HCA HEALTHCARE, INC., 10-K filed on 2/14/2025
Annual Report
v3.25.0.1
Cover Page - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Jan. 31, 2025
Jun. 30, 2024
Cover [Abstract]      
Document Type 10-K    
Amendment Flag false    
Document Period End Date Dec. 31, 2024    
Document Fiscal Year Focus 2024    
Document Fiscal Period Focus FY    
Trading Symbol HCA    
Entity Registrant Name HCA Healthcare, Inc.    
Entity Central Index Key 0000860730    
Current Fiscal Year End Date --12-31    
Entity Current Reporting Status Yes    
Entity Filer Category Large Accelerated Filer    
Entity Shell Company false    
Entity Small Business false    
Entity Emerging Growth Company false    
Entity Common Stock, Shares Outstanding   248,341,900  
Entity Interactive Data Current Yes    
Entity File Number 1-11239    
Entity Incorporation, State or Country Code DE    
Entity Tax Identification Number 27-3865930    
Entity Address, Address Line One One Park Plaza    
Entity Address, City or Town Nashville    
Entity Address, State or Province TN    
Entity Address, Postal Zip Code 37203    
City Area Code 615    
Local Phone Number 344-9551    
Document Annual Report true    
Document Transition Report false    
Title of 12(b) Security Common Stock, $0.01 Par Value    
Security Exchange Name NYSE    
Entity Voluntary Filers No    
Entity Well-known Seasoned Issuer Yes    
Entity Public Float     $ 60,369
ICFR Auditor Attestation Flag true    
Auditor Firm ID 42    
Auditor Name Ernst & Young LLP    
Auditor Location Nashville, Tennessee, United States of America    
Auditor Opinion

Opinion on Internal Control Over Financial Reporting

We have audited HCA Healthcare, Inc.’s internal control over financial reporting as of December 31, 2024, based on criteria established in Internal Control—Integrated Framework issued by the Committee of Sponsoring Organizations of the Treadway Commission (2013 framework) (the COSO criteria). In our opinion, HCA Healthcare, Inc. (the Company) maintained, in all material respects, effective internal control over financial reporting as of December 31, 2024, based on the COSO criteria.

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the consolidated balance sheets of HCA Healthcare, Inc. as of December 31, 2024 and 2023, and the related consolidated statements of income, comprehensive income, stockholders’ equity (deficit), and cash flows for each of the three years in the period ended December 31, 2024, and the related notes and our report dated February 13, 2025 expressed an unqualified opinion thereon.

Opinion on the Financial Statements

We have audited the accompanying consolidated balance sheets of HCA Healthcare, Inc. (the Company) as of December 31, 2024 and 2023, the related consolidated statements of income, comprehensive income, stockholders’ equity (deficit) and cash flows for each of the three years in the period ended December 31, 2024, and the related notes (collectively referred to as the “consolidated financial statements”). In our opinion, the consolidated financial statements present fairly, in all material respects, the financial position of the Company at December 31, 2024 and 2023, and the results of its operations and its cash flows for each of the three years in the period ended December 31, 2024, in conformity with U.S. generally accepted accounting principles.

We also have audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the Company's internal control over financial reporting as of December 31, 2024, based on criteria established in Internal Control-Integrated Framework issued by the Committee of Sponsoring Organizations of the Treadway Commission (2013 framework), and our report dated February 13, 2025 expressed an unqualified opinion thereon.

   
Document Financial Statement Error Correction [Flag] false    
Documents Incorporated by Reference

Portions of the Registrant’s definitive proxy materials for its 2025 Annual Meeting of Stockholders are incorporated by reference into Part III hereof.

   
v3.25.0.1
Consolidated Income Statements - USD ($)
shares in Thousands, $ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Income Statement [Abstract]      
Revenues $ 70,603 $ 64,968 $ 60,233
Salaries and benefits 31,170 29,487 27,685
Supplies 10,755 9,902 9,371
Other operating expenses 14,819 12,875 11,155
Equity in earnings of affiliates (23) (22) (45)
Depreciation and amortization 3,312 3,077 2,969
Interest expense 2,061 1,938 1,741
Losses (gains) on sales of facilities (14) 5 (1,301)
Losses on retirement of debt 0 0 78
Total expenses including equity in earnings of affiliates 62,080 57,262 51,653
Income before income taxes 8,523 7,706 8,580
Provision for income taxes 1,866 1,615 1,746
Net income 6,657 6,091 6,834
Net income attributable to noncontrolling interests 897 849 1,191
Net income attributable to HCA Healthcare, Inc. $ 5,760 $ 5,242 $ 5,643
Per share data:      
Basic earnings per share $ 22.27 $ 19.25 $ 19.43
Diluted earnings per share $ 22 $ 18.97 $ 19.15
Shares used in earnings per share calculations (in millions):      
Basic 258,603 272,404 290,348
Diluted 261,806 276,412 294,666
v3.25.0.1
Consolidated Comprehensive Income Statements - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Statement of Comprehensive Income [Abstract]      
Net income $ 6,657 $ 6,091 $ 6,834
Other comprehensive income (loss) before taxes:      
Foreign currency translation (16) 41 (111)
Unrealized gains (losses) on available-for-sale securities 1 11 (55)
Losses (gains) included in other operating expenses 0 (1) 1
Total Unrealized losses on available-for-sale securities 1 10 (54)
Defined benefit plans 65 27 49
Pension costs included in salaries and benefits 1 3 9
Total defined benefit plans 66 30 58
Change in fair value of derivative financial instruments 0 0 6
Interest costs included in interest expense 0 0 2
Total change in fair value of derivative financial instruments 0 0 8
Other comprehensive income (loss) before taxes 51 81 (99)
Income taxes (benefits) related to other comprehensive income items 13 16 (13)
Other comprehensive income (loss) 38 65 (86)
Comprehensive income 6,695 6,156 6,748
Comprehensive income attributable to noncontrolling interests 897 849 1,191
Comprehensive income attributable to HCA Healthcare, Inc. $ 5,798 $ 5,307 $ 5,557
v3.25.0.1
Consolidated Balance Sheets - USD ($)
$ in Millions
Dec. 31, 2024
Dec. 31, 2023
Current assets:    
Cash and cash equivalents $ 1,933 $ 935
Accounts receivable 10,751 9,958
Inventories 1,738 2,021
Other 1,992 2,013
Total current assets 16,414 14,927
Property and equipment, at cost:    
Land 3,295 3,120
Buildings 22,691 21,560
Equipment 34,670 31,998
Construction in progress 1,858 1,870
Property and equipment, at cost 62,514 58,548
Accumulated depreciation (33,100) (30,833)
Property and equipment, net 29,414 27,715
Investments of insurance subsidiaries 569 477
Investments in and advances to affiliates 662 756
Goodwill and other intangible assets 10,093 9,945
Right-of-use operating lease assets 2,131 2,207
Other 230 184
Total assets 59,513 56,211
Current liabilities:    
Accounts payable 4,276 4,233
Accrued salaries 2,304 2,127
Other accrued expenses 3,899 3,871
Long-term debt due within one year 4,698 2,424
Total current liabilities 15,177 12,655
Long-term debt, less debt issuance costs and discounts of $369 and $333 38,333 37,169
Professional liability risks 1,544 1,557
Right-of-use operating lease obligations 1,863 1,903
Income taxes and other liabilities 2,041 1,867
Stockholders' equity (deficit):    
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 249,981,400 shares - 2024 and 265,537,300 shares - 2023 3 3
Accumulated other comprehensive loss (387) (425)
Retained deficit (2,115) (1,352)
Stockholders' deficit attributable to HCA Healthcare, Inc. (2,499) (1,774)
Noncontrolling interests 3,054 2,834
Total stockholders' equity (deficit) 555 1,060
Total liabilities and stockholders' equity (deficit) $ 59,513 $ 56,211
v3.25.0.1
Consolidated Balance Sheets (Parenthetical) - USD ($)
$ in Millions
Dec. 31, 2024
Dec. 31, 2023
Statement of Financial Position [Abstract]    
Debt issuance costs $ 369 $ 333
Common stock, par value $ 0.01 $ 0.01
Common stock, shares authorized 1,800,000,000 1,800,000,000
Common stock, shares outstanding 249,981,400 265,537,300
v3.25.0.1
Consolidated Statements of Stockholders' Equity (Deficit) - USD ($)
$ in Millions
Total
Common Stock [Member]
Capital in Excess of Par Value [Member]
Accumulated Other Comprehensive Loss [Member]
Retained Earnings (Deficit) [Member]
Equity Attributable to Noncontrolling Interests [Member]
Balance at Dec. 31, 2021 $ 1,489 $ 3 $ 0 $ (404) $ (532) $ 2,422
Balance, shares at Dec. 31, 2021   305,477,000        
Comprehensive income (loss) 6,748     (86) 5,643 1,191
Repurchase of common stock $ (7,000)   (264)   (6,736)  
Repurchase of common stock, shares (30,747,000) (30,747,000)        
Share-based benefit plans $ 282   282      
Share-based benefit plans, shares   2,648,000        
Cash dividends declared (655)       (655)  
Distributions (1,025)         (1,025)
Other 88   (18)     106
Balance at Dec. 31, 2022 (73) $ 3 0 (490) (2,280) 2,694
Balance, shares at Dec. 31, 2022   277,378,000        
Comprehensive income (loss) 6,156     65 5,242 849
Repurchase of common stock $ (3,842)   (172)   (3,670)  
Repurchase of common stock, shares (14,465,000) (14,465,000)        
Share-based benefit plans $ 172   172      
Share-based benefit plans, shares   2,624,000        
Cash dividends declared (658)       (658)  
Distributions (640)         (640)
Other (55)       14 (69)
Balance at Dec. 31, 2023 1,060 $ 3 0 (425) (1,352) 2,834
Balance, shares at Dec. 31, 2023   265,537,000        
Comprehensive income (loss) 6,695     38 5,760 897
Repurchase of common stock $ (6,064)   (261)   (5,803)  
Repurchase of common stock, shares (17,798,000) (17,798,000)        
Share-based benefit plans $ 261   261      
Share-based benefit plans, shares   2,242,000        
Cash dividends declared (688)       (688)  
Distributions (711)         (711)
Other 2       (32) 34
Balance at Dec. 31, 2024 $ 555 $ 3 $ 0 $ (387) $ (2,115) $ 3,054
Balance, shares at Dec. 31, 2024   249,981,000        
v3.25.0.1
Consolidated Statements of Stockholders' Equity (Deficit) (Parenthetical) - $ / shares
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Statement of Stockholders' Equity [Abstract]      
Cash dividends declared, per share $ 2.64 $ 2.4 $ 2.24
v3.25.0.1
Consolidated Statements of Cash Flows - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Cash flows from operating activities:      
Net income $ 6,657 $ 6,091 $ 6,834
Increase (decrease) in cash from operating assets and liabilities:      
Accounts receivable (799) (935) (797)
Inventories and other assets 334 (126) (59)
Accounts payable and accrued expenses 359 604 (296)
Depreciation and amortization 3,312 3,077 2,969
Income taxes 22 229 571
Losses (gains) on sales of facilities (14) 5 (1,301)
Losses on retirement of debt 0 0 78
Amortization of debt issuance costs and discounts 35 35 29
Share-based compensation 360 262 341
Other 248 189 153
Net cash provided by operating activities 10,514 9,431 8,522
Cash flows from investing activities:      
Purchase of property and equipment (4,875) (4,744) (4,395)
Acquisition of hospitals and health care entities (266) (635) (224)
Sales of hospitals and health care entities 328 193 1,237
Change in investments (115) (112) 14
Other (5) (19) (21)
Net cash used in investing activities (4,933) (5,317) (3,389)
Cash flows from financing activities:      
Issuances of long-term debt 7,495 3,224 5,997
Net change in revolving credit facilities (1,880) (1,020) 120
Repayment of long-term debt (2,410) (909) (2,830)
Distributions to noncontrolling interests (711) (640) (1,025)
Payment of debt issuance costs (67) (31) (53)
Payment of dividends (690) (661) (653)
Repurchase of common stock (6,042) (3,811) (7,000)
Other (277) (246) (212)
Net cash used in financing activities (4,582) (4,094) (5,656)
Effect of exchange rate changes on cash and cash equivalents (1) 7 (20)
Change in cash and cash equivalents 998 27 (543)
Cash and cash equivalents at beginning of period 935 908 1,451
Cash and cash equivalents at end of period 1,933 935 908
Interest payments 1,938 1,892 1,662
Income tax payments, net $ 1,844 $ 1,386 $ 1,175
v3.25.0.1
Pay vs Performance Disclosure - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Pay vs Performance Disclosure      
Net Income (Loss) $ 5,760 $ 5,242 $ 5,643
v3.25.0.1
Insider Trading Arrangements
3 Months Ended
Dec. 31, 2024
Trading Arrangements, by Individual  
Rule 10b5-1 Arrangement Adopted false
Non-Rule 10b5-1 Arrangement Adopted false
Rule 10b5-1 Arrangement Terminated false
Non-Rule 10b5-1 Arrangement Terminated false
v3.25.0.1
Insider Trading Policies and Procedures
3 Months Ended
Dec. 31, 2024
Insider Trading Policies and Procedures [Line Items]  
Insider Trading Policies and Procedures Adopted true
v3.25.0.1
Cybersecurity Risk Management, Strategy, and Governance
12 Months Ended
Dec. 31, 2024
Cybersecurity Risk Management, Strategy, and Governance [Line Items]  
Cybersecurity Risk Management Processes for Assessing, Identifying, and Managing Threats [Text Block]

Item 1C. Cybersecurity

Management is responsible for the day-to-day handling of risks facing our Company, while the Board of Directors, as a whole and through its committees, oversees risk management, including cybersecurity risks. The Board has delegated certain risk management responsibilities with respect to cybersecurity to our Audit and Compliance Committee.

The Audit and Compliance Committee periodically reviews our data security programs, including cybersecurity processes and procedures regarding cybersecurity threats, AI, disaster recovery and critical business continuity, and reviews our programs and plans that management has established to monitor compliance with data security compliance programs and test emergency operations preparedness. The Audit and Compliance Committee also receives reports regarding risks associated with our data security programs and management’s plans for monitoring and testing compliance with data security regulations.

The Audit and Compliance Committee meetings take place on a quarterly basis and include a report from our Chief Security Officer ("CSO") regarding our security programs, including (i) the status on activities under way to support our security strategy, (ii) an overview of the current threat landscape, including emerging threats and trends that may affect us, (iii) key performance measures of security operations and (iv) general security program needs. The security program includes cybersecurity and information security risk management. Our senior security leadership team has an average of 20 years of data security experience, and each member has served in multiple roles within our security programs.

We seek to leverage a comprehensive risk management program aligned with the National Institute of Technology Cybersecurity Framework 2.0 that encompasses a structured approach to assess, identify, and manage cyber and information security risks. The internal processes for these activities are evaluated for alignment with our objectives and overall risk tolerance. This approach is consistent with our overall risk management efforts. The CSO participates with other senior officers, including the Chief Executive Officer, Chief Information Officer, Chief Financial Officer, Chief Legal and Administrative Officer, Chief Ethics and Compliance Officer and others on our risk management committee, which develops and coordinates enterprise cybersecurity and information security policy and strategy, and provides guidance to senior management.

