renewal of lease	90 days
Period of rights of refusal to leased facilities	180 days
Number of hospital facilities \| Hospital	3	3
Number of free-standing emergency departments to be acquired \| Facility	2
Relationship with Universal Health Realty Income Trust \| Minimum
Related Party Transaction [Line Items]
Lease initial terms	13 years
Relationship with Universal Health Realty Income Trust \| Minimum \| Limited Liability Companies
Related Party Transaction [Line Items]
Non-controlling ownership interests by subsidiaries	95.00%
Relationship with Universal Health Realty Income Trust \| Maximum
Related Party Transaction [Line Items]
Lease initial terms	15 years
Relationship with Universal Health Realty Income Trust \| Maximum \| Limited Liability Companies
Related Party Transaction [Line Items]
Non-controlling ownership interests by subsidiaries	100.00%
Relationship with Universal Health Realty Income Trust \| Advisory Fee
Related Party Transaction [Line Items]
Net revenues	$ 1,000,000	$ 904,000
Premier, Inc. \| Group Purchasing Organization Agreement \| Restricted Stock
Related Party Transaction [Line Items]
Shares vesting period			7 years
Shares vesting period start year			2014
Shares vesting period end year			2020
Market value of retained vested shares	51,000,000				$ 56,000,000
Premier, Inc. \| Other (Income) Expense, Net \| ASU 2016-01
Related Party Transaction [Line Items]
Unrealized loss	$ (4,000,000)

Remaining Renewal Options and Terms for Hospital Facilities Leased from Trust (Detail)

3 Months Ended

Mar. 31, 2019

USD ($)

McAllen Medical Center

Property Subject to or Available for Operating Lease [Line Items]

Annual Minimum Rent

$ 5,485,000

End of Lease Term

2026-12

Renewal Term (years)

5 years

^[1]

Wellington Regional Medical Center

Property Subject to or Available for Operating Lease [Line Items]

Annual Minimum Rent

$ 3,030,000

End of Lease Term

2021-12

Renewal Term (years)

10 years

^[2]

Southwest Healthcare System, Inland Valley Campus

Property Subject to or Available for Operating Lease [Line Items]

Annual Minimum Rent

$ 2,648,000

End of Lease Term

2021-12

Renewal Term (years)

10 years

^[2]

[1]	We have one 5-year renewal option at existing lease rates (through 2031).
[2]	We have two 5-year renewal options at fair market value lease rates (2022 through 2031).

Remaining Renewal Options and Terms for Hospital Facilities Leased from Trust (Parenthetical) (Detail)	3 Months Ended
	Mar. 31, 2019 RenewalOption
McAllen Medical Center
Property Subject to or Available for Operating Lease [Line Items]
Number of renewal options at existing lease rates	1
Renewal options term at existing lease rates	5 years
McAllen Medical Center \| Maximum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at existing lease rates expiration year	2031
Wellington Regional Medical Center
Property Subject to or Available for Operating Lease [Line Items]
Number of renewal options at fair market lease rates	2
Renewal options term at fair market lease rates	5 years
Wellington Regional Medical Center \| Maximum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2031
Wellington Regional Medical Center \| Minimum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2022
Southwest Healthcare System, Inland Valley Campus
Property Subject to or Available for Operating Lease [Line Items]
Number of renewal options at fair market lease rates	2
Renewal options term at fair market lease rates	5 years
Southwest Healthcare System, Inland Valley Campus \| Maximum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2031
Southwest Healthcare System, Inland Valley Campus \| Minimum
Property Subject to or Available for Operating Lease [Line Items]
Renewal options at fair market value lease rates expiration year	2022

Other Noncurrent Liabilities and Redeemable/Noncontrolling Interests - Additional Information (Detail) $ in Millions	Mar. 31, 2019 USD ($) Facility
Minority Interest [Line Items]
Behavioral health care facilities with outside owners holding non-controlling minority interest \| Facility	2
Non-controlling interest balances	$ 70
Redeemable non-controlling interest balances	$ 4
Outside Owners \| Acute Care Facility \| Washington, District of Columbia
Minority Interest [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners	20.00%
Outside Owners \| Acute Care Facility \| Texas
Minority Interest [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners	11.00%
Outside Owners \| Acute Care Facility \| Nevada
Minority Interest [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners	5.00%
Outside Owners \| Behavioral Health Care Facility \| Pennsylvania
Minority Interest [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners	20.00%
Outside Owners \| Behavioral Health Care Facility \| Ohio
Minority Interest [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners	30.00%
Outside Owners \| Behavioral Health Care Facility \| Washington
Minority Interest [Line Items]
Percentage of non-controlling, minority ownership interests held by outside owners	20.00%