We utilize cross-functional teams and risk assessment tools and technologies to identify potential cybersecurity and information security threats and risks. These teams include representatives from various departments within our Company to promote a holistic view of the organizations cybersecurity and information security risk landscape and to facilitate communication. We have implemented multiple layers of security measures designed to protect the confidentiality, integrity and availability of our data and the systems and devices that store and transmit such data. We also seek to embed security measures into software and system development processes and to use current security technologies. In addition, we engage third parties to actively monitor potential threats as well as our security defenses. The risk landscape is assessed to determine the likelihood and potential impact of identified risks. This assessment involves a combination of qualitative and quantitative analyses to help prioritize identified risks and determine the appropriate risk treatment. The effectiveness of the cybersecurity and information security program is tested through a combination of internal and external assessments. Updates are provided to senior management and the Audit and Compliance Committee for informed decision-making and are integrated into our broader enterprise risk management processes.

We also seek to oversee and identify potential cybersecurity and information security threats and risks relating to suppliers and third-party service providers. These efforts may include due diligence to assess the partys cybersecurity practices, controls, and compliance with relevant statutes and regulations; the use of contractual agreements that outline certain cybersecurity requirements; and using outside services to perform ongoing monitoring of select suppliers and third-party service providers. We also collaborate with select third-party suppliers to develop and align incident response plans.

No risks from cybersecurity threats or previous cybersecurity incidents have materially affected our business strategy, results of operations, or financial condition. However, there can be no assurance that our controls and procedures in place to monitor and mitigate the risks of cybersecurity threats, including the remediation of critical information security and software vulnerabilities, will be sufficient and/or timely and that we will not suffer material losses or consequences in the future. Additionally, while we have in place insurance coverage designed to address certain aspects of cybersecurity risks, such insurance coverage may be insufficient to cover all insured losses or all types of claims that may arise.

Cybersecurity Risk Management Processes Integrated [Flag] true
Cybersecurity Risk Management Processes Integrated [Text Block] The effectiveness of the cybersecurity and information security program is tested through a combination of internal and external assessments. Updates are provided to senior management and the Audit and Compliance Committee for informed decision-making and are integrated into our broader enterprise risk management processes.
Cybersecurity Risk Management Third Party Engaged [Flag] true
Cybersecurity Risk Third Party Oversight and Identification Processes [Flag] true
Cybersecurity Risk Materially Affected or Reasonably Likely to Materially Affect Registrant [Flag] true
Cybersecurity Risk Materially Affected or Reasonably Likely to Materially Affect Registrant [Text Block] No risks from cybersecurity threats or previous cybersecurity incidents have materially affected our business strategy, results of operations, or financial condition. However, there can be no assurance that our controls and procedures in place to monitor and mitigate the risks of cybersecurity threats, including the remediation of critical information security and software vulnerabilities, will be sufficient and/or timely and that we will not suffer material losses or consequences in the future.
Cybersecurity Risk Board of Directors Oversight [Text Block]

Management is responsible for the day-to-day handling of risks facing our Company, while the Board of Directors, as a whole and through its committees, oversees risk management, including cybersecurity risks. The Board has delegated certain risk management responsibilities with respect to cybersecurity to our Audit and Compliance Committee.

The Audit and Compliance Committee periodically reviews our data security programs, including cybersecurity processes and procedures regarding cybersecurity threats, AI, disaster recovery and critical business continuity, and reviews our programs and plans that management has established to monitor compliance with data security compliance programs and test emergency operations preparedness. The Audit and Compliance Committee also receives reports regarding risks associated with our data security programs and management’s plans for monitoring and testing compliance with data security regulations.

The Audit and Compliance Committee meetings take place on a quarterly basis and include a report from our Chief Security Officer ("CSO") regarding our security programs, including (i) the status on activities under way to support our security strategy, (ii) an overview of the current threat landscape, including emerging threats and trends that may affect us, (iii) key performance measures of security operations and (iv) general security program needs. The security program includes cybersecurity and information security risk management. Our senior security leadership team has an average of 20 years of data security experience, and each member has served in multiple roles within our security programs.

We seek to leverage a comprehensive risk management program aligned with the National Institute of Technology Cybersecurity Framework 2.0 that encompasses a structured approach to assess, identify, and manage cyber and information security risks. The internal processes for these activities are evaluated for alignment with our objectives and overall risk tolerance. This approach is consistent with our overall risk management efforts. The CSO participates with other senior officers, including the Chief Executive Officer, Chief Information Officer, Chief Financial Officer, Chief Legal and Administrative Officer, Chief Ethics and Compliance Officer and others on our risk management committee, which develops and coordinates enterprise cybersecurity and information security policy and strategy, and provides guidance to senior management.

Cybersecurity Risk Board Committee or Subcommittee Responsible for Oversight [Text Block] The Board has delegated certain risk management responsibilities with respect to cybersecurity to our Audit and Compliance Committee.
Cybersecurity Risk Process for Informing Board Committee or Subcommittee Responsible for Oversight [Text Block] The Audit and Compliance Committee periodically reviews our data security programs, including cybersecurity processes and procedures regarding cybersecurity threats, AI, disaster recovery and critical business continuity, and reviews our programs and plans that management has established to monitor compliance with data security compliance programs and test emergency operations preparedness. The Audit and Compliance Committee also receives reports regarding risks associated with our data security programs and management’s plans for monitoring and testing compliance with data security regulations.
Cybersecurity Risk Role of Management [Text Block]

Management is responsible for the day-to-day handling of risks facing our Company, while the Board of Directors, as a whole and through its committees, oversees risk management, including cybersecurity risks. The Board has delegated certain risk management responsibilities with respect to cybersecurity to our Audit and Compliance Committee.

The Audit and Compliance Committee periodically reviews our data security programs, including cybersecurity processes and procedures regarding cybersecurity threats, AI, disaster recovery and critical business continuity, and reviews our programs and plans that management has established to monitor compliance with data security compliance programs and test emergency operations preparedness. The Audit and Compliance Committee also receives reports regarding risks associated with our data security programs and management’s plans for monitoring and testing compliance with data security regulations.

Cybersecurity Risk Management Positions or Committees Responsible [Flag] true
Cybersecurity Risk Management Positions or Committees Responsible [Text Block] The CSO participates with other senior officers, including the Chief Executive Officer, Chief Information Officer, Chief Financial Officer, Chief Legal and Administrative Officer, Chief Ethics and Compliance Officer and others on our risk management committee, which develops and coordinates enterprise cybersecurity and information security policy and strategy, and provides guidance to senior management.
Cybersecurity Risk Management Expertise of Management Responsible [Text Block] Our senior security leadership team has an average of 20 years of data security experience, and each member has served in multiple roles within our security programs.
Cybersecurity Risk Process for Informing Management or Committees Responsible [Text Block] The Audit and Compliance Committee meetings take place on a quarterly basis and include a report from our Chief Security Officer ("CSO") regarding our security programs, including (i) the status on activities under way to support our security strategy, (ii) an overview of the current threat landscape, including emerging threats and trends that may affect us, (iii) key performance measures of security operations and (iv) general security program needs.
Cybersecurity Risk Management Positions or Committees Responsible Report to Board [Flag] true
v3.25.0.1
Accounting Policies
12 Months Ended
Dec. 31, 2024
Accounting Policies [Abstract]  
Accounting Policies

NOTE 1 — ACCOUNTING POLICIES

Reporting Entity

HCA Healthcare, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At December 31, 2024 these affiliates owned and operated 190 hospitals, 124 freestanding surgery centers, 26 freestanding endoscopy centers and provided extensive outpatient and ancillary services. HCA Healthcare, Inc.’s facilities are located in 20 states and England. The terms “Company,” “HCA,” “we,” “our” or “us,” as used herein and unless otherwise stated or indicated by context, refer to HCA Healthcare, Inc. and its affiliates. The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA and the term “employees” refers to employees of affiliates of HCA.

Basis of Presentation

The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates.

The consolidated financial statements include all subsidiaries and entities controlled by HCA. We generally define “control” as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which we absorb a majority of the entity’s expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of ownership, contractual or other financial interests in the entity. The accounts of acquired entities are included in our consolidated financial statements for periods subsequent to our acquisition of controlling interests. Significant intercompany transactions have been eliminated. Investments in entities we do not control, but in which we have a substantial ownership interest and can exercise significant influence, are accounted for using the equity method.

The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative include our corporate office costs, which were $421 million, $353 million and $307 million for the years ended December 31, 2024, 2023 and 2022, respectively.

Revenues

Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges), and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals.

NOTE 1 — ACCOUNTING POLICIES (continued)

Revenues (continued)

Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured and other discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Our revenues by primary third-party payer classification and other (including uninsured patients) for the years ended December 31, are summarized in the following table (dollars in millions):

 

 

 

Years Ended December 31,

 

 

 

2024

 

 

Ratio

 

 

2023

 

 

Ratio

 

 

2022

 

 

Ratio

 

Medicare

 

$

10,780

 

 

 

15.3

%

 

$

10,585

 

 

 

16.3

%

 

$

10,447

 

 

 

17.3

%

Managed Medicare

 

 

11,987

 

 

 

17.0

 

 

 

10,496

 

 

 

16.2

 

 

 

9,201

 

 

 

15.3

 

Medicaid

 

 

4,678

 

 

 

6.6

 

 

 

3,606

 

 

 

5.6

 

 

 

2,636

 

 

 

4.4

 

Managed Medicaid

 

 

3,980

 

 

 

5.6

 

 

 

3,879

 

 

 

6.0

 

 

 

3,998

 

 

 

6.6

 

Managed care and other insurers

 

 

34,954

 

 

 

49.5

 

 

 

31,819

 

 

 

49.0

 

 

 

29,120

 

 

 

48.3

 

International (managed care and other insurers)

 

 

1,682

 

 

 

2.4

 

 

 

1,509

 

 

 

2.3

 

 

 

1,317

 

 

 

2.2

 

Other

 

 

2,542

 

 

 

3.6

 

 

 

3,074

 

 

 

4.6

 

 

 

3,514

 

 

 

5.9

 

Revenues

 

$

70,603

 

 

 

100.0

%

 

$

64,968

 

 

 

100.0

%

 

$

60,233

 

 

 

100.0

%

Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process). The adjustments to estimated Medicare and Medicaid reimbursement and disproportionate-share amounts, related primarily to cost reports filed during the respective year, resulted in net increases to revenues of $42 million, $84 million and $56 million in 2024, 2023 and 2022, respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in net increases to revenues of $78 million in 2024, $58 million in 2023 and $42 million in 2022.

The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive.

Patients treated at hospitals for non-elective care, who have income at or below 400% of the federal poverty level, are eligible for charity care, and we limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. Patients treated at hospitals for non-elective care, who have income above 400% of the federal poverty level, are eligible for certain other discounts which limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. We apply additional discounts to limit patient responsibility for certain emergency services. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. We may provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance, or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied.

NOTE 1 — ACCOUNTING POLICIES (continued)

Revenues (continued)

The collection of outstanding receivables from Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the age of those accounts. Accounts are written off when all reasonable collection efforts have been performed.

The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period comparisons of our revenues. At December 31, 2024 and 2023, estimated implicit price concessions of $7.773 billion and $7.283 billion, respectively, had been recorded to adjust our revenues and accounts receivable to the estimated amounts we expect to collect.

To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions):

 

 

2024

 

 

2023

 

 

2022

 

Patient care costs (salaries and benefits, supplies, other operating
   expenses and depreciation and amortization)

 

$

60,056

 

 

$

55,341

 

 

$

51,180

 

Cost-to-charges ratio (patient care costs as percentage of gross
   patient charges)

 

 

10.1

%

 

 

10.5

%

 

 

11.0

%

Total uncompensated care

 

$

43,231

 

 

$

35,426

 

 

$

31,734

 

Multiply by the cost-to-charges ratio

 

 

10.1

%

 

 

10.5

%

 

 

11.0

%

Estimated cost of total uncompensated care

 

$

4,366

 

 

$

3,720

 

 

$

3,491

 

The total uncompensated care amounts include charity care of $15.942 billion, $14.425 billion and $13.615 billion for the years ended December 31, 2024, 2023 and 2022, respectively. The estimated cost of charity care was $1.610 billion, $1.515 billion and $1.498 billion for the years ended December 31, 2024, 2023 and 2022, respectively.

Recent Pronouncements

In December 2023, the FASB issued Accounting Standards Update 2023-09, Improvements to Income Tax Disclosures (“ASU 2023-09”), which requires enhanced annual disclosures for specific categories in the rate reconciliation and income taxes paid disaggregated by federal, state and foreign taxes. ASU 2023-09 is effective for public business entities for annual periods beginning on or after December 15, 2024. We plan to adopt ASU 2023-09 effective January 1, 2025 applying a retrospective approach to all prior periods presented in the financial statements. We do not believe the adoption of this new standard will have a material effect on our disclosures.

NOTE 1 — ACCOUNTING POLICIES (continued)

Cash and Cash Equivalents

Cash and cash equivalents include highly liquid investments with a maturity of three months or less when purchased. Our insurance subsidiaries’ cash equivalent investments in excess of the amounts required to pay estimated professional liability claims during the next twelve months are not included in cash and cash equivalents as these funds are not available for general corporate purposes. Carrying values of cash and cash equivalents approximate fair value due to the short-term nature of these instruments.

Accounts Receivable

We receive payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. We recognize that revenues and receivables from government agencies are significant to our operations, but do not believe there are significant credit risks associated with these government agencies. We do not believe there are any other significant concentrations of revenues from any particular payer that would subject us to any significant credit risks in the collection of our accounts receivable. Days revenues in accounts receivable were 54 days, 53 days and 53 days at December 31, 2024, 2023 and 2022, respectively. Changes in general economic conditions, revenue cycle service center operations, payer mix, payer claim processing, or federal or state governmental health care coverage could affect our collection of accounts receivable, cash flows and results of operations.

Inventories

Inventories are stated at the lower of cost (first-in, first-out) or market.

Property and Equipment

Depreciation expense, computed using the straight-line method, was $3.294 billion in 2024, $3.052 billion in 2023 and $2.941 billion in 2022. Buildings and improvements are depreciated over estimated useful lives ranging generally from 10 to 40 years. Estimated useful lives of equipment vary generally from four to 10 years.

When events, circumstances or operating results indicate the carrying values of certain property and equipment expected to be held and used might be impaired, we prepare projections of the undiscounted future cash flows expected to result from the use of the assets and their eventual disposition. If the projections indicate the recorded amounts are not expected to be recoverable, such amounts are reduced to estimated fair value. Fair value may be estimated based upon internal evaluations that include quantitative analyses of revenues and cash flows, reviews of recent sales of similar assets and independent appraisals.