Treasury - Additional Information (Detail)				3 Months Ended					12 Months Ended
Treasury - Additional Information (Detail)	Nov. 26, 2018 USD ($)	Oct. 23, 2018 USD ($)	Jun. 07, 2016 USD ($)	Mar. 31, 2019 USD ($)	Mar. 31, 2018 USD ($)	Dec. 31, 2015 USD ($) Derivative	Sep. 30, 2015 USD ($) Derivative	Jun. 30, 2015 USD ($) Derivative	Dec. 31, 2015 USD ($) Derivative	Dec. 31, 2018 USD ($)	Oct. 31, 2018 USD ($)	Sep. 30, 2018	Jun. 03, 2016 USD ($)	Aug. 07, 2014 USD ($)
Equity Class Of Treasury Stock [Line Items]
Line of credit facility, starting date				Oct. 23, 2018
Rate adjustment to weighted average federal funds rate for credit facility borrowings				0.50%
Rate adjustment to one month Eurodollar rate on credit facility borrowings				1.00%
Accounts receivable securitization program credit facility, borrowing capacity				$ 450,000,000	$ 440,000,000
Accounts receivable securitization program credit facility, amount outstanding				290,000,000
Accounts receivable securitization program credit facility, available borrowing capacity				160,000,000
Debt instrument carrying amount				3,900,000,000						$ 4,000,000,000
Fair value of debt				3,900,000,000						$ 4,000,000,000
Number of additional forward starting interest rate swaps \| Derivative							4
One Point Three One Percent Forward Starting Interest Rate Swaps
Equity Class Of Treasury Stock [Line Items]
Number of additional forward starting interest rate swaps \| Derivative									9
Maturity date of interest rate cash flow hedges									Apr. 15, 2019
Fixed rate payable on interest rate swap						1.31%			1.31%
One Point Four Zero Percent Forward Starting Interest Rate Swaps
Equity Class Of Treasury Stock [Line Items]
Number of additional forward starting interest rate swaps \| Derivative								4,000,000
Maturity date of interest rate cash flow hedges								Apr. 15, 2019
Average fixed rate payable on interest rate swap								1.40%
Forward Starting Interest Rate Swaps
Equity Class Of Treasury Stock [Line Items]
Maturity date of interest rate cash flow hedges							Apr. 15, 2019
Average fixed rate payable on interest rate swap							1.23%
One Point Two One Percent Forward Starting Interest Rate Swaps
Equity Class Of Treasury Stock [Line Items]
Number of additional forward starting interest rate swaps \| Derivative						1
Maturity date of interest rate cash flow hedges						Apr. 15, 2019
Fixed rate payable on interest rate swap						1.21%			1.21%
Foreign Currency Forward Exchange Contracts
Equity Class Of Treasury Stock [Line Items]
Net cash inflows (outflows)				13,000,000	$ (46,000,000)
Cash Flow Hedging \| One Point Three One Percent Forward Starting Interest Rate Swaps
Equity Class Of Treasury Stock [Line Items]
Notional amount of interest rate cash flow hedges						$ 1,000,000,000			$ 1,000,000,000
Cash Flow Hedging \| One Point Four Zero Percent Forward Starting Interest Rate Swaps
Equity Class Of Treasury Stock [Line Items]
Notional amount of interest rate cash flow hedges								$ 500,000,000
Cash Flow Hedging \| Forward Starting Interest Rate Swaps
Equity Class Of Treasury Stock [Line Items]
Notional amount of interest rate cash flow hedges							$ 400,000,000
Cash Flow Hedging \| One Point Two Three Percent Forward Starting Interest Rate Swaps One
Equity Class Of Treasury Stock [Line Items]
Notional amount of interest rate cash flow hedges							100,000,000
Cash Flow Hedging \| One Point Two Three Percent Forward Starting Interest Rate Swaps Two
Equity Class Of Treasury Stock [Line Items]
Notional amount of interest rate cash flow hedges							200,000,000
Cash Flow Hedging \| One Point Two Three Percent Forward Starting Interest Rate Swaps Three
Equity Class Of Treasury Stock [Line Items]
Notional amount of interest rate cash flow hedges							$ 100,000,000
Cash Flow Hedging \| One Point Two One Percent Forward Starting Interest Rate Swaps
Equity Class Of Treasury Stock [Line Items]
Notional amount of interest rate cash flow hedges						$ 100,000,000			$ 100,000,000
Revolving Credit Facility
Equity Class Of Treasury Stock [Line Items]
Line of credit facility, borrowing capacity		$ 1,000,000,000	$ 800,000,000	1,000,000,000
Line of credit facility increased amount		200,000,000
Line of credit facility, available borrowing capacity				973,000,000
Line of credit facility amount outstanding				$ 0
Current applicable margins				1.50%
Revolving Credit Facility \| ABR-based loans
Equity Class Of Treasury Stock [Line Items]
Current applicable margins				0.50%
Revolving Credit Facility \| Minimum \| One Month Eurodollar Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio				0.375%