Property and equipment to be disposed of are reported at the lower of their carrying amounts or fair value less costs to sell or close. The estimates of fair value are usually based upon recent sales of similar assets and market responses based upon discussions with and offers received from potential buyers.

NOTE 1 — ACCOUNTING POLICIES (continued)

Investments of Insurance Subsidiaries

At December 31, 2024 and 2023, the investment securities held by our insurance subsidiaries were classified as “available-for-sale” as defined in Accounting Standards Codification (“ASC”) No. 320, Investments — Debt Securities and are recorded at fair value. The investment securities are held for the purpose of providing a funding source to pay liability claims covered by the insurance subsidiaries. We perform quarterly assessments of individual investment securities to determine whether declines in fair value are due to credit-related or noncredit-related factors. Our investment securities evaluation process involves subjective judgments, often involves estimating the outcome of future events, and requires a significant level of professional judgment in determining whether a credit-related impairment has occurred. We evaluate, among other things, the financial position and near-term prospects of the issuer, conditions in the issuer’s industry, liquidity of the investment, changes in the amount or timing of expected future cash flows from the investment, and recent downgrades of the issuer by a rating agency, to determine if, and when, a decline in the fair value of an investment below amortized cost is considered to be a credit-related impairment. The extent to which the fair value of the investment is less than amortized cost and our ability and intent to retain the investment, to allow for any anticipated recovery of the investment’s fair value, are important components of our investment securities evaluation process.

Goodwill and Intangible Assets

Goodwill is not amortized but is subject to annual impairment tests. In addition to the annual impairment review, impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Impairment testing for goodwill is done at the reporting unit level. Reporting units are one level below the business segment level, and our impairment testing is performed at the operating division level. We compare the fair value of the reporting unit assets to the carrying amount, on at least an annual basis, to determine if there is potential impairment. If the fair value of the reporting unit assets is less than their carrying value, an impairment loss is recognized. Fair value is estimated based upon internal evaluations of each reporting unit that include quantitative analyses of market multiples, revenues and cash flows and reviews of recent sales of similar facilities. No goodwill impairments were recognized during 2024, 2023 or 2022.

During 2024, goodwill increased by $170 million related to acquisitions and declined by $6 million related to foreign currency translation and other adjustments. During 2023, goodwill increased by $362 million related to acquisitions and declined by $50 million related to foreign currency translation and other adjustments.

During 2024 and 2023, identifiable intangible assets declined by $16 million and $20 million, respectively, due to amortization and other adjustments. Identifiable intangible assets with finite lives are amortized over estimated lives ranging generally from three to 10 years. The gross carrying amount of amortizable identifiable intangible assets at both December 31, 2024 and 2023 was $274 million and accumulated amortization was $244 million and $228 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2024 and 2023 was $293 million. Indefinite-lived identifiable intangible assets are not amortized but are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist.

Debt Issuance Costs and Discounts

Debt issuance costs and discounts are amortized based upon the terms of the respective debt obligations. The gross carrying amounts of debt issuance costs and discounts at December 31, 2024 and 2023 were $608 million and $559 million, respectively, and accumulated amortization was $239 million and $226 million, respectively. Amortization of debt issuance costs and discounts is included in interest expense and was $35 million, $35 million and $29 million for 2024, 2023 and 2022, respectively.

NOTE 1 — ACCOUNTING POLICIES (continued)

Professional Liability Claims

Reserves for professional liability risks were $2.131 billion and $2.089 billion at December 31, 2024 and 2023, respectively. The current portion of the reserves, $587 million and $532 million at December 31, 2024 and 2023, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $627 million, $619 million and $517 million for 2024, 2023 and 2022, respectively, and are included in “other operating expenses” in our consolidated income statements. Provisions for losses related to professional liability risks are based upon actuarially determined estimates. We recorded an increase to the provision for professional liability risks of $40 million during 2023 and a reduction to the provision for professional liability risks of $55 million for 2022, due to the receipt of updated actuarial information. Loss and loss expense reserves represent the estimated ultimate net cost of all reported and unreported losses incurred and unpaid through the respective consolidated balance sheet dates. The reserves for unpaid losses and loss expenses are estimated using individual case-basis valuations and actuarial analyses. Those estimates are subject to the effects of trends in loss severity and frequency. The estimates are continually reviewed and adjustments are recorded as experience develops or new information becomes known. Adjustments to the estimated reserve amounts are included in current operating results. The reserves for professional liability risks cover approximately 2,100 individual claims at both December 31, 2024 and 2023 and estimates for unreported potential claims. The time period required to resolve these claims can vary depending upon the jurisdiction and whether the claim is settled or litigated. During 2024 and 2023, $600 million and $550 million, respectively, of net payments were made for professional and general liability claims. The estimation of the timing of payments beyond a year can vary significantly. Although considerable variability is inherent in professional liability reserve estimates, we believe the reserves for losses and loss expenses are adequate; however, there can be no assurance the ultimate liability will not exceed our estimates.

A portion of our professional liability risks is insured through our insurance subsidiary. Subject, in most cases, to a $15 million per occurrence self-insured retention, our facilities are insured by our insurance subsidiary for losses up to $80 million per occurrence ($110 million effective January 1, 2025). The insurance subsidiary has obtained reinsurance for professional liability risks generally above a retention level of either $25 million or $35 million per occurrence, depending on the jurisdiction for the related claim. We also maintain professional liability insurance with unrelated commercial carriers for losses in excess of amounts insured by our insurance subsidiary.

The obligations covered by reinsurance and excess insurance contracts are included in the reserves for professional liability risks, as we remain liable to the extent the reinsurers and excess insurance carriers do not meet their obligations under the reinsurance and excess insurance contracts. The amounts receivable under the reinsurance contracts were $35 million and $34 million at December 31, 2024 and 2023, respectively, recorded in “other assets,” and $45 million and $8 million at December 31, 2024 and 2023, respectively, recorded in “other current assets.”

Financial Instruments

Derivative financial instruments have been employed to manage risks, including interest rate exposures, and have not been used for trading or speculative purposes. Changes in the fair value of derivatives are recognized periodically either in earnings or in stockholders’ equity, as a component of other comprehensive income, depending on whether the derivative financial instrument qualifies for hedge accounting, and if so, whether it qualifies as a fair value hedge or a cash flow hedge. Gains and losses on derivatives designated as cash flow hedges, to the extent they are effective, are recorded in other comprehensive income, and subsequently reclassified to earnings to offset the impact of the hedged items when they occur. The net interest paid or received on interest rate swaps is recognized as interest expense.

Noncontrolling Interests in Consolidated Entities

The consolidated financial statements include all assets, liabilities, revenues and expenses of less than 100% owned entities that we control. Accordingly, we have recorded noncontrolling interests in the earnings and equity of such entities.

v3.25.0.1
Share-Based Compensation
12 Months Ended
Dec. 31, 2024
Share-Based Payment Arrangement [Abstract]  
Share-Based Compensation

NOTE 2 — SHARE-BASED COMPENSATION

Stock Incentive Plans

Our stock incentive plans are designed to promote the long-term financial interests and growth of the Company by attracting and retaining management and other personnel, motivating them to achieve long range goals and aligning their interests with those of our stockholders. Stock appreciation right (“SAR”) and restricted share unit (“RSU”) grants vest solely based upon continued employment over a specific period of time, and performance share unit (“PSU”) grants vest based upon both continued employment over a specific period of time and the achievement of predetermined financial targets over a specific period of time. At December 31, 2024 there were 7.316 million shares available for future grants.

Employee Stock Purchase Plan

Our employee stock purchase plan (“ESPP”) provides our participating employees an opportunity to obtain shares of our common stock at a discount (through payroll deductions over three-month periods). At December 31, 2024, 9.618 million shares of common stock were reserved for ESPP issuances. During 2024, 2023 and 2022, the Company recognized $18 million, $17 million and $16 million, respectively, of compensation expense related to the ESPP.

SAR, RSU and PSU Activity

The fair value of each SAR award is estimated on the grant date, using valuation models and the weighted average assumptions indicated in the following table. Awards under our stock incentive plans generally vest based on continued employment (“Time SARs” and “RSUs”) or based upon continued employment and the achievement of certain financial targets (“Performance SARs” and “PSUs”). PSUs have a three-year cumulative earnings per share target, and the number of PSUs earned can vary from zero (for actual performance of less than 90% of target) to two times the original PSU grant (for actual performance of 110% or more of target). Each grant is valued as a single award with an expected term equal to the average expected term of the component vesting tranches. The expected term of the share-based award is limited by the contractual term. We use historical exercise behavior data and other factors to estimate the expected term of the SARs.

Compensation cost is recognized on the straight-line attribution method. The straight-line attribution method requires that total compensation expense recognized must at least equal the vested portion of the grant-date fair value. The expected volatility is derived using historical stock price information for our common stock and the volatility implied by the trading of options to purchase our stock on open-market exchanges. The risk-free interest rate is the approximate yield on United States Treasury Strips having a life equal to the expected share-based award life on the date of grant. The expected life is an estimate of the number of years a share-based award will be held before it is exercised. The expected dividend yield is estimated based on the assumption that the dividend yield at date of grant will be maintained over the expected life of the grant.

 

 

 

2024

 

 

2023

 

 

2022

 

Risk-free interest rate

 

 

3.94

%

 

 

3.69

%

 

 

1.64

%

Expected volatility

 

 

33

%

 

 

36

%

 

 

34

%

Expected life, in years

 

 

5.23

 

 

 

5.14

 

 

 

5.11

 

Expected dividend yield

 

 

0.87

%

 

 

0.95

%

 

 

0.95

%

 

NOTE 2 — SHARE-BASED COMPENSATION (continued)

SAR, RSU and PSU Activity (continued)

Information regarding Time SAR and Performance SAR activity during 2024, 2023 and 2022 is summarized below (share amounts in thousands):

 

 

Time
SARs

 

 

Performance
SARs

 

 

Total
SARs

 

 

Weighted
Average
Exercise
Price

 

 

Weighted
Average
Remaining
Contractual Term

 

Aggregate
Intrinsic Value
(dollars in millions)

 

SARs outstanding, December 31, 2021

 

 

6,162

 

 

 

286

 

 

 

6,448

 

 

$

113.15

 

 

 

 

 

 

Granted

 

 

570

 

 

 

 

 

 

570

 

 

 

236.00

 

 

 

 

 

 

Exercised

 

 

(660

)

 

 

(159

)

 

 

(819

)

 

 

90.84

 

 

 

 

 

 

Cancelled

 

 

(112

)

 

 

 

 

 

(112

)

 

 

182.87

 

 

 

 

 

 

SARs outstanding, December 31, 2022

 

 

5,960

 

 

 

127

 

 

 

6,087

 

 

 

126.38

 

 

 

 

 

 

Granted

 

 

580

 

 

 

 

 

 

580

 

 

 

253.49

 

 

 

 

 

 

Exercised

 

 

(1,156

)

 

 

(83

)

 

 

(1,239

)

 

 

95.29

 

 

 

 

 

 

Cancelled

 

 

(59

)

 

 

 

 

 

(59

)

 

 

202.05

 

 

 

 

 

 

SARs outstanding, December 31, 2023

 

 

5,325

 

 

 

44

 

 

 

5,369

 

 

 

146.46

 

 

 

 

 

 

Granted

 

 

491

 

 

 

 

 

 

491

 

 

 

305.44

 

 

 

 

 

 

Exercised

 

 

(1,128

)

 

 

(44

)

 

 

(1,172

)

 

 

111.02

 

 

 

 

 

 

Cancelled

 

 

(101

)

 

 

 

 

 

(101

)

 

 

246.78

 

 

 

 

 

 

SARs outstanding, December 31, 2024

 

 

4,587

 

 

 

 

 

 

4,587

 

 

$

170.31

 

 

5.3 years

 

$

598

 

SARs exercisable, December 31, 2024

 

 

3,322

 

 

 

 

 

 

3,322

 

 

$

136.86

 

 

4.3 years

 

$

542

 

 

The weighted average fair values of SARs granted during 2024, 2023 and 2022 were $102.65, $87.47 and $69.55 per share, respectively. The intrinsic values of SARs exercised during 2024, 2023 and 2022 were $257 million, $207 million and $115 million, respectively. As of December 31, 2024, the unrecognized compensation cost related to nonvested SARs was $47 million.

Information regarding RSU and PSU activity during 2024, 2023 and 2022 is summarized below (share amounts in thousands):

 

 

RSUs

 

 

PSUs

 

 

Total RSUs
and PSUs

 

 

Weighted
Average
Grant
Date Fair
Value

 

RSUs and PSUs outstanding, December 31, 2021

 

 

2,191

 

 

 

2,083

 

 

 

4,274

 

 

$

150.32

 

Granted

 

 

611

 

 

 

455

 

 

 

1,066

 

 

 

235.71

 

Performance adjustment

 

 

 

 

 

699

 

 

 

699

 

 

 

138.45

 

Vested

 

 

(878

)

 

 

(1,399

)

 

 

(2,277

)

 

 

138.41

 

Cancelled

 

 

(140

)

 

 

(123

)

 

 

(263

)

 

 

183.86

 

RSUs and PSUs outstanding, December 31, 2022

 

 

1,784

 

 

 

1,715

 

 

 

3,499

 

 

 

179.18

 

Granted

 

 

609

 

 

 

479

 

 

 

1,088

 

 

 

253.85

 

Performance adjustment

 

 

 

 

 

697

 

 

 

697

 

 

 

144.42

 

Vested

 

 

(717

)

 

 

(1,393

)

 

 

(2,110

)

 

 

152.50

 

Cancelled

 

 

(125

)

 

 

(88

)

 

 

(213

)

 

 

217.78

 

RSUs and PSUs outstanding, December 31, 2023

 

 

1,551

 

 

 

1,410

 

 

 

2,961

 

 

 

214.71

 

Granted

 

 

582

 

 

 

434

 

 

 

1,016

 

 

 

305.97

 

Performance adjustment

 

 

 

 

 

566

 

 

 

566

 

 

 

174.55

 

Vested

 

 

(639

)

 

 

(1,132

)

 

 

(1,771

)

 

 

181.81

 

Cancelled

 

 

(138

)

 

 

(103

)

 

 

(241

)

 

 

260.96

 

RSUs and PSUs outstanding, December 31, 2024

 

 

1,356

 

 

 

1,175

 

 

 

2,531

 

 

$

260.95

 

 

NOTE 2 — SHARE-BASED COMPENSATION (continued)

SAR, RSU and PSU Activity (continued)

 

The fair values of RSUs and PSUs that vested during 2024, 2023 and 2022 were $539 million, $550 million and $550 million, respectively. As of December 31, 2024, the unrecognized compensation cost related to RSUs and PSUs was $383 million.

v3.25.0.1
Acquisitions and Dispositions
12 Months Ended
Dec. 31, 2024
Business Combinations [Abstract]  
Acquisitions and Dispositions

NOTE 3 — ACQUISITIONS AND DISPOSITIONS

During 2024, we paid $112 million to acquire three hospital facilities in Texas and $154 million to acquire nonhospital health care entities. During 2023, we paid $229 million to acquire four hospital facilities in Texas and $406 million to acquire nonhospital health care entities. During 2022, we paid $224 million to acquire nonhospital health care entities (noncontrolling interests of $72 million were recorded). Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values. The purchase price paid in excess of the fair value of identifiable net assets of these acquired entities aggregated $170 million, $362 million and $262 million in 2024, 2023 and 2022, respectively. The consolidated financial statements include the accounts and operations of the acquired entities subsequent to the respective acquisition dates. The pro forma effects of these acquired entities on our results of operations for periods prior to the respective acquisition dates were not significant.