Revolving Credit Facility \| Minimum \| One Two Three Six Month Eurodollar Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio				1.375%
Revolving Credit Facility \| Maximum \| One Month Eurodollar Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio				0.625%
Revolving Credit Facility \| Maximum \| One Two Three Six Month Eurodollar Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio				1.625%
Revolving Credit Facility \| Short Term on Demand Credit Facility
Equity Class Of Treasury Stock [Line Items]
Line of credit facility amount outstanding				$ 15,000,000
Revolving Credit Facility \| Letter of Credit
Equity Class Of Treasury Stock [Line Items]
Line of credit facility, borrowing capacity				125,000,000
Line of credit facility amount outstanding				12,000,000
Tranche A Term Loan
Equity Class Of Treasury Stock [Line Items]
Line of credit facility, borrowing capacity		2,000,000,000	$ 1,710,000,000
Line of credit facility increased amount		$ 290,000,000
Senior notes, maturity date		Oct. 23, 2023	Aug. 07, 2019
Line of credit facility amount outstanding				1,988,000,000
Tranche A Term Loan \| Quarterly Payment for First Eight Installments
Equity Class Of Treasury Stock [Line Items]
Scheduled principal payments per quarter				$ 12,500,000
Debt Instrument Periodic Payment, description				covering the period of March of 2019 through December of 2020
Tranche A Term Loan \| Quarterly Payment after Eight Installments Until Maturity
Equity Class Of Treasury Stock [Line Items]
Scheduled principal payments per quarter				$ 25,000,000
Debt Instrument Periodic Payment, description				commencing in March of 2021 until maturity in October of 2023
Tranche B Term Loan
Equity Class Of Treasury Stock [Line Items]
Line of credit facility, borrowing capacity											$ 500,000,000
Senior notes, maturity date				Oct. 31, 2025
Line of credit facility amount outstanding				$ 499,000,000
Scheduled principal payments per quarter				$ 1,250,000
Debt Instrument Periodic Payment, description				which commenced on March 31, 2019 until maturity in October of 2025
New Senior Secured Notes
Equity Class Of Treasury Stock [Line Items]
Senior notes, issued				$ 1,100,000,000
New Senior Secured Notes \| 3.75% Senior Secured Notes due 2019
Equity Class Of Treasury Stock [Line Items]
Senior Notes														$ 300,000,000
Senior notes, interest rate														3.75%
Redemption of senior notes	$ 300,000,000
Redemption price, percentage	100.485%
Redemption premium paid	$ 1,000,000
New Senior Secured Notes \| 4.75% Senior Secured Notes due 2022
Equity Class Of Treasury Stock [Line Items]
Senior notes, maturity date				Aug. 01, 2022
Senior notes, interest rate				4.75%
Senior notes, issued				$ 700,000,000
New Senior Secured Notes \| 4.75% Senior Secured Notes due 2022 \| Senior Secured Notes Issued on August Seven Two Thousand Fourteen
Equity Class Of Treasury Stock [Line Items]
Senior notes, issued				300,000,000
New Senior Secured Notes \| 4.75% Senior Secured Notes due 2022 \| Senior Secured Notes Issued on June Three Two Thousand Sixteen
Equity Class Of Treasury Stock [Line Items]
Senior notes, issued				$ 400,000,000
Senior notes issued percentage				101.50%
Senior notes yield percentage				4.35%
New Senior Secured Notes \| 5.00% Senior Secured Notes due 2026
Equity Class Of Treasury Stock [Line Items]
Senior notes, maturity date				Jun. 01, 2026
New Senior Secured Notes \| 5.00% Senior Secured Notes due 2026 \| Senior Secured Notes Issued on June Three Two Thousand Sixteen
Equity Class Of Treasury Stock [Line Items]
Senior notes, interest rate													5.00%
Senior notes, issued													$ 400,000,000
Term Loan A
Equity Class Of Treasury Stock [Line Items]
Current applicable margins				1.50%
Term Loan A \| ABR-based loans
Equity Class Of Treasury Stock [Line Items]
Current applicable margins				0.50%
Term Loan A \| Minimum \| One Month Eurodollar Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio												0.375%
Term Loan A \| Minimum \| One Two Three Six Month Eurodollar Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio				1.375%
Term Loan A \| Maximum \| One Month Eurodollar Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio												0.625%
Term Loan A \| Maximum \| One Two Three Six Month Eurodollar Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio				1.625%
Term Loan A \| Tranche B Term Loan \| One Month Eurodollar Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio				0.75%
Term Loan A \| Tranche B Term Loan \| One Two Three Six Month Eurodollar Rate Plus Index Based Loans
Equity Class Of Treasury Stock [Line Items]
Consolidated Leverage Ratio				1.75%

Summary of Effects of Interest Rate Swap Agreements and Foreign Currency Foreign Exchange Contracts on Result of Operations (Detail) - USD ($)
$ in Thousands

3 Months Ended

Mar. 31, 2019

Mar. 31, 2018

Derivative Instruments Gain Loss [Line Items]

Gain/(Loss) recognized in AOCI

$ (2,917)

$ 2,124

Designated As Hedging Instrument | Cash Flow Hedging | Interest Rate Swap

Derivative Instruments Gain Loss [Line Items]

Gain/(Loss) recognized in AOCI

^[1]

(2,917)

2,124

Designated As Hedging Instrument | Net Investment Hedge | Foreign Currency Foreign Exchange Contracts

Derivative Instruments Gain Loss [Line Items]

Gain/(Loss) recognized in AOCI

^[2]

$ 5,221

$ (45,853)

[1]	The amount of gain reclassified out of AOCI into Interest expense, net was $2.9 million and $709,000 during the three month periods ended March 31, 2019 and 2018, respectively.
[2]	The amount reclassified out of AOCI into Other (income) expense, net includes the net effect of a $3.8 million gain offset by a $3.8 million loss recorded on repatriation of cash related to our net investment in the U.K. for the three month period ended March 31, 2019. There were no amounts reclassified out of AOCI for the three month period ended March 31, 2018

Summary of Effects of Interest Rate Swap Agreements and Foreign Currency Foreign Exchange Contracts on Result of Operations (Parenthetical) (Detail) - Designated As Hedging Instrument - USD ($)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
UK \| Net Investment Hedge \| Foreign Currency Foreign Exchange Contracts
Derivative Instruments Gain Loss [Line Items]
Loss recorded on repatriation of cash related to investment	$ 3,800,000
Interest Expense, Net \| Cash Flow Hedging \| Interest Rate Swap
Derivative Instruments Gain Loss [Line Items]
Gain reclassified out of AOCI into other (income) expenses	2,900,000	$ 709,000
Other (Income) Expense, Net \| Net Investment Hedge \| Foreign Currency Foreign Exchange Contracts
Derivative Instruments Gain Loss [Line Items]
Gain reclassified out of AOCI into other (income) expenses	$ 3,800,000	$ 0

Summary of Cash, Cash Equivalents and Restricted Cash Reported In Condensed Consolidated Statements of Cash Flows (Detail) - USD ($)
$ in Thousands

Mar. 31, 2019

Dec. 31, 2018

Cash And Cash Equivalents Period Increase Decrease [Abstract]

Cash and cash equivalents

$ 62,726

$ 105,220

Restricted cash and cash equivalents

^[1]

$ 94,850

$ 94,465

Restricted Cash and Cash Equivalents, Noncurrent, Asset, Statement of Financial Position [Extensible List]

us-gaap:OtherAssetsMiscellaneousNoncurrent

Total cash, cash equivalents and restricted cash

$ 157,576

$ 199,685

[1]	Restricted cash and cash equivalents is included in other assets on the accompanying consolidated balance sheet.

Summary of Assets and Liabilities Recorded at Fair Value on Recurring Basis (Detail) - Recurring - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Assets:
Assets, fair value	$ 195,875	$ 213,370
Liabilities:
Liabilities, fair value	33,778	32,998
Money Market Mutual Funds \| Other Assets
Assets:
Assets, fair value	106,916	106,530
Certificates of Deposit \| Other Assets
Assets:
Assets, fair value	5,415	5,415
Available for Sale Securities \| Other Assets
Assets:
Assets, fair value	51,337	55,594
Deferred Compensation Assets \| Other Assets
Assets:
Assets, fair value	33,778	32,998
Interest Rate Swap Agreements \| Accounts Receivable, Net
Assets:
Assets, fair value	1,008	3,925
Foreign Currency Foreign Exchange Contracts \| Other Current Assets
Assets:
Assets, fair value		8,908
Offsetting of assets, fair value	(2,579)
Deferred Compensation Liabilities \| Other Noncurrent Liabilities
Liabilities:
Liabilities, fair value	33,778	32,998
Basis of Fair Value Measurement, Level 1
Assets:
Assets, fair value	197,446	200,537
Liabilities:
Liabilities, fair value	33,778	32,998
Basis of Fair Value Measurement, Level 1 \| Money Market Mutual Funds \| Other Assets
Assets:
Assets, fair value	106,916	106,530
Basis of Fair Value Measurement, Level 1 \| Certificates of Deposit \| Other Assets
Assets:
Assets, fair value	5,415	5,415
Basis of Fair Value Measurement, Level 1 \| Available for Sale Securities \| Other Assets
Assets:
Assets, fair value	51,337	55,594
Basis of Fair Value Measurement, Level 1 \| Deferred Compensation Assets \| Other Assets
Assets:
Assets, fair value	33,778	32,998
Basis of Fair Value Measurement, Level 1 \| Deferred Compensation Liabilities \| Other Noncurrent Liabilities
Liabilities:
Liabilities, fair value	33,778	32,998
Basis of Fair Value Measurement, Level 2
Assets:
Assets, fair value		12,833
Assets, fair value	(1,571)
Basis of Fair Value Measurement, Level 2 \| Interest Rate Swap Agreements \| Accounts Receivable, Net
Assets:
Assets, fair value	1,008	3,925
Basis of Fair Value Measurement, Level 2 \| Foreign Currency Foreign Exchange Contracts \| Other Current Assets
Assets:
Assets, fair value		$ 8,908
Offsetting of assets, fair value	$ (2,579)