During 2024, we received proceeds of $295 million and recognized a pretax gain of $189 million ($145 million net of tax) related to the sale of a hospital facility in California. We also received proceeds of $33 million and recognized a pretax loss of $5 million ($4 million after tax) related to sales of real estate and other health care entity investments. In addition, we recognized a pretax loss of $170 million ($130 million after tax) related to a hospital facility in California that we have executed a definitive agreement to sell in 2025. During 2023, we received proceeds of $162 million for the sale of two hospital facilities in Louisiana. We also received proceeds of $31 million related to sales of real estate and other health care entity investments. We recognized a pretax loss of $5 million for these transactions. During 2022, we received proceeds of $326 million and recognized a pretax gain of $274 million ($200 million after tax) related to sales of real estate and other health care entity investments. We also received proceeds of $911 million and recognized a pretax gain of $1.027 billion ($527 million after tax and amounts attributable to noncontrolling interests) in 2022 related to the sale of a controlling interest in a subsidiary of our group purchasing organization.

v3.25.0.1
Income Taxes
12 Months Ended
Dec. 31, 2024
Income Tax Disclosure [Abstract]  
Income Taxes

NOTE 4 — INCOME TAXES

The provision for income taxes consists of the following (dollars in millions):

 

 

2024

 

 

2023

 

 

2022

 

Current:

 

 

 

 

 

 

 

 

 

Federal

 

$

1,202

 

 

$

1,118

 

 

$

1,222

 

State

 

 

212

 

 

 

213

 

 

 

206

 

Foreign

 

 

20

 

 

 

3

 

 

 

18

 

Deferred:

 

 

 

 

 

 

 

 

 

Federal

 

 

394

 

 

 

241

 

 

 

261

 

State

 

 

31

 

 

 

21

 

 

 

27

 

Foreign

 

 

7

 

 

 

19

 

 

 

12

 

 

 

$

1,866

 

 

$

1,615

 

 

$

1,746

 

 

Our provision for income taxes for the years ended December 31, 2024, 2023 and 2022 included tax benefits of $102 million, $93 million and $77 million, respectively, related to the settlement of employee equity awards. The provision for income taxes reflects a $61 million reduction in interest (net of tax) and penalty expense and $36 million and $23 million of interest expense (net of tax) for the years ended December 31, 2024, 2023 and 2022, respectively. During 2024, we derecognized deferred tax assets and increased our tax provision by $276 million due to an internal restructuring of certain affiliates. Our foreign pretax income was $79 million, $85 million and $66 million for the years ended December 31, 2024, 2023 and 2022, respectively.

NOTE 4 — INCOME TAXES (continued)

A reconciliation of the federal statutory rate to the effective income tax rate follows:

 

 

2024

 

 

2023

 

 

2022

 

Federal statutory rate

 

 

21.0

%

 

 

21.0

%

 

 

21.0

%

State income taxes, net of federal tax benefit

 

 

2.7

 

 

 

2.6

 

 

 

2.3

 

Change in liability for uncertain tax positions

 

 

(2.3

)

 

 

0.4

 

 

 

0.7

 

Tax benefit from settlements of employee equity awards

 

 

(1.2

)

 

 

(1.2

)

 

 

(0.9

)

Internal restructuring of affiliates

 

 

3.5

 

 

 

 

 

 

 

Other items, net

 

 

0.8

 

 

 

0.8

 

 

 

0.5

 

Effective income tax rate on income attributable to HCA Healthcare, Inc.

 

 

24.5

 

 

 

23.6

 

 

 

23.6

 

Income attributable to noncontrolling interests from consolidated partnerships

 

 

(2.6

)

 

 

(2.6

)

 

 

(3.3

)

Effective income tax rate on income before income taxes

 

 

21.9

%

 

 

21.0

%

 

 

20.3

%

A summary of the items comprising our deferred tax assets and liabilities at December 31 follows (dollars in millions):

 

 

2024

 

 

2023

 

 

 

Assets

 

 

Liabilities

 

 

Assets

 

 

Liabilities

 

Depreciation and fixed asset basis differences

 

$

 

 

$

1,139

 

 

$

 

 

$

1,048

 

Allowances for professional liability and other risks

 

 

395

 

 

 

 

 

 

452

 

 

 

 

Accounts receivable

 

 

418

 

 

 

 

 

 

363

 

 

 

 

Compensation

 

 

285

 

 

 

 

 

 

308

 

 

 

 

Right-of-use lease assets and obligations

 

 

478

 

 

 

462

 

 

 

506

 

 

 

492

 

Other

 

 

297

 

 

 

932

 

 

 

592

 

 

 

860

 

 

 

$

1,873

 

 

$

2,533

 

 

$

2,221

 

 

$

2,400

 

At December 31, 2024, state net operating loss carryforwards (expiring in years 2025 through 2042) available to offset future taxable income approximated $167 million. Utilization of net operating loss carryforwards in any one year may be limited.

The following table summarizes the activity related to our gross unrecognized tax benefits, excluding accrued interest and penalties of $115 million and $177 million as of December 31, 2024 and 2023, respectively (dollars in millions):

 

 

 

2024

 

 

2023

 

Balance at January 1

 

$

639

 

 

$

639

 

Additions based on tax positions related to the current year

 

 

40

 

 

 

30

 

Additions for tax positions of prior years

 

 

63

 

 

 

4

 

Reductions for tax positions of prior years

 

 

(206

)

 

 

(10

)

Settlements

 

 

(17

)

 

 

 

Lapse of applicable statutes of limitations

 

 

(15

)

 

 

(24

)

Balance at December 31

 

$

504

 

 

$

639

 

 

Unrecognized tax benefits of $295 million as of December 31, 2024 ($320 million as of December 31, 2023) would affect the effective rate, if recognized.

 

During 2024, the Internal Revenue Service (“IRS”) completed its examination of our 2016, 2017 and 2018 income tax returns, resolving all federal income tax matters for those years, and the 2020 federal statute of limitations expired. We reduced our tax provision by $254 million, including interest of $118 million (net of tax). Of this amount, $181 million, including $47 million of interest (net of tax) related to the tax rate changes under the 2017 Tax Cuts and Jobs Act.

NOTE 4 — INCOME TAXES (continued)

At December 31, 2024, the IRS was examining the Company's 2022 and 2023 income tax returns and the 2019 income tax returns of certain affiliates. We are subject to examination by the IRS for tax years after 2020, as well as by state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change.

v3.25.0.1
Earnings Per Share
12 Months Ended
Dec. 31, 2024
Earnings Per Share [Abstract]  
Earnings Per Share

NOTE 5 — EARNINGS PER SHARE

We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding plus the dilutive effect of outstanding SARs, RSUs and PSUs, computed using the treasury stock method. During 2024, 2023 and 2022, we repurchased 17.798 million shares, 14.465 million shares and 30.747 million shares, respectively, of our common stock.

The following table sets forth the computations of basic and diluted earnings per share for the years ended December 31, 2024, 2023 and 2022 (dollars and shares in millions, except per share amounts):

 

 

 

2024

 

 

2023

 

 

2022

 

Net income attributable to HCA Healthcare, Inc.

 

$

5,760

 

 

$

5,242

 

 

$

5,643

 

 

 

 

 

 

 

 

 

 

 

Weighted average common shares outstanding

 

 

258.603

 

 

 

272.404

 

 

 

290.348

 

Effect of dilutive incremental shares

 

 

3.203

 

 

 

4.008

 

 

 

4.318

 

Shares used for diluted earnings per share

 

 

261.806

 

 

 

276.412

 

 

 

294.666

 

Earnings per share:

 

 

 

 

 

 

 

 

 

Basic earnings per share

 

$

22.27

 

 

$

19.25

 

 

$

19.43

 

Diluted earnings per share

 

$

22.00

 

 

$

18.97

 

 

$

19.15

 

v3.25.0.1
Investments of Insurance Subsidiaries
12 Months Ended
Dec. 31, 2024
Investments, Debt and Equity Securities [Abstract]  
Investments of Insurance Subsidiaries

NOTE 6 — INVESTMENTS OF INSURANCE SUBSIDIARIES

A summary of the insurance subsidiaries’ investments at December 31 follows (dollars in millions):

 

 

2024

 

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

388

 

 

$

 

 

$

(27

)

 

$

361

 

Money market funds and other

 

 

296

 

 

 

 

 

 

 

 

 

296

 

 

 

$

684

 

 

$

 

 

$

(27

)

 

 

657

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(88

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

569

 

 

NOTE 6 — INVESTMENTS OF INSURANCE SUBSIDIARIES (continued)

 

 

2023

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

404

 

 

$

1

 

 

$

(29

)

 

$

376

 

Money market funds and other

 

 

188

 

 

 

 

 

 

 

 

 

188

 

 

$

592

 

 

$

1

 

 

$

(29

)

 

 

564

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(87

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

477

 

 

At December 31, 2024 and 2023, the investments in debt securities of our insurance subsidiaries were classified as “available-for-sale.” Changes in unrealized gains and losses that are not credit-related are recorded as adjustments to other comprehensive income (loss).

Scheduled maturities of investments in debt securities at December 31, 2024 were as follows (dollars in millions):

 

 

 

Amortized
Cost

 

 

Fair
Value

 

Due in one year or less

 

$

31

 

 

$

31

 

Due after one year through five years

 

 

145

 

 

 

140

 

Due after five years through ten years

 

 

147

 

 

 

130

 

Due after ten years

 

 

65

 

 

 

60

 

 

 

$

388

 

 

$

361

 

 

The average expected maturity of the investments in debt securities at December 31, 2024 was 4.4 years, compared to the average scheduled maturity of 8.1 years. Expected and scheduled maturities may differ because the issuers of certain securities have the right to call, prepay or otherwise redeem such obligations prior to their scheduled maturity date.

v3.25.0.1
Assets and Liabilities Measured at Fair Value
12 Months Ended
Dec. 31, 2024
Fair Value Disclosures [Abstract]  
Assets and Liabilities Measured at Fair Value

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE

Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”) emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).

Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment.

The investments of our insurance subsidiaries are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency.

NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued)

The following tables summarize the investments of our insurance subsidiaries measured at fair value on a recurring basis as of December 31, 2024 and 2023, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

 

 

2024

 

 

 

 

 

 

Fair Value Measurements Using

 

 

 

Fair Value

 

 

Quoted Prices in
Active Markets for
Identical Assets
(Level 1)

 

 

Significant Other
Observable Inputs
(Level 2)

 

 

Significant
Unobservable Inputs
(Level 3)

 

Debt securities

 

$

361

 

 

$

 

 

$

361

 

 

$

 

Money market funds and other

 

 

296

 

 

 

296

 

 

 

 

 

 

 

Investments of insurance subsidiaries

 

 

657

 

 

 

296

 

 

 

361

 

 

 

 

Less amounts classified as current assets

 

 

(88

)

 

 

(88

)

 

 

 

 

 

 

 

 

$

569

 

 

$

208

 

 

$

361

 

 

$

 

 

 

2023

 

 

 

 

 

Fair Value Measurements Using

 

 

Fair Value

 

 

Quoted Prices in
Active Markets for
Identical Assets
(Level 1)

 

 

Significant Other
Observable Inputs
(Level 2)

 

 

Significant
Unobservable Inputs
(Level 3)

 

Debt securities

 

$

376

 

 

$

 

 

$

376

 

 

$

 

Money market funds and other

 

 

188

 

 

 

188

 

 

 

 

 

 

 

Investments of insurance subsidiaries

 

 

564

 

 

 

188

 

 

 

376

 

 

 

 

Less amounts classified as current assets

 

 

(87

)

 

 

(87

)

 

 

 

 

 

 

 

$

477

 

 

$

101

 

 

$

376

 

 

$

 

 

The estimated fair value of our long-term debt was $40.845 billion and $38.253 billion at December 31, 2024 and 2023, respectively, compared to carrying amounts, gross of debt issuance costs, premiums and discounts, aggregating $43.400 billion and $39.926 billion, respectively. The estimates of fair value are generally based on Level 2 inputs, including quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities.

v3.25.0.1
Long-Term Debt
12 Months Ended
Dec. 31, 2024
Debt Disclosure [Abstract]  
Long-Term Debt

NOTE 8 — LONG-TERM DEBT

A summary of long-term debt at December 31, including related interest rates at December 31, 2024, follows (dollars in millions):

 

 

 

2024

 

 

2023

 

Senior secured asset-based revolving credit facility

 

$

 

 

$

1,880

 

Senior secured revolving credit facility

 

 

 

 

 

 

Senior secured term loan facilities (effective interest rate of 5.8%)

 

 

1,238

 

 

 

1,313

 

Other senior secured debt (effective interest rate of 4.6%)

 

 

1,046

 

 

 

967

 

Senior secured debt

 

 

2,284

 

 

 

4,160

 

Senior unsecured notes (effective interest rate of 5.1%)

 

 

41,116

 

 

 

35,766

 

Debt issuance costs and discounts

 

 

(369

)

 

 

(333

)

Total debt (average life of 10.9 years, rates averaging 5.1%)

 

 

43,031

 

 

 

39,593

 

Less amounts due within one year

 

 

4,698

 

 

 

2,424

 

 

 

$

38,333

 

 

$

37,169

 

 

NOTE 8 — LONG-TERM DEBT (continued)

During 2024, we issued $4.500 billion aggregate principal amount of senior notes comprised of (i) $1.000 billion aggregate principal amount of 5.450% senior notes due 2031 (the “Existing 2031 Notes”), (ii) $1.300 billion aggregate principal amount of 5.600% senior notes due 2034, (iii) $1.500 billion aggregate principal amount of 6.000% senior notes due 2054 and (iv) $700 million aggregate principal amount of 6.100% senior notes due 2064. We used the net proceeds to repay borrowings under our asset-based revolving credit facility and for general corporate purposes. During 2024, we repaid all of the $2.000 billion aggregate principal amount of 5.000% senior notes due 2024 at maturity.

During 2024, we also issued $3.000 billion aggregate principal amount of senior notes comprised of (i) $750 million aggregate principal amount of 5.450% senior notes due 2031 (the “New 2031 Notes”), (ii) $1.250 billion aggregate principal amount of 5.450% senior notes due 2034 and (iii) $1.000 billion aggregate principal amount of 5.950% senior notes due 2054. The New 2031 Notes represent a further issuance of our Existing 2031 Notes, issued during February 2024, and together with the New 2031 Notes, the aggregate principal amount of these notes is $1.750 billion. We used the net proceeds to repay borrowings under our asset-based revolving credit facility and for general corporate purposes.