Commitments and Contingencies - Additional Information (Detail) £ in Millions	3 Months Ended			12 Months Ended						60 Months Ended
	Mar. 31, 2019 USD ($)	Mar. 31, 2019 GBP (£)	Mar. 31, 2018 USD ($)	Dec. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Dec. 31, 2014 USD ($)	Dec. 31, 2013 USD ($)	Dec. 31, 2012 USD ($)	Dec. 31, 2011 USD ($) Hospital	Mar. 31, 2019 USD ($)	Jan. 31, 2017 USD ($)	Jan. 31, 2017 GBP (£)	Dec. 31, 2016 USD ($)	Dec. 31, 2015 USD ($)
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability, current	$ 42,000,000			$ 42,000,000						$ 42,000,000
Compensation liability claims	71,000,000			72,000,000						71,000,000
Compensation and related benefits	40,000,000			40,000,000						40,000,000
Accounts receivable, net	1,602,405,000			1,509,909,000						1,602,405,000
Department of Human Services
Commitments and Contingencies Disclosure [Line Items]
Repayment of legal settlement amount on demand						$ 4,000,000	$ 4,000,000	$ 4,000,000	$ 4,000,000
Amount claimed from over payments of legal settlements						7,000,000	7,000,000	$ 4,000,000
Amount claimed from over payments of legal settlements due to change in calculations							2,000,000
DOJ
Commitments and Contingencies Disclosure [Line Items]
Increase in aggregate pre-tax reserve	123,000,000			123,000,000	$ 22,000,000
Pre-tax increase to reserve for civil aspects			$ 13,000,000	102,000,000
River Point Behavioral Health
Commitments and Contingencies Disclosure [Line Items]
Amount withheld in contingent medicare payment suspension										9,000,000
Wind Storms
Commitments and Contingencies Disclosure [Line Items]
Minimum Insurance Deductible	50,000									50,000
Maximum insurance deductible	250,000									250,000
Flood
Commitments and Contingencies Disclosure [Line Items]
Maximum insurance deductible	500,000									500,000
Illinois
Commitments and Contingencies Disclosure [Line Items]
Accounts receivable, net	34,000,000			32,000,000						34,000,000
Accounts receivable net greater than sixty days Past due	19,000,000			18,000,000						19,000,000
Pennsylvania \| Department of Human Services
Commitments and Contingencies Disclosure [Line Items]
Number of behavioral health care hospitals \| Hospital									7
Cygnet Health Care Limited
Commitments and Contingencies Disclosure [Line Items]
Property insurance \| £		£ 1,290
Maximum \| Wind Storms
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	$ 1,000,000,000									$ 1,000,000,000
Percentage of insurance deductible	5.00%									5.00%
Maximum \| LAS VEGAS, NEVADA \| Earthquake
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	$ 500,000,000									$ 500,000,000
Maximum \| CALIFORNIA \| Earthquake
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	130,000,000									130,000,000
Maximum \| Faulty Zones of UNITED STATES \| Earthquake
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	100,000,000									100,000,000
Maximum \| PUERTO RICO \| Earthquake
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	40,000,000									40,000,000
Maximum \| OTHER STATES \| Earthquake
Commitments and Contingencies Disclosure [Line Items]
Commercial property insurance policies covering catastrophic losses	$ 250,000,000									$ 250,000,000
Minimum \| Wind Storms
Commitments and Contingencies Disclosure [Line Items]
Percentage of insurance deductible	3.00%									3.00%
General and Professional Liability
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability	$ 246,000,000			$ 243,000,000						$ 246,000,000
Subsidiaries \| Professional Liability \| Cygnet Health Care Limited
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability \| £												£ 10
Subsidiaries \| Professional Liability \| Maximum
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability											$ 5,000,000		$ 10,000,000
Subsidiaries \| General Liability \| Cygnet Health Care Limited
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability \| £												£ 25
Subsidiaries \| General Liability \| Maximum
Commitments and Contingencies Disclosure [Line Items]
Self-insured for professional and general liability											$ 3,000,000		3,000,000
Subsidiaries \| General And Professional Liability Insurance Policies
Commitments and Contingencies Disclosure [Line Items]
Percentage of liability for claims paid under commercially insured coverage	10.00%									10.00%
Subsidiaries \| General And Professional Liability Insurance Policies \| Maximum
Commitments and Contingencies Disclosure [Line Items]
Purchased several excess policies through commercial insurance carriers per occurrence						$ 250,000,000	$ 200,000,000						$ 250,000,000	$ 250,000,000
Liability for claims paid under commercially insured coverage	$ 5,000,000									$ 5,000,000
Subsidiaries \| General And Professional Liability Insurance Policies \| Maximum \| Located in U.K.
Commitments and Contingencies Disclosure [Line Items]
Liability for claims paid under commercially insured coverage	$ 8,500,000									$ 8,500,000

Segment Reporting (Detail) - USD ($)
$ in Thousands

3 Months Ended

Mar. 31, 2019

Mar. 31, 2018

Dec. 31, 2018

Segment Reporting Information [Line Items]

Gross inpatient revenues

$ 9,647,713

$ 8,764,024

Gross outpatient revenues

4,524,160

3,969,842

Total net revenues

2,804,391

2,687,516

Income/(loss) before allocation of corporate overhead and income taxes

296,296

296,238

Allocation of corporate overhead

Income before income taxes

296,296

296,238

Total assets

11,721,277

11,023,517

$ 11,265,480

Acute Care Hospital Services

Segment Reporting Information [Line Items]

Gross inpatient revenues

7,163,714

6,361,766

Gross outpatient revenues

4,257,614

3,714,661

Total net revenues

1,514,844

1,445,632

Income/(loss) before allocation of corporate overhead and income taxes

192,213

203,711

Allocation of corporate overhead

(57,500)

(49,891)

Income before income taxes

134,713

153,820

Total assets

4,372,628

3,924,302

Behavioral Health Services

Segment Reporting Information [Line Items]

Gross inpatient revenues

^[1]

2,483,999

2,402,258

Gross outpatient revenues

^[1]

266,546

255,181

Total net revenues

^[1]

1,286,383

1,237,996

Income/(loss) before allocation of corporate overhead and income taxes

^[1]

244,168

238,748

Allocation of corporate overhead

^[1]

(41,647)

(40,332)

Income before income taxes

^[1]

202,521

198,416

Total assets

^[1]

6,972,929

6,649,732

Other

Segment Reporting Information [Line Items]

Gross inpatient revenues

Gross outpatient revenues

Total net revenues

3,164

3,888

Income/(loss) before allocation of corporate overhead and income taxes

(140,085)

(146,221)

Allocation of corporate overhead

99,147

90,223

Income before income taxes

(40,938)

(55,998)

Total assets

$ 375,720

$ 449,483

[1]

Segment Reporting (Parenthetical) (Detail) - USD ($)
$ in Thousands

3 Months Ended

Mar. 31, 2019

Mar. 31, 2018

Dec. 31, 2018

Segment Reporting Information [Line Items]

Net revenues

$ 2,804,391

$ 2,687,516

Total assets

11,721,277

11,023,517

$ 11,265,480

Behavioral Health Services

Segment Reporting Information [Line Items]

Net revenues

^[1]

1,286,383

1,237,996

Total assets

^[1]

6,972,929

6,649,732

Behavioral Health Services | Located in U.K.

Segment Reporting Information [Line Items]

Net revenues

137,000

115,000

Total assets

$ 1,237,000

$ 1,176,000

[1]

Computation of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Basic and Diluted:
Net income attributable to UHS	$ 234,168	$ 223,832
Less: Net income attributable to unvested restricted share grants	(515)	(104)
Net income attributable to UHS – basic and diluted	$ 233,653	$ 223,728
Weighted average number of common shares - basic	90,776	94,226
Net effect of dilutive stock options and grants based on the treasury stock method	191	457
Weighted average number of common shares and equivalents - diluted	90,967	94,683
Earnings per basic share attributable to UHS:	$ 2.57	$ 2.37
Earnings per diluted share attributable to UHS:	$ 2.57	$ 2.36

- Definition

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(19))
-URI http://asc.fasb.org/extlink&oid=114873790&loc=SL114874131-224263

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
-Paragraph 7
-URI http://asc.fasb.org/extlink&oid=109260490&loc=d3e1337-109256

Reference 3: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 55
-Paragraph 52
-URI http://asc.fasb.org/extlink&oid=109256448&loc=d3e4984-109258

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(21))
-URI http://asc.fasb.org/extlink&oid=115205541&loc=SL114868664-224227

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 11
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22694-107794

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 50
-Paragraph 1
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=6371337&loc=d3e3550-109257

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
-Paragraph 2
-URI http://asc.fasb.org/extlink&oid=109260490&loc=d3e1252-109256

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(23))
-URI http://asc.fasb.org/extlink&oid=114873765&loc=SL114874048-224260

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
-Paragraph 60B
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=109260490&loc=SL5780133-109256

+ Details

- Definition

The amount of net income (loss) for the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 55
-Paragraph 52
-URI http://asc.fasb.org/extlink&oid=109256448&loc=d3e4984-109258

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
-Paragraph 2
-URI http://asc.fasb.org/extlink&oid=109260490&loc=d3e1252-109256

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 50
-Paragraph 1
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=6371337&loc=d3e3550-109257

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(23))
-URI http://asc.fasb.org/extlink&oid=114873765&loc=SL114874048-224260

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 250
-SubTopic 10
-Section 50
-Paragraph 11
-URI http://asc.fasb.org/extlink&oid=109234566&loc=d3e22694-107794

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
-Paragraph 7
-URI http://asc.fasb.org/extlink&oid=109260490&loc=d3e1337-109256

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(21))
-URI http://asc.fasb.org/extlink&oid=115205541&loc=SL114868664-224227

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
-Paragraph 60B
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=109260490&loc=SL5780133-109256

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(19))
-URI http://asc.fasb.org/extlink&oid=114873790&loc=SL114874131-224263

+ Details

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References + Details

Earnings Per Share Data ("EPS") and Stock Based Compensation - Additional Information (Detail) - USD ($)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Anti-dilutive weighted average stock options excluded from computation of earnings per share	7,000,000	2,900,000
Stock options granted during period	2,390,390
Weighted-average grant date fair value, per share	$ 30.43
Compensation cost recognized	$ 17,591,000	$ 19,700,000
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Compensation cost recognized, pre-tax charge	15,800,000	18,900,000
Restricted Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Compensation cost recognized, pre-tax charge	1,500,000	$ 545,000
Unrecognized compensation cost	$ 175,700,000
Unrecognized compensation cost vesting period	3 years 1 month 6 days
Restricted shares granted during period	142,288,000
Weighted-average grant date fair value, per share	$ 134.23
Unvested Stock option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost	$ 175,700,000
Unrecognized compensation cost vesting period	3 years 1 month 6 days