Senior Secured Credit Facilities And Other Senior Secured Debt

We have entered into the following senior secured credit facilities: (i) a $4.500 billion asset-based revolving credit facility maturing on June 30, 2026 with a borrowing base of 85% of eligible accounts receivable, subject to customary reserves and eligibility criteria (none outstanding at December 31, 2024) (the “ABL credit facility”); (ii) a $3.500 billion senior secured revolving credit facility maturing on June 30, 2026 (none outstanding at December 31, 2024 without giving effect to certain outstanding letters of credit); and (iii) a $1.238 billion senior secured term loan facility maturing on June 30, 2026. We refer to the facilities described under (ii) and (iii) above, collectively, as the “cash flow credit facility” and, together with the ABL credit facility, the “senior secured credit facilities.” Finance leases and other secured debt totaled $1.046 billion at December 31, 2024.

Borrowings under the senior secured credit facilities bear interest at a rate equal to, at our option, either (a) a base rate determined by reference to the higher of (1) the federal funds rate plus 0.50% or (2) the prime rate of Bank of America or (b) a reference rate (the Secured Overnight Financing Rate (SOFR)) for the relevant interest period, plus, in each case, an applicable margin. The applicable margin for borrowings under the senior secured credit facilities may be reduced subject to attaining certain leverage ratios.

The senior secured credit facilities contain a number of covenants that restrict, subject to certain exceptions, our (and some or all of our subsidiaries’) ability to incur additional indebtedness, repay subordinated indebtedness, create liens on assets, sell assets, make investments, loans or advances, engage in certain transactions with affiliates, pay dividends and distributions, and enter into sale and leaseback transactions. In addition, we are required to satisfy and maintain a maximum total leverage ratio covenant under the cash flow credit facility and, in certain situations under the ABL credit facility, a minimum interest coverage ratio covenant.

Senior Unsecured Notes

Senior unsecured notes consist of (i) $40.541 billion aggregate principal amount of senior notes with maturities ranging from 2025 to 2064; (ii) an aggregate principal amount of $125 million medium-term notes maturing 2025; and (iii) an aggregate principal amount of $450 million debentures with maturities ranging from 2027 to 2095.

General Debt Information

The senior secured credit facilities are fully and unconditionally guaranteed by substantially all existing and future, direct and indirect, 100% owned material domestic subsidiaries that are “Unrestricted Subsidiaries” under our Indenture (the “1993 Indenture”) dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our ABL credit facility).

All obligations under the ABL credit facility, and the guarantees of those obligations, are secured, subject to permitted liens and other exceptions, by a first-priority lien on substantially all of the receivables of the borrowers and each guarantor under such ABL credit facility (the “Receivables Collateral”).

NOTE 8 — LONG-TERM DEBT (continued)

General Debt Information (continued)

All obligations under the cash flow credit facility and the guarantees of such obligations are secured, subject to permitted liens and other exceptions, by:

a first-priority lien on the capital stock owned by HCA Inc., or by any guarantor, in each of their respective first-tier subsidiaries;
a first-priority lien on substantially all present and future assets of HCA Inc. and of each guarantor other than (i) “Principal Properties” (as defined in the 1993 Indenture), (ii) certain other real properties and (iii) deposit accounts, other bank or securities accounts, cash, leaseholds, motor-vehicles and certain other exceptions; and
a second-priority lien on certain of the Receivables Collateral.

Maturities of long-term debt in years 2026 through 2029 are $5.386 billion, $2.460 billion, $2.606 billion and $3.563 billion, respectively.

v3.25.0.1
Leases
12 Months Ended
Dec. 31, 2024
Leases [Abstract]  
Leases

NOTE 9 — LEASES

We lease property and equipment under finance and operating leases. For leases with terms greater than 12 months, we record the related assets and obligations at the present value of lease payments over the term. Many of our leases include rental escalation clauses and renewal options that are factored into our determination of lease payments, when appropriate. We do not separate lease and nonlease components of contracts. Generally, we use our estimated incremental borrowing rate to discount the lease payments, as most of our leases do not provide a readily determinable implicit interest rate.

The following table presents our lease-related assets and liabilities at December 31, 2024 and 2023 (dollars in millions):

 

 

Balance Sheet Classification

 

2024

 

 

2023

 

Assets:

 

 

 

 

 

 

 

 

Operating leases

 

Right-of-use operating lease assets

 

$

2,131

 

 

$

2,207

 

Finance leases

 

Property and equipment

 

 

646

 

 

 

556

 

Total lease assets

 

 

 

$

2,777

 

 

$

2,763

 

Liabilities:

 

 

 

 

 

 

 

 

Current:

 

 

 

 

 

 

 

 

Operating leases

 

Other accrued expenses

 

$

343

 

 

$

363

 

Finance leases

 

Long-term debt due within one year

 

 

162

 

 

 

166

 

Noncurrent:

 

 

 

 

 

 

 

 

Operating leases

 

Right-of-use operating lease obligations

 

 

1,863

 

 

 

1,903

 

Finance leases

 

Long-term debt

 

 

624

 

 

 

541

 

Total lease liabilities

 

 

 

$

2,992

 

 

$

2,973

 

Weighted-average remaining term:

 

 

 

 

 

 

 

 

Operating leases

 

 

 

11.3 years

 

 

11.8 years

 

Finance leases

 

 

 

10.5 years

 

 

9.0 years

 

Weighted-average discount rate:

 

 

 

 

 

 

 

 

Operating leases

 

 

 

 

5.1

%

 

 

4.9

%

Finance leases

 

 

 

 

5.3

%

 

 

4.9

%

 

NOTE 9 — LEASES (continued)

The following table presents certain information related to expenses for finance and operating leases for the years ended December 31, 2024, 2023 and 2022 (dollars in millions):

 

 

2024

 

 

2023

 

 

2022

 

Finance lease expense:

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 

$

159

 

 

$

164

 

 

$

163

 

Interest

 

 

37

 

 

 

31

 

 

 

29

 

Operating leases(1)

 

 

503

 

 

 

495

 

 

 

484

 

Short-term lease expense(1)

 

 

365

 

 

 

337

 

 

 

329

 

Variable lease expense(1)

 

 

181

 

 

 

162

 

 

 

163

 

 

 

$

1,245

 

 

$

1,189

 

 

$

1,168

 

(1)
Expenses are included in “other operating expenses” in our consolidated income statements.

The following table presents supplemental cash flow information for the years ended December 31, 2024, 2023 and 2022 (dollars in millions):

 

 

 

2024

 

 

2023

 

 

2022

 

Cash paid for amounts included in the measurement of lease liabilities:

 

 

 

 

 

 

 

 

 

Operating cash flows for operating leases

 

$

490

 

 

$

479

 

 

$

473

 

Operating cash flows for finance leases

 

 

37

 

 

 

31

 

 

 

29

 

Financing cash flows for finance leases

 

 

172

 

 

 

140

 

 

 

124

 

Maturities of Lease Liabilities

The following table reconciles the undiscounted minimum lease payment amounts to the operating and finance lease liabilities recorded on the balance sheet at December 31, 2024 and 2023 (dollars in millions):

 

 

 

2024

 

 

2023

 

 

 

Operating
Leases

 

 

Finance
Leases

 

 

Operating
Leases

 

 

Finance
Leases

 

Year 1

 

$

455

 

 

$

197

 

 

$

452

 

 

$

193

 

Year 2

 

 

405

 

 

 

146

 

 

 

394

 

 

 

155

 

Year 3

 

 

344

 

 

 

99

 

 

 

340

 

 

 

115

 

Year 4

 

 

281

 

 

 

81

 

 

 

288

 

 

 

60

 

Year 5

 

 

221

 

 

 

71

 

 

 

228

 

 

 

45

 

Thereafter

 

 

1,460

 

 

 

497

 

 

 

1,540

 

 

 

356

 

Total minimum lease payments

 

 

3,166

 

 

 

1,091

 

 

 

3,242

 

 

 

924

 

Less: amount of lease payments representing interest

 

 

(960

)

 

 

(305

)

 

 

(976

)

 

 

(217

)

Present value of future minimum lease payments

 

 

2,206

 

 

 

786

 

 

 

2,266

 

 

 

707

 

Less: current lease obligations

 

 

(343

)

 

 

(162

)

 

 

(363

)

 

 

(166

)

Long-term lease obligations

 

$

1,863

 

 

$

624

 

 

$

1,903

 

 

$

541

 

v3.25.0.1
Contingencies
12 Months Ended
Dec. 31, 2024
Commitments and Contingencies Disclosure [Abstract]  
Contingencies

NOTE 10 — CONTINGENCIES

We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us, which may not be covered by insurance. We are also subject to claims by various taxing authorities for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations, financial position or liquidity.

NOTE 10 — CONTINGENCIES (continued)

Government Investigations, Claims and Litigation

Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam, or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our results of operations, financial position or liquidity.

We accrue for such contingencies to the extent that it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. If we are a party to any proceeding that, either individually or in the aggregate, is probable or reasonably possible of having a material, adverse effect on the business, our results of operations, financial position or liquidity, we disclose a summary of such contingencies and the amount or range of reasonably possible losses in excess of recorded amounts or that we are unable to reasonably estimate the amount or range of losses.

v3.25.0.1
Capital Stock
12 Months Ended
Dec. 31, 2024
Federal Home Loan Banks [Abstract]  
Capital Stock

NOTE 11 — CAPITAL STOCK

The amended and restated certificate of incorporation authorizes the Company to issue up to 1,800,000,000 shares of common stock, and our amended and restated by-laws set the number of directors constituting the board of directors of the Company at not less than three members, the exact number to be determined from time to time by resolution adopted by the affirmative vote of a majority of the total number of directors then in office.

Share Repurchase Transactions

During January 2025, January 2024, January 2023, January 2022 and February 2021, our Board of Directors authorized share repurchase programs for up to $10 billion, $6 billion, $3 billion, $8 billion and $6 billion, respectively, of the Company’s outstanding common stock.

During 2024, we repurchased 17.798 million shares of our common stock at an average price of $337.74 per share through market purchases pursuant to the January 2023 authorization (which was completed during 2024) and the January 2024 authorization. At December 31, 2024, we had $764 million of repurchase authorization available under the January 2024 authorization. During 2023, we repurchased 14.465 million shares of our common stock at an average price of $263.47 per share through market purchases pursuant to the January 2022 authorization (which was completed during 2023) and the January 2023 authorization. During 2022, we repurchased 30.747 million shares of our common stock at an average price of $227.67 per share through market purchases pursuant to the February 2021 authorizations (which were completed during 2022) and the January 2022 authorization.

v3.25.0.1
Employee Benefit Plans
12 Months Ended
Dec. 31, 2024
Retirement Benefits [Abstract]  
Employee Benefit Plans

NOTE 12 — EMPLOYEE BENEFIT PLANS

We maintain defined contribution benefit plans that are available to employees who meet certain minimum requirements. The plans require that we match participant contributions up to certain maximum levels (generally, 100% of the first 3% to 9%, depending upon years of vesting service, of compensation deferred by participants). Benefits expense under these plans totaled $689 million for 2024, $659 million for 2023 and $606 million for 2022. Our matching contributions are funded during the year following the participant contributions.

We maintain the noncontributory, nonqualified Restoration Plan to provide retirement benefits for eligible employees. Eligibility for the Restoration Plan is based upon earning eligible compensation in excess of a base amount and attaining 1,000 or more hours of service during the plan year. Company credits to participants’ hypothetical account balances (the Restoration Plan is not funded) depend upon participants’ compensation, years of vesting service, hypothetical investment returns (gains or losses) and certain IRS limitations. The amount recognized under this plan was $31 million expense for 2024, $40 million expense for 2023 and a $27 million credit for 2022. Accrued benefits liabilities under this plan totaled $229 million at December 31, 2024 and $227 million at December 31, 2023.

NOTE 12 — EMPLOYEE BENEFIT PLANS (continued)

We maintain a Supplemental Executive Retirement Plan (“SERP”) for certain executives (the SERP is not funded). The plan is designed to ensure that upon retirement the participant receives the value of a prescribed life annuity from the combination of the SERP and our other benefit plans. Benefits expense under the plan was $7 million for 2024, $10 million for 2023 and $22 million for 2022. Accrued benefits liabilities under this plan totaled $109 million at December 31, 2024 and $106 million at December 31, 2023.

We maintain defined benefit pension plans which resulted from certain hospital acquisitions in prior years. The amount recognized under these plans was a $6 million credit for 2024, $2 million expense for 2023, and an $11 million credit for 2022. Net assets available for benefits in excess of the projected benefit obligation under these plans were $118 million and $43 million at December 31, 2024 and 2023, respectively.

v3.25.0.1
Segment and Geographic Information
12 Months Ended
Dec. 31, 2024
Segment Reporting [Abstract]  
Segment and Geographic Information

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION

Effective January 1, 2024, we adopted Accounting Standards Update 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures. We operate in one line of business, which is operating hospitals and related health care entities. We operate in three geographically organized groups: the National, Atlantic and American Groups. At December 31, 2024, the National Group included 55 hospitals located in Alaska, California, Idaho, Indiana, Kentucky, Nevada, New Hampshire, North Carolina, Tennessee, Utah and Virginia, the Atlantic Group included 62 hospitals located in Florida, Georgia, Northern Kansas, Missouri and South Carolina, and the American Group included 65 hospitals located in Colorado, Central Kansas, Louisiana and Texas. The eight hospitals we operate in England are included in the Corporate and other group.

Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses and gains on sales of facilities, losses on retirement of debt, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, salaries and benefits, supplies, other operating expenses, equity in earnings or losses of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets that are provided to the Chief Operating Decision Maker, which is the Chief Executive Officer, are summarized in the following tables (dollars in millions) and represent the operating segments at December 31, 2024:

 

 

 

For the Year Ended December 31, 2024

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

Revenues

 

$

19,614

 

 

$

23,171

 

 

$

24,601

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

7,483

 

 

 

8,525

 

 

 

8,529

 

Supplies

 

 

2,812

 

 

 

3,553

 

 

 

4,035

 

Other operating expenses

 

 

4,892

 

 

 

6,124

 

 

 

6,363

 

Equity in (earnings) losses of affiliates

 

 

2

 

 

 

(3

)

 

 

(62

)

 

 

 

15,189

 

 

 

18,199

 

 

 

18,865

 

Adjusted segment EBITDA

 

$

4,425

 

 

$

4,972

 

 

$

5,736

 

 

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

 

 

For the Year Ended December 31, 2023

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

Revenues

 

$

18,105

 

 

$

21,167

 

 

$

22,318

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

7,196

 

 

 

8,058

 

 

 

8,080

 

Supplies

 

 

2,658

 

 

 

3,331

 

 

 

3,616

 

Other operating expenses

 

 

4,253

 

 

 

5,289

 

 

 

5,473

 

Equity in (earnings) losses of affiliates

 

 

(2

)

 

 

(3

)

 

 

(59

)

 

 

 

14,105

 

 

 

16,675

 

 

 

17,110

 

Adjusted segment EBITDA

 

$

4,000

 

 

$

4,492

 

 

$

5,208

 

 

 

 

 

For the Year Ended December 31, 2022

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

Revenues

 

$

16,767

 

 

$

19,324

 

 

$

20,858

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

6,959

 

 

 

7,752

 

 

 

7,757

 

Supplies

 

 

2,569

 

 

 

3,088

 

 

 

3,331

 

Other operating expenses

 

 

3,624

 

 

 

4,606

 

 

 

4,711

 

Equity in (earnings) losses of affiliates

 

 

(1

)

 

 

(3

)

 

 

(43

)

 

 

 

13,151

 

 

 

15,443

 

 

 

15,756

 

Adjusted segment EBITDA

 

$

3,616

 

 

$

3,881

 

 

$

5,102

 

 

 

 

For the Year Ended December 31,

 

 

 

2024

 

 

2023

 

 

2022

 

Adjusted segment EBITDA:

 

 

 

 

 

 

 

 

 

National Group

 

$

4,425

 

 

$

4,000

 

 

$

3,616

 

Atlantic Group

 

 

4,972

 

 

 

4,492

 

 

 

3,881

 

American Group

 

 

5,736

 

 

 

5,208

 

 

 

5,102

 

 

 

 

15,133

 

 

 

13,700

 

 

 

12,599

 

Adjustments to reconcile Total Adjusted segment
  EBITDA to consolidated Income before income taxes:

 

 

 

 

 

 

 

 

 

Corporate and Other

 

 

1,251

 

 

 

974

 

 

 

532

 

Depreciation and amortization

 

 

3,312

 

 

 

3,077

 

 

 

2,969

 

Interest expense

 

 

2,061

 

 

 

1,938

 

 

 

1,741

 

Losses (gains) on sales of facilities

 

 

(14

)

 

 

5

 

 

 

(1,301

)

Losses on retirement of debt

 

 

 

 

 

 

 

 

78

 

Income before income taxes

 

$

8,523

 

 

$

7,706

 

 

$

8,580

 

 

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

 

 

For the Year Ended December 31,

 

 

 

2024

 

 

2023

 

 

2022

 

Revenues:

 

 

 

 

 

 

 

 

 

National Group

 

$

19,614

 

 

$

18,105

 

 

$

16,767

 

Atlantic Group

 

 

23,171

 

 

 

21,167

 

 

 

19,324

 

American Group

 

 

24,601

 

 

 

22,318

 

 

 

20,858

 

Corporate and other

 

 

3,217

 

 

 

3,378

 

 

 

3,284

 

 

 

$

70,603

 

 

$

64,968

 

 

$

60,233

 

 

 

 

 

 

 

 

 

 

 

Depreciation and amortization:

 

 

 

 

 

 

 

 

 

National Group

 

$

857

 

 

$

834

 

 

$

801

 

Atlantic Group

 

 

1,061

 

 

 

989

 

 

 

921

 

American Group

 

 

1,083

 

 

 

971

 

 

 

937

 

Corporate and other

 

 

311

 

 

 

283

 

 

 

310

 

 

 

$

3,312

 

 

$

3,077

 

 

$

2,969

 

 

 

 

 

December 31,

 

 

 

2024

 

 

2023

 

 

2022

 

Assets:

 

 

 

 

 

 

 

 

 

National Group

 

$

12,855

 

 

$

12,487

 

 

$

11,793

 

Atlantic Group

 

 

17,168

 

 

 

16,098

 

 

 

15,092

 

American Group

 

 

20,714

 

 

 

19,786

 

 

 

17,934

 

Corporate and other

 

 

8,776

 

 

 

7,840

 

 

 

7,619

 

 

 

$

59,513

 

 

$

56,211

 

 

$

52,438

 

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

 

Corporate
and Other

 

 

Total

 

Goodwill and other intangible assets:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at December 31, 2021

 

$

1,212

 

 

$

1,970

 

 

$

5,062

 

 

$

1,296

 

 

$

9,540

 

Acquisitions

 

 

75

 

 

 

90

 

 

 

90

 

 

 

7

 

 

 

262

 

Foreign currency translation, amortization and other

 

 

(43

)

 

 

(3

)

 

 

 

 

 

(103

)

 

 

(149

)

Balance at December 31, 2022

 

 

1,244

 

 

 

2,057

 

 

 

5,152

 

 

 

1,200

 

 

 

9,653

 

Acquisitions

 

 

 

 

 

8

 

 

 

326

 

 

 

28

 

 

 

362

 

Foreign currency translation, amortization and other

 

 

(3

)

 

 

(1

)

 

 

 

 

 

(66

)

 

 

(70

)

Balance at December 31, 2023

 

 

1,241

 

 

 

2,064

 

 

 

5,478

 

 

 

1,162

 

 

 

9,945

 

Acquisitions

 

 

 

 

 

61

 

 

 

105

 

 

 

4

 

 

 

170

 

Foreign currency translation, amortization and other

 

 

(4

)

 

 

(1

)

 

 

3

 

 

 

(20

)

 

 

(22

)

Balance at December 31, 2024

 

$

1,237

 

 

$

2,124

 

 

$

5,586

 

 

$

1,146

 

 

$

10,093

 

v3.25.0.1
Other Comprehensive Loss
12 Months Ended
Dec. 31, 2024
Equity [Abstract]  
Other Comprehensive Loss

NOTE 14 — OTHER COMPREHENSIVE LOSS

The components of accumulated other comprehensive loss are as follows (dollars in millions):

 

 

 

Unrealized
Gains (Losses) on
Available-
for-Sale
Securities

 

 

Foreign
Currency
Translation
Adjustments

 

 

Defined
Benefit
Plans

 

 

Change
in Fair
Value of
Derivative
Instruments

 

 

Total

 

Balances at December 31, 2021

 

$

12

 

 

$

(278

)

 

$

(132

)

 

$

(6

)

 

$

(404

)

Unrealized losses on available-for-sale securities, net
   of $
12 income tax benefit

 

 

(43

)

 

 

 

 

 

 

 

 

 

 

 

(43

)

Foreign currency translation adjustments, net of $16
   income tax benefit

 

 

 

 

 

(95

)

 

 

 

 

 

 

 

 

(95

)

Defined benefit plans, net of $11 of income taxes

 

 

 

 

 

 

 

 

38

 

 

 

 

 

 

38

 

Change in fair value of derivative instruments, net of
   $
1 of income taxes

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

5

 

Expense reclassified into operations from other
   comprehensive income, net of none, $
2 and $1
   income tax benefits, respectively

 

 

1

 

 

 

 

 

 

7

 

 

 

1

 

 

 

9

 

Balances at December 31, 2022

 

 

(30

)

 

 

(373

)

 

 

(87

)

 

 

 

 

 

(490

)

Unrealized gains on available-for-sale securities, net
   of $
2 of income taxes

 

 

9

 

 

 

 

 

 

 

 

 

 

 

 

9

 

Foreign currency translation adjustments, net of $7
   of income taxes

 

 

 

 

 

34

 

 

 

 

 

 

 

 

 

34

 

Defined benefit plans, net of $6 of income taxes

 

 

 

 

 

 

 

 

21

 

 

 

 

 

 

21

 

Expense (benefit) reclassified into operations from
   other comprehensive income, net of
none of income
   taxes and $
1 income tax benefit, respectively

 

 

(1

)

 

 

 

 

 

2

 

 

 

 

 

 

1

 

Balances at December 31, 2023

 

 

(22

)

 

 

(339

)

 

 

(64

)

 

 

 

 

 

(425

)

Unrealized gains on available-for-sale securities

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

1

 

Foreign currency translation adjustments, net of $2
   income tax benefit

 

 

 

 

 

(14

)

 

 

 

 

 

 

 

 

(14

)

Defined benefit plans, net of $15 of income taxes

 

 

 

 

 

 

 

 

50

 

 

 

 

 

 

50

 

Expense reclassified into operations from
   other comprehensive income

 

 

 

 

 

 

 

 

1

 

 

 

 

 

 

1

 

Balances at December 31, 2024

 

$

(21

)

 

$

(353

)

 

$

(13

)

 

$

 

 

$

(387

)

v3.25.0.1
Accrued Expenses
12 Months Ended
Dec. 31, 2024
Text Block [Abstract]  
Other Accrued Expenses

NOTE 15 — OTHER ACCRUED EXPENSES

A summary of other accrued expenses at December 31 follows (dollars in millions):

 

 

2024

 

 

2023

 

Professional liability risks

 

$

587

 

 

$

532

 

Defined contribution benefit plans

 

 

704

 

 

 

668

 

Right-of-use operating leases

 

 

343

 

 

 

363

 

Taxes other than income

 

 

419

 

 

 

382

 

Interest

 

 

502

 

 

 

414

 

Employee medical benefits

 

 

206

 

 

 

199

 

Other

 

 

1,138

 

 

 

1,313

 

 

 

$

3,899

 

 

$

3,871

 

v3.25.0.1
Accounting Policies (Policies)
12 Months Ended
Dec. 31, 2024
Basis of Presentation

Basis of Presentation

The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates.

The consolidated financial statements include all subsidiaries and entities controlled by HCA. We generally define “control” as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which we absorb a majority of the entity’s expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of ownership, contractual or other financial interests in the entity. The accounts of acquired entities are included in our consolidated financial statements for periods subsequent to our acquisition of controlling interests. Significant intercompany transactions have been eliminated. Investments in entities we do not control, but in which we have a substantial ownership interest and can exercise significant influence, are accounted for using the equity method.

The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative include our corporate office costs, which were $421 million, $353 million and $307 million for the years ended December 31, 2024, 2023 and 2022, respectively.

Revenues

Revenues

Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges), and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals.

NOTE 1 — ACCOUNTING POLICIES (continued)

Revenues (continued)

Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured and other discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Our revenues by primary third-party payer classification and other (including uninsured patients) for the years ended December 31, are summarized in the following table (dollars in millions):

 

 

 

Years Ended December 31,

 

 

 

2024

 

 

Ratio

 

 

2023

 

 

Ratio

 

 

2022

 

 

Ratio

 

Medicare

 

$

10,780

 

 

 

15.3

%

 

$

10,585

 

 

 

16.3

%

 

$

10,447

 

 

 

17.3

%

Managed Medicare

 

 

11,987

 

 

 

17.0

 

 

 

10,496

 

 

 

16.2

 

 

 

9,201

 

 

 

15.3

 

Medicaid

 

 

4,678

 

 

 

6.6

 

 

 

3,606

 

 

 

5.6

 

 

 

2,636

 

 

 

4.4

 

Managed Medicaid

 

 

3,980

 

 

 

5.6

 

 

 

3,879

 

 

 

6.0

 

 

 

3,998

 

 

 

6.6

 

Managed care and other insurers

 

 

34,954

 

 

 

49.5

 

 

 

31,819

 

 

 

49.0

 

 

 

29,120

 

 

 

48.3

 

International (managed care and other insurers)

 

 

1,682

 

 

 

2.4

 

 

 

1,509

 

 

 

2.3

 

 

 

1,317

 

 

 

2.2

 

Other

 

 

2,542

 

 

 

3.6

 

 

 

3,074

 

 

 

4.6

 

 

 

3,514

 

 

 

5.9

 

Revenues

 

$

70,603

 

 

 

100.0

%

 

$

64,968

 

 

 

100.0

%

 

$

60,233

 

 

 

100.0

%

Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process). The adjustments to estimated Medicare and Medicaid reimbursement and disproportionate-share amounts, related primarily to cost reports filed during the respective year, resulted in net increases to revenues of $42 million, $84 million and $56 million in 2024, 2023 and 2022, respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in net increases to revenues of $78 million in 2024, $58 million in 2023 and $42 million in 2022.

The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive.

Patients treated at hospitals for non-elective care, who have income at or below 400% of the federal poverty level, are eligible for charity care, and we limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. Patients treated at hospitals for non-elective care, who have income above 400% of the federal poverty level, are eligible for certain other discounts which limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. We apply additional discounts to limit patient responsibility for certain emergency services. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. We may provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance, or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied.

NOTE 1 — ACCOUNTING POLICIES (continued)

Revenues (continued)

The collection of outstanding receivables from Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the age of those accounts. Accounts are written off when all reasonable collection efforts have been performed.

The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period comparisons of our revenues. At December 31, 2024 and 2023, estimated implicit price concessions of $7.773 billion and $7.283 billion, respectively, had been recorded to adjust our revenues and accounts receivable to the estimated amounts we expect to collect.

To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions):

 

 

2024

 

 

2023

 

 

2022

 

Patient care costs (salaries and benefits, supplies, other operating
   expenses and depreciation and amortization)

 

$

60,056

 

 

$

55,341

 

 

$

51,180

 

Cost-to-charges ratio (patient care costs as percentage of gross
   patient charges)

 

 

10.1

%

 

 

10.5

%

 

 

11.0

%

Total uncompensated care

 

$

43,231

 

 

$

35,426

 

 

$

31,734

 

Multiply by the cost-to-charges ratio

 

 

10.1

%

 

 

10.5

%

 

 

11.0

%

Estimated cost of total uncompensated care

 

$

4,366

 

 

$

3,720

 

 

$

3,491

 

The total uncompensated care amounts include charity care of $15.942 billion, $14.425 billion and $13.615 billion for the years ended December 31, 2024, 2023 and 2022, respectively. The estimated cost of charity care was $1.610 billion, $1.515 billion and $1.498 billion for the years ended December 31, 2024, 2023 and 2022, respectively.

Recent Pronouncements

Recent Pronouncements

In December 2023, the FASB issued Accounting Standards Update 2023-09, Improvements to Income Tax Disclosures (“ASU 2023-09”), which requires enhanced annual disclosures for specific categories in the rate reconciliation and income taxes paid disaggregated by federal, state and foreign taxes. ASU 2023-09 is effective for public business entities for annual periods beginning on or after December 15, 2024. We plan to adopt ASU 2023-09 effective January 1, 2025 applying a retrospective approach to all prior periods presented in the financial statements. We do not believe the adoption of this new standard will have a material effect on our disclosures.

Cash and Cash Equivalents

Cash and Cash Equivalents

Cash and cash equivalents include highly liquid investments with a maturity of three months or less when purchased. Our insurance subsidiaries’ cash equivalent investments in excess of the amounts required to pay estimated professional liability claims during the next twelve months are not included in cash and cash equivalents as these funds are not available for general corporate purposes. Carrying values of cash and cash equivalents approximate fair value due to the short-term nature of these instruments.

Accounts Receivable

Accounts Receivable

We receive payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. We recognize that revenues and receivables from government agencies are significant to our operations, but do not believe there are significant credit risks associated with these government agencies. We do not believe there are any other significant concentrations of revenues from any particular payer that would subject us to any significant credit risks in the collection of our accounts receivable. Days revenues in accounts receivable were 54 days, 53 days and 53 days at December 31, 2024, 2023 and 2022, respectively. Changes in general economic conditions, revenue cycle service center operations, payer mix, payer claim processing, or federal or state governmental health care coverage could affect our collection of accounts receivable, cash flows and results of operations.

Inventories

Inventories

Inventories are stated at the lower of cost (first-in, first-out) or market.

Property and Equipment

Property and Equipment

Depreciation expense, computed using the straight-line method, was $3.294 billion in 2024, $3.052 billion in 2023 and $2.941 billion in 2022. Buildings and improvements are depreciated over estimated useful lives ranging generally from 10 to 40 years. Estimated useful lives of equipment vary generally from four to 10 years.

When events, circumstances or operating results indicate the carrying values of certain property and equipment expected to be held and used might be impaired, we prepare projections of the undiscounted future cash flows expected to result from the use of the assets and their eventual disposition. If the projections indicate the recorded amounts are not expected to be recoverable, such amounts are reduced to estimated fair value. Fair value may be estimated based upon internal evaluations that include quantitative analyses of revenues and cash flows, reviews of recent sales of similar assets and independent appraisals.

Property and equipment to be disposed of are reported at the lower of their carrying amounts or fair value less costs to sell or close. The estimates of fair value are usually based upon recent sales of similar assets and market responses based upon discussions with and offers received from potential buyers.

Investments of Insurance Subsidiaries

Investments of Insurance Subsidiaries

At December 31, 2024 and 2023, the investment securities held by our insurance subsidiaries were classified as “available-for-sale” as defined in Accounting Standards Codification (“ASC”) No. 320, Investments — Debt Securities and are recorded at fair value. The investment securities are held for the purpose of providing a funding source to pay liability claims covered by the insurance subsidiaries. We perform quarterly assessments of individual investment securities to determine whether declines in fair value are due to credit-related or noncredit-related factors. Our investment securities evaluation process involves subjective judgments, often involves estimating the outcome of future events, and requires a significant level of professional judgment in determining whether a credit-related impairment has occurred. We evaluate, among other things, the financial position and near-term prospects of the issuer, conditions in the issuer’s industry, liquidity of the investment, changes in the amount or timing of expected future cash flows from the investment, and recent downgrades of the issuer by a rating agency, to determine if, and when, a decline in the fair value of an investment below amortized cost is considered to be a credit-related impairment. The extent to which the fair value of the investment is less than amortized cost and our ability and intent to retain the investment, to allow for any anticipated recovery of the investment’s fair value, are important components of our investment securities evaluation process.

Goodwill and Intangible Assets

Goodwill and Intangible Assets

Goodwill is not amortized but is subject to annual impairment tests. In addition to the annual impairment review, impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Impairment testing for goodwill is done at the reporting unit level. Reporting units are one level below the business segment level, and our impairment testing is performed at the operating division level. We compare the fair value of the reporting unit assets to the carrying amount, on at least an annual basis, to determine if there is potential impairment. If the fair value of the reporting unit assets is less than their carrying value, an impairment loss is recognized. Fair value is estimated based upon internal evaluations of each reporting unit that include quantitative analyses of market multiples, revenues and cash flows and reviews of recent sales of similar facilities. No goodwill impairments were recognized during 2024, 2023 or 2022.

During 2024, goodwill increased by $170 million related to acquisitions and declined by $6 million related to foreign currency translation and other adjustments. During 2023, goodwill increased by $362 million related to acquisitions and declined by $50 million related to foreign currency translation and other adjustments.

During 2024 and 2023, identifiable intangible assets declined by $16 million and $20 million, respectively, due to amortization and other adjustments. Identifiable intangible assets with finite lives are amortized over estimated lives ranging generally from three to 10 years. The gross carrying amount of amortizable identifiable intangible assets at both December 31, 2024 and 2023 was $274 million and accumulated amortization was $244 million and $228 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2024 and 2023 was $293 million. Indefinite-lived identifiable intangible assets are not amortized but are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist.

Debt Issuance Costs and Discounts

Debt Issuance Costs and Discounts

Debt issuance costs and discounts are amortized based upon the terms of the respective debt obligations. The gross carrying amounts of debt issuance costs and discounts at December 31, 2024 and 2023 were $608 million and $559 million, respectively, and accumulated amortization was $239 million and $226 million, respectively. Amortization of debt issuance costs and discounts is included in interest expense and was $35 million, $35 million and $29 million for 2024, 2023 and 2022, respectively.

Professional Liability Claims

Professional Liability Claims

Reserves for professional liability risks were $2.131 billion and $2.089 billion at December 31, 2024 and 2023, respectively. The current portion of the reserves, $587 million and $532 million at December 31, 2024 and 2023, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $627 million, $619 million and $517 million for 2024, 2023 and 2022, respectively, and are included in “other operating expenses” in our consolidated income statements. Provisions for losses related to professional liability risks are based upon actuarially determined estimates. We recorded an increase to the provision for professional liability risks of $40 million during 2023 and a reduction to the provision for professional liability risks of $55 million for 2022, due to the receipt of updated actuarial information. Loss and loss expense reserves represent the estimated ultimate net cost of all reported and unreported losses incurred and unpaid through the respective consolidated balance sheet dates. The reserves for unpaid losses and loss expenses are estimated using individual case-basis valuations and actuarial analyses. Those estimates are subject to the effects of trends in loss severity and frequency. The estimates are continually reviewed and adjustments are recorded as experience develops or new information becomes known. Adjustments to the estimated reserve amounts are included in current operating results. The reserves for professional liability risks cover approximately 2,100 individual claims at both December 31, 2024 and 2023 and estimates for unreported potential claims. The time period required to resolve these claims can vary depending upon the jurisdiction and whether the claim is settled or litigated. During 2024 and 2023, $600 million and $550 million, respectively, of net payments were made for professional and general liability claims. The estimation of the timing of payments beyond a year can vary significantly. Although considerable variability is inherent in professional liability reserve estimates, we believe the reserves for losses and loss expenses are adequate; however, there can be no assurance the ultimate liability will not exceed our estimates.

A portion of our professional liability risks is insured through our insurance subsidiary. Subject, in most cases, to a $15 million per occurrence self-insured retention, our facilities are insured by our insurance subsidiary for losses up to $80 million per occurrence ($110 million effective January 1, 2025). The insurance subsidiary has obtained reinsurance for professional liability risks generally above a retention level of either $25 million or $35 million per occurrence, depending on the jurisdiction for the related claim. We also maintain professional liability insurance with unrelated commercial carriers for losses in excess of amounts insured by our insurance subsidiary.

The obligations covered by reinsurance and excess insurance contracts are included in the reserves for professional liability risks, as we remain liable to the extent the reinsurers and excess insurance carriers do not meet their obligations under the reinsurance and excess insurance contracts. The amounts receivable under the reinsurance contracts were $35 million and $34 million at December 31, 2024 and 2023, respectively, recorded in “other assets,” and $45 million and $8 million at December 31, 2024 and 2023, respectively, recorded in “other current assets.”

Financial Instruments

Financial Instruments

Derivative financial instruments have been employed to manage risks, including interest rate exposures, and have not been used for trading or speculative purposes. Changes in the fair value of derivatives are recognized periodically either in earnings or in stockholders’ equity, as a component of other comprehensive income, depending on whether the derivative financial instrument qualifies for hedge accounting, and if so, whether it qualifies as a fair value hedge or a cash flow hedge. Gains and losses on derivatives designated as cash flow hedges, to the extent they are effective, are recorded in other comprehensive income, and subsequently reclassified to earnings to offset the impact of the hedged items when they occur. The net interest paid or received on interest rate swaps is recognized as interest expense.

Noncontrolling Interests in Consolidated Entities

Noncontrolling Interests in Consolidated Entities

The consolidated financial statements include all assets, liabilities, revenues and expenses of less than 100% owned entities that we control. Accordingly, we have recorded noncontrolling interests in the earnings and equity of such entities.

Earning Per Share We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding plus the dilutive effect of outstanding SARs, RSUs and PSUs, computed using the treasury stock method.
Fair Value Measurements and Disclosures

Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”) emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).

Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment.

Investment Securities

The investments of our insurance subsidiaries are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency.

Government Investigations, Claims and Litigation

Government Investigations, Claims and Litigation

Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam, or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our results of operations, financial position or liquidity.

We accrue for such contingencies to the extent that it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. If we are a party to any proceeding that, either individually or in the aggregate, is probable or reasonably possible of having a material, adverse effect on the business, our results of operations, financial position or liquidity, we disclose a summary of such contingencies and the amount or range of reasonably possible losses in excess of recorded amounts or that we are unable to reasonably estimate the amount or range of losses.

v3.25.0.1
Accounting Policies (Tables)
12 Months Ended
Dec. 31, 2024
Accounting Policies [Abstract]  
Schedule of Revenues from Third Party Payers, Uninsured and Other Payers Our revenues by primary third-party payer classification and other (including uninsured patients) for the years ended December 31, are summarized in the following table (dollars in millions):

 

 

 

Years Ended December 31,

 

 

 

2024

 

 

Ratio

 

 

2023

 

 

Ratio

 

 

2022

 

 

Ratio

 

Medicare

 

$

10,780

 

 

 

15.3

%

 

$

10,585

 

 

 

16.3

%

 

$

10,447

 

 

 

17.3

%

Managed Medicare

 

 

11,987

 

 

 

17.0

 

 

 

10,496

 

 

 

16.2

 

 

 

9,201

 

 

 

15.3

 

Medicaid

 

 

4,678

 

 

 

6.6

 

 

 

3,606

 

 

 

5.6

 

 

 

2,636

 

 

 

4.4

 

Managed Medicaid

 

 

3,980

 

 

 

5.6

 

 

 

3,879

 

 

 

6.0

 

 

 

3,998

 

 

 

6.6

 

Managed care and other insurers

 

 

34,954

 

 

 

49.5

 

 

 

31,819

 

 

 

49.0

 

 

 

29,120

 

 

 

48.3

 

International (managed care and other insurers)

 

 

1,682

 

 

 

2.4

 

 

 

1,509

 

 

 

2.3

 

 

 

1,317

 

 

 

2.2

 

Other

 

 

2,542

 

 

 

3.6

 

 

 

3,074

 

 

 

4.6

 

 

 

3,514

 

 

 

5.9

 

Revenues

 

$

70,603

 

 

 

100.0

%

 

$

64,968

 

 

 

100.0

%

 

$

60,233

 

 

 

100.0

%

Schedule of Estimated Cost of Uncompensated Care A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions):

 

 

2024

 

 

2023

 

 

2022

 

Patient care costs (salaries and benefits, supplies, other operating
   expenses and depreciation and amortization)

 

$

60,056

 

 

$

55,341

 

 

$

51,180

 

Cost-to-charges ratio (patient care costs as percentage of gross
   patient charges)

 

 

10.1

%

 

 

10.5

%

 

 

11.0

%

Total uncompensated care

 

$

43,231

 

 

$

35,426

 

 

$

31,734

 

Multiply by the cost-to-charges ratio

 

 

10.1

%

 

 

10.5

%

 

 

11.0

%

Estimated cost of total uncompensated care

 

$

4,366

 

 

$

3,720

 

 

$

3,491

 

v3.25.0.1
Share-Based Compensation (Tables)
12 Months Ended
Dec. 31, 2024
Share-Based Payment Arrangement [Abstract]  
Schedule of Fair Value of Each Stock Option Award is Estimated on Grant Date, Using Option Valuation Models The expected dividend yield is estimated based on the assumption that the dividend yield at date of grant will be maintained over the expected life of the grant.

 

 

 

2024

 

 

2023

 

 

2022

 

Risk-free interest rate

 

 

3.94

%

 

 

3.69

%

 

 

1.64

%

Expected volatility

 

 

33

%

 

 

36

%

 

 

34

%

Expected life, in years

 

 

5.23

 

 

 

5.14

 

 

 

5.11

 

Expected dividend yield

 

 

0.87

%

 

 

0.95

%

 

 

0.95

%

 

Schedule of Stock Appreciation Rights Activity

Information regarding Time SAR and Performance SAR activity during 2024, 2023 and 2022 is summarized below (share amounts in thousands):

 

 

Time
SARs

 

 

Performance
SARs

 

 

Total
SARs

 

 

Weighted
Average
Exercise
Price

 

 

Weighted
Average
Remaining
Contractual Term

 

Aggregate
Intrinsic Value
(dollars in millions)

 

SARs outstanding, December 31, 2021

 

 

6,162

 

 

 

286

 

 

 

6,448

 

 

$

113.15

 

 

 

 

 

 

Granted

 

 

570

 

 

 

 

 

 

570

 

 

 

236.00

 

 

 

 

 

 

Exercised

 

 

(660

)

 

 

(159

)

 

 

(819

)

 

 

90.84

 

 

 

 

 

 

Cancelled

 

 

(112

)

 

 

 

 

 

(112

)

 

 

182.87

 

 

 

 

 

 

SARs outstanding, December 31, 2022

 

 

5,960

 

 

 

127

 

 

 

6,087

 

 

 

126.38

 

 

 

 

 

 

Granted

 

 

580

 

 

 

 

 

 

580

 

 

 

253.49

 

 

 

 

 

 

Exercised

 

 

(1,156

)

 

 

(83

)

 

 

(1,239

)

 

 

95.29

 

 

 

 

 

 

Cancelled

 

 

(59

)

 

 

 

 

 

(59

)

 

 

202.05

 

 

 

 

 

 

SARs outstanding, December 31, 2023

 

 

5,325

 

 

 

44

 

 

 

5,369

 

 

 

146.46

 

 

 

 

 

 

Granted

 

 

491

 

 

 

 

 

 

491

 

 

 

305.44

 

 

 

 

 

 

Exercised

 

 

(1,128

)

 

 

(44

)

 

 

(1,172

)

 

 

111.02

 

 

 

 

 

 

Cancelled

 

 

(101

)

 

 

 

 

 

(101

)

 

 

246.78

 

 

 

 

 

 

SARs outstanding, December 31, 2024

 

 

4,587

 

 

 

 

 

 

4,587

 

 

$

170.31

 

 

5.3 years

 

$

598

 

SARs exercisable, December 31, 2024

 

 

3,322

 

 

 

 

 

 

3,322

 

 

$

136.86

 

 

4.3 years

 

$

542

 

Schedule of Restricted Stock Units Activity

Information regarding RSU and PSU activity during 2024, 2023 and 2022 is summarized below (share amounts in thousands):

 

 

RSUs

 

 

PSUs

 

 

Total RSUs
and PSUs

 

 

Weighted
Average
Grant
Date Fair
Value

 

RSUs and PSUs outstanding, December 31, 2021

 

 

2,191

 

 

 

2,083

 

 

 

4,274

 

 

$

150.32

 

Granted

 

 

611

 

 

 

455

 

 

 

1,066

 

 

 

235.71

 

Performance adjustment

 

 

 

 

 

699

 

 

 

699

 

 

 

138.45

 

Vested

 

 

(878

)

 

 

(1,399

)

 

 

(2,277

)

 

 

138.41

 

Cancelled

 

 

(140

)

 

 

(123

)

 

 

(263

)

 

 

183.86

 

RSUs and PSUs outstanding, December 31, 2022

 

 

1,784

 

 

 

1,715

 

 

 