Dispositions and Acquisitions - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2019 USD ($)	Mar. 31, 2018 USD ($) Bed
Business Acquisition [Line Items]
Acquisition, cash paid	$ 0	$ 21,000,000
Aggregate cash proceeds from divestiture of businesses	$ 0	$ 0
Gulfport Behavioral Health System \| Located in Gulfport
Business Acquisition [Line Items]
Number of beds \| Bed		109

Income Taxes - Additional Information (Detail) - USD ($)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Jan. 01, 2019
Income Taxes [Line Items]
Effective income tax rate	19.90%	22.80%
Increase (decrease) in provision for income taxes	$ (9,000,000)
Provision for income taxes	$ 11,000,000	$ 2,000,000
Unrecognized tax benefits			$ 2,000,000
Impact of unrecognized tax benefits if recognized			$ 1,000,000
Period of expiration of the statute of limitations for certain jurisdictions	Within the next twelve months
Jurisdictions statutes of limitations expiration period	12 months
Maximum
Income Taxes [Line Items]
Provisional deferred tax - GILTI	$ 1,000,000	$ 1,000,000
Accrued interest and penalties	$ 1,000,000
Foreign and U.S. state and local jurisdictions have statutes of limitations, in years	4 years
Minimum
Income Taxes [Line Items]
Foreign and U.S. state and local jurisdictions have statutes of limitations, in years	3 years

Schedule of Disaggregates Revenue by Major Source (Detail) - USD ($)
$ in Thousands

3 Months Ended

Mar. 31, 2019

Mar. 31, 2018

Disaggregation Of Revenue [Line Items]

Net revenues

$ 2,804,391

$ 2,687,516

Percentage of Net Revenue

100.00%

Medicare

Disaggregation Of Revenue [Line Items]

Net revenues

$ 473,365

$ 485,245

Percentage of Net Revenue

17.00%

18.00%

Managed Medicare

Disaggregation Of Revenue [Line Items]

Net revenues

$ 261,362

$ 221,952

Percentage of Net Revenue

9.00%

8.00%

Medicaid

Disaggregation Of Revenue [Line Items]

Net revenues

$ 277,426

$ 283,302

Percentage of Net Revenue

10.00%

11.00%

Managed Medicaid

Disaggregation Of Revenue [Line Items]

Net revenues

$ 401,004

$ 342,053

Percentage of Net Revenue

14.00%

13.00%

Managed Care (HMO and PPOs)

Disaggregation Of Revenue [Line Items]

Net revenues

$ 918,265

$ 855,842

Percentage of Net Revenue

33.00%

32.00%

UK Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 136,702

$ 114,741

Percentage of Net Revenue

5.00%

4.00%

Other Patient Revenue and Adjustments,Net

Disaggregation Of Revenue [Line Items]

Net revenues

$ 175,361

$ 229,555

Percentage of Net Revenue

6.00%

9.00%

Other Non-patient Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 160,906

$ 154,826

Percentage of Net Revenue

6.00%

Acute Care Hospital Services

Disaggregation Of Revenue [Line Items]

Net revenues

$ 1,514,844

$ 1,445,632

Percentage of Net Revenue

100.00%

Acute Care Hospital Services | Medicare

Disaggregation Of Revenue [Line Items]

Net revenues

$ 335,909

$ 342,718

Percentage of Net Revenue

22.00%

24.00%

Acute Care Hospital Services | Managed Medicare

Disaggregation Of Revenue [Line Items]

Net revenues

$ 209,103

$ 176,957

Percentage of Net Revenue

14.00%

12.00%

Acute Care Hospital Services | Medicaid

Disaggregation Of Revenue [Line Items]

Net revenues

$ 104,510

$ 105,966

Percentage of Net Revenue

7.00%

Acute Care Hospital Services | Managed Medicaid

Disaggregation Of Revenue [Line Items]

Net revenues

$ 133,731

$ 111,277

Percentage of Net Revenue

9.00%

8.00%

Acute Care Hospital Services | Managed Care (HMO and PPOs)

Disaggregation Of Revenue [Line Items]

Net revenues

$ 570,383

$ 497,780

Percentage of Net Revenue

38.00%

34.00%

Acute Care Hospital Services | UK Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 0

Percentage of Net Revenue

0.00%

Acute Care Hospital Services | Other Patient Revenue and Adjustments,Net

Disaggregation Of Revenue [Line Items]

Net revenues

$ 51,883

$ 112,570

Percentage of Net Revenue

3.00%

8.00%

Acute Care Hospital Services | Other Non-patient Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 109,325

$ 98,364

Percentage of Net Revenue

7.00%

Behavioral Health Services

Disaggregation Of Revenue [Line Items]

Net revenues

^[1]

$ 1,286,383

$ 1,237,996

Percentage of Net Revenue

100.00%

Behavioral Health Services | Medicare

Disaggregation Of Revenue [Line Items]

Net revenues

$ 137,456

$ 142,527

Percentage of Net Revenue

11.00%

12.00%

Behavioral Health Services | Managed Medicare

Disaggregation Of Revenue [Line Items]

Net revenues

$ 52,259

$ 44,995

Percentage of Net Revenue

4.00%

Behavioral Health Services | Medicaid

Disaggregation Of Revenue [Line Items]

Net revenues

$ 172,916

$ 177,336

Percentage of Net Revenue

13.00%

14.00%

Behavioral Health Services | Managed Medicaid

Disaggregation Of Revenue [Line Items]

Net revenues

$ 267,273

$ 230,776

Percentage of Net Revenue

21.00%

19.00%

Behavioral Health Services | Managed Care (HMO and PPOs)

Disaggregation Of Revenue [Line Items]

Net revenues

$ 347,882

$ 358,062

Percentage of Net Revenue

27.00%

29.00%

Behavioral Health Services | UK Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 136,702

$ 114,741

Percentage of Net Revenue

11.00%

9.00%

Behavioral Health Services | Other Patient Revenue and Adjustments,Net

Disaggregation Of Revenue [Line Items]

Net revenues

$ 123,478

$ 116,985

Percentage of Net Revenue

10.00%

9.00%

Behavioral Health Services | Other Non-patient Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 48,417

$ 52,574

Percentage of Net Revenue

4.00%

Other

Disaggregation Of Revenue [Line Items]

Net revenues

$ 3,164

$ 3,888

Other | Other Non-patient Revenue

Disaggregation Of Revenue [Line Items]

Net revenues

$ 3,164

$ 3,888

[1]

Lease Accounting - Additional Information (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2019 USD ($)
Lessee Lease Description [Line Items]
Lessee, operating lease, existence of option to extend [true false]	true
Right-of-use assets obtained in exchange for operating lease obligations	$ 355,981
New Operating Leases
Lessee Lease Description [Line Items]
Right-of-use assets obtained in exchange for operating lease obligations	$ 6,000
Minimum
Lessee Lease Description [Line Items]
Initial term of real estate lease	5 years
Real estate leases option to extend lease term	5 years
Maximum
Lessee Lease Description [Line Items]
Initial term of real estate lease	10 years
Real estate leases option to extend lease term	10 years

Components of Lease Expense (Detail)
$ in Thousands

3 Months Ended

Mar. 31, 2019

USD ($)

Leases [Abstract]

Operating lease cost

$ 18,079

Variable and short term lease cost

8,046

^[1]

Total lease cost

26,125

Finance lease cost:

Amortization of right-of-use-assets

481

Interest on lease liabilities

484

Total finance lease cost

$ 965

[1]	Includes equipment, month-to-month and leases with a maturity of less than 12 months.

Supplemental Cash Flow Information Related to Leases (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2019 USD ($)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 25,884
Operating cash flows from finance leases	575
Financing cash flows from finance leases	433
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	355,981
Finance leases	$ 0

Supplemental Balance Sheet Information Related to Leases (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Operating Leases
Right of use assets-operating leases	$ 342,032	$ 0
Operating lease liabilities	56,136	0
Operating lease liabilities noncurrent	286,101	0
Total operating lease liabilities	342,237
Finance Leases
Property and equipment	8,733,367	8,563,455
Less: accumulated depreciation	(3,818,529)	(3,715,515)
Property, plant and equipment, net, Total	4,914,838	$ 4,847,940
Current maturities of long-term debt	1,737
Long-term debt	17,612
Total finance lease liabilities	$ 19,349
Weighted Average remaining lease term, years
Operating leases	10 years 4 months 24 days
Finance leases	7 years 9 months 18 days
Weighted Average discount rate
Operating leases	4.70%
Finance leases	10.50%
Finance Lease
Finance Leases
Property and equipment	$ 23,250
Less: accumulated depreciation	(9,882)
Property, plant and equipment, net, Total	$ 13,368

Future Maturities of Lease Liabilities (Detail) $ in Thousands	Mar. 31, 2019 USD ($)
Operating Leases
2019 (remaining 9 months)	$ 52,447
2020	62,920
2021	55,817
2022	45,404
2023	41,277
Later years	183,572
Total lease payments	441,437
less imputed interest	(99,200)
Total	342,237
Finance Leases
2019 (remaining 9 months)	2,842
2020	3,375
2021	3,257
2022	3,559
2023	3,654
Later years	12,096
Total lease payments	28,783
less imputed interest	(9,434)
Total	$ 19,349

Future Minimum Rental Payments under Lease Commitments (Detail) $ in Thousands	Dec. 31, 2018 USD ($)
Capital Leases
2019	$ 3,996
2020	3,345
2021	3,227
2022	3,508
2023	3,624
Later years	12,070
Total minimum rental	29,770
Less: Amount representing interest	(9,829)
Present value of minimum rental commitments	19,941
Less: Current portion of capital lease obligations	(2,128)
Long-term portion of capital lease obligations	17,813
Operating Leases
2019	72,353
2020	59,492
2021	48,891
2022	35,233
2023	28,839
Later years	123,039
Total minimum rental	$ 367,847

Dividends - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Dividends [Abstract]
Dividends declared and paid	$ 9.1	$ 9.4
Quarterly cash dividend	$ 0.10	$ 0.10