3,499

 

 

 

179.18

 

Granted

 

 

609

 

 

 

479

 

 

 

1,088

 

 

 

253.85

 

Performance adjustment

 

 

 

 

 

697

 

 

 

697

 

 

 

144.42

 

Vested

 

 

(717

)

 

 

(1,393

)

 

 

(2,110

)

 

 

152.50

 

Cancelled

 

 

(125

)

 

 

(88

)

 

 

(213

)

 

 

217.78

 

RSUs and PSUs outstanding, December 31, 2023

 

 

1,551

 

 

 

1,410

 

 

 

2,961

 

 

 

214.71

 

Granted

 

 

582

 

 

 

434

 

 

 

1,016

 

 

 

305.97

 

Performance adjustment

 

 

 

 

 

566

 

 

 

566

 

 

 

174.55

 

Vested

 

 

(639

)

 

 

(1,132

)

 

 

(1,771

)

 

 

181.81

 

Cancelled

 

 

(138

)

 

 

(103

)

 

 

(241

)

 

 

260.96

 

RSUs and PSUs outstanding, December 31, 2024

 

 

1,356

 

 

 

1,175

 

 

 

2,531

 

 

$

260.95

 

 

v3.25.0.1
Income Taxes (Tables)
12 Months Ended
Dec. 31, 2024
Income Tax Disclosure [Abstract]  
Schedule of Provision for Income Taxes

The provision for income taxes consists of the following (dollars in millions):

 

 

2024

 

 

2023

 

 

2022

 

Current:

 

 

 

 

 

 

 

 

 

Federal

 

$

1,202

 

 

$

1,118

 

 

$

1,222

 

State

 

 

212

 

 

 

213

 

 

 

206

 

Foreign

 

 

20

 

 

 

3

 

 

 

18

 

Deferred:

 

 

 

 

 

 

 

 

 

Federal

 

 

394

 

 

 

241

 

 

 

261

 

State

 

 

31

 

 

 

21

 

 

 

27

 

Foreign

 

 

7

 

 

 

19

 

 

 

12

 

 

 

$

1,866

 

 

$

1,615

 

 

$

1,746

 

Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate

A reconciliation of the federal statutory rate to the effective income tax rate follows:

 

 

2024

 

 

2023

 

 

2022

 

Federal statutory rate

 

 

21.0

%

 

 

21.0

%

 

 

21.0

%

State income taxes, net of federal tax benefit

 

 

2.7

 

 

 

2.6

 

 

 

2.3

 

Change in liability for uncertain tax positions

 

 

(2.3

)

 

 

0.4

 

 

 

0.7

 

Tax benefit from settlements of employee equity awards

 

 

(1.2

)

 

 

(1.2

)

 

 

(0.9

)

Internal restructuring of affiliates

 

 

3.5

 

 

 

 

 

 

 

Other items, net

 

 

0.8

 

 

 

0.8

 

 

 

0.5

 

Effective income tax rate on income attributable to HCA Healthcare, Inc.

 

 

24.5

 

 

 

23.6

 

 

 

23.6

 

Income attributable to noncontrolling interests from consolidated partnerships

 

 

(2.6

)

 

 

(2.6

)

 

 

(3.3

)

Effective income tax rate on income before income taxes

 

 

21.9

%

 

 

21.0

%

 

 

20.3

%

Schedule of Deferred Tax Assets and Liabilities

A summary of the items comprising our deferred tax assets and liabilities at December 31 follows (dollars in millions):

 

 

2024

 

 

2023

 

 

 

Assets

 

 

Liabilities

 

 

Assets

 

 

Liabilities

 

Depreciation and fixed asset basis differences

 

$

 

 

$

1,139

 

 

$

 

 

$

1,048

 

Allowances for professional liability and other risks

 

 

395

 

 

 

 

 

 

452

 

 

 

 

Accounts receivable

 

 

418

 

 

 

 

 

 

363

 

 

 

 

Compensation

 

 

285

 

 

 

 

 

 

308

 

 

 

 

Right-of-use lease assets and obligations

 

 

478

 

 

 

462

 

 

 

506

 

 

 

492

 

Other

 

 

297

 

 

 

932

 

 

 

592

 

 

 

860

 

 

 

$

1,873

 

 

$

2,533

 

 

$

2,221

 

 

$

2,400

 

Schedule of Activity Related to our Gross Unrecognized Tax Benefits

The following table summarizes the activity related to our gross unrecognized tax benefits, excluding accrued interest and penalties of $115 million and $177 million as of December 31, 2024 and 2023, respectively (dollars in millions):

 

 

 

2024

 

 

2023

 

Balance at January 1

 

$

639

 

 

$

639

 

Additions based on tax positions related to the current year

 

 

40

 

 

 

30

 

Additions for tax positions of prior years

 

 

63

 

 

 

4

 

Reductions for tax positions of prior years

 

 

(206

)

 

 

(10

)

Settlements

 

 

(17

)

 

 

 

Lapse of applicable statutes of limitations

 

 

(15

)

 

 

(24

)

Balance at December 31

 

$

504

 

 

$

639

 

 

v3.25.0.1
Earnings Per Share (Tables)
12 Months Ended
Dec. 31, 2024
Earnings Per Share [Abstract]  
Schedule of Computations of Basic and Diluted Earnings Per Share

The following table sets forth the computations of basic and diluted earnings per share for the years ended December 31, 2024, 2023 and 2022 (dollars and shares in millions, except per share amounts):

 

 

 

2024

 

 

2023

 

 

2022

 

Net income attributable to HCA Healthcare, Inc.

 

$

5,760

 

 

$

5,242

 

 

$

5,643

 

 

 

 

 

 

 

 

 

 

 

Weighted average common shares outstanding

 

 

258.603

 

 

 

272.404

 

 

 

290.348

 

Effect of dilutive incremental shares

 

 

3.203

 

 

 

4.008

 

 

 

4.318

 

Shares used for diluted earnings per share

 

 

261.806

 

 

 

276.412

 

 

 

294.666

 

Earnings per share:

 

 

 

 

 

 

 

 

 

Basic earnings per share

 

$

22.27

 

 

$

19.25

 

 

$

19.43

 

Diluted earnings per share

 

$

22.00

 

 

$

18.97

 

 

$

19.15

 

v3.25.0.1
Investments of Insurance Subsidiaries (Tables)
12 Months Ended
Dec. 31, 2024
Investments, Debt and Equity Securities [Abstract]  
Schedule of Investments

A summary of the insurance subsidiaries’ investments at December 31 follows (dollars in millions):

 

 

2024

 

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

388

 

 

$

 

 

$

(27

)

 

$

361

 

Money market funds and other

 

 

296

 

 

 

 

 

 

 

 

 

296

 

 

 

$

684

 

 

$

 

 

$

(27

)

 

 

657

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(88

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

569

 

 

NOTE 6 — INVESTMENTS OF INSURANCE SUBSIDIARIES (continued)

 

 

2023

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

404

 

 

$

1

 

 

$

(29

)

 

$

376

 

Money market funds and other

 

 

188

 

 

 

 

 

 

 

 

 

188

 

 

$

592

 

 

$

1

 

 

$

(29

)

 

 

564

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(87

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

477

 

Schedule of Maturities of Investments

Scheduled maturities of investments in debt securities at December 31, 2024 were as follows (dollars in millions):

 

 

 

Amortized
Cost

 

 

Fair
Value

 

Due in one year or less

 

$

31

 

 

$

31

 

Due after one year through five years

 

 

145

 

 

 

140

 

Due after five years through ten years

 

 

147

 

 

 

130

 

Due after ten years

 

 

65

 

 

 

60

 

 

 

$

388

 

 

$

361

 

v3.25.0.1
Assets and Liabilities Measured at Fair Value (Tables)
12 Months Ended
Dec. 31, 2024
Fair Value Disclosures [Abstract]  
Summary of Investments of Insurance Subsidiaries Measured at Fair Value on Recurring Basis

The following tables summarize the investments of our insurance subsidiaries measured at fair value on a recurring basis as of December 31, 2024 and 2023, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

 

 

2024

 

 

 

 

 

 

Fair Value Measurements Using

 

 

 

Fair Value

 

 

Quoted Prices in
Active Markets for
Identical Assets
(Level 1)

 

 

Significant Other
Observable Inputs
(Level 2)

 

 

Significant
Unobservable Inputs
(Level 3)

 

Debt securities

 

$

361

 

 

$

 

 

$

361

 

 

$

 

Money market funds and other

 

 

296

 

 

 

296

 

 

 

 

 

 

 

Investments of insurance subsidiaries

 

 

657

 

 

 

296

 

 

 

361

 

 

 

 

Less amounts classified as current assets

 

 

(88

)

 

 

(88

)

 

 

 

 

 

 

 

 

$

569

 

 

$

208

 

 

$

361

 

 

$

 

 

 

2023

 

 

 

 

 

Fair Value Measurements Using

 

 

Fair Value

 

 

Quoted Prices in
Active Markets for
Identical Assets
(Level 1)

 

 

Significant Other
Observable Inputs
(Level 2)

 

 

Significant
Unobservable Inputs
(Level 3)

 

Debt securities

 

$

376

 

 

$

 

 

$

376

 

 

$

 

Money market funds and other

 

 

188

 

 

 

188

 

 

 

 

 

 

 

Investments of insurance subsidiaries

 

 

564

 

 

 

188

 

 

 

376

 

 

 

 

Less amounts classified as current assets

 

 

(87

)

 

 

(87

)

 

 

 

 

 

 

 

$

477

 

 

$

101

 

 

$

376

 

 

$

 

v3.25.0.1
Long-Term Debt (Tables)
12 Months Ended
Dec. 31, 2024
Debt Disclosure [Abstract]  
Schedule of Long-Term Debt

A summary of long-term debt at December 31, including related interest rates at December 31, 2024, follows (dollars in millions):

 

 

 

2024

 

 

2023

 

Senior secured asset-based revolving credit facility

 

$

 

 

$

1,880

 

Senior secured revolving credit facility

 

 

 

 

 

 

Senior secured term loan facilities (effective interest rate of 5.8%)

 

 

1,238

 

 

 

1,313

 

Other senior secured debt (effective interest rate of 4.6%)

 

 

1,046

 

 

 

967

 

Senior secured debt

 

 

2,284

 

 

 

4,160

 

Senior unsecured notes (effective interest rate of 5.1%)

 

 

41,116

 

 

 

35,766

 

Debt issuance costs and discounts

 

 

(369

)

 

 

(333

)

Total debt (average life of 10.9 years, rates averaging 5.1%)

 

 

43,031

 

 

 

39,593

 

Less amounts due within one year

 

 

4,698

 

 

 

2,424

 

 

 

$

38,333

 

 

$

37,169

 

 

v3.25.0.1
Leases (Tables)
12 Months Ended
Dec. 31, 2024
Leases [Abstract]  
Schedule of lease-related assets and liabilities

The following table presents our lease-related assets and liabilities at December 31, 2024 and 2023 (dollars in millions):

 

 

Balance Sheet Classification

 

2024

 

 

2023

 

Assets:

 

 

 

 

 

 

 

 

Operating leases

 

Right-of-use operating lease assets

 

$

2,131

 

 

$

2,207

 

Finance leases

 

Property and equipment

 

 

646

 

 

 

556

 

Total lease assets

 

 

 

$

2,777

 

 

$

2,763

 

Liabilities:

 

 

 

 

 

 

 

 

Current:

 

 

 

 

 

 

 

 

Operating leases

 

Other accrued expenses

 

$

343

 

 

$

363

 

Finance leases

 

Long-term debt due within one year

 

 

162

 

 

 

166

 

Noncurrent:

 

 

 

 

 

 

 

 

Operating leases

 

Right-of-use operating lease obligations

 

 

1,863

 

 

 

1,903

 

Finance leases

 

Long-term debt

 

 

624

 

 

 

541

 

Total lease liabilities

 

 

 

$

2,992

 

 

$

2,973

 

Weighted-average remaining term:

 

 

 

 

 

 

 

 

Operating leases

 

 

 

11.3 years

 

 

11.8 years

 

Finance leases

 

 

 

10.5 years

 

 

9.0 years

 

Weighted-average discount rate:

 

 

 

 

 

 

 

 

Operating leases

 

 

 

 

5.1

%

 

 

4.9

%

Finance leases

 

 

 

 

5.3

%

 

 

4.9

%

 

Schedule of lease expense for finance and operating leases

 

 

2024

 

 

2023

 

 

2022

 

Finance lease expense:

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 

$

159

 

 

$

164

 

 

$

163

 

Interest

 

 

37

 

 

 

31

 

 

 

29

 

Operating leases(1)

 

 

503

 

 

 

495

 

 

 

484

 

Short-term lease expense(1)

 

 

365

 

 

 

337

 

 

 

329

 

Variable lease expense(1)

 

 

181

 

 

 

162

 

 

 

163

 

 

 

$

1,245

 

 

$

1,189

 

 

$

1,168

 

Expenses are included in “other operating expenses” in our consolidated income statements.
Schedule of supplemental cash flow information

The following table presents supplemental cash flow information for the years ended December 31, 2024, 2023 and 2022 (dollars in millions):

 

 

 

2024

 

 

2023

 

 

2022

 

Cash paid for amounts included in the measurement of lease liabilities:

 

 

 

 

 

 

 

 

 

Operating cash flows for operating leases

 

$

490

 

 

$

479

 

 

$

473

 

Operating cash flows for finance leases

 

 

37

 

 

 

31

 

 

 

29

 

Financing cash flows for finance leases

 

 

172

 

 

 

140

 

 

 

124

 

Schedule of undiscounted cash flows to the finance lease liabilities and operating lease liabilities recorded on balance sheet

The following table reconciles the undiscounted minimum lease payment amounts to the operating and finance lease liabilities recorded on the balance sheet at December 31, 2024 and 2023 (dollars in millions):

 

 

 

2024

 

 

2023

 

 

 

Operating
Leases

 

 

Finance
Leases

 

 

Operating
Leases

 

 

Finance
Leases

 

Year 1

 

$

455

 

 

$

197

 

 

$

452

 

 

$

193

 

Year 2

 

 

405

 

 

 

146

 

 

 

394

 

 

 

155

 

Year 3

 

 

344

 

 

 

99

 

 

 

340

 

 

 

115

 

Year 4

 

 

281

 

 

 

81

 

 

 

288

 

 

 

60

 

Year 5

 

 

221

 

 

 

71

 

 

 

228

 

 

 

45

 

Thereafter

 

 

1,460

 

 

 

497

 

 

 

1,540

 

 

 

356

 

Total minimum lease payments

 

 

3,166

 

 

 

1,091

 

 

 

3,242

 

 

 

924

 

Less: amount of lease payments representing interest

 

 

(960

)

 

 

(305

)

 

 

(976

)

 

 

(217

)

Present value of future minimum lease payments

 

 

2,206

 

 

 

786

 

 

 

2,266

 

 

 

707

 

Less: current lease obligations

 

 

(343

)

 

 

(162

)

 

 

(363

)

 

 

(166

)

Long-term lease obligations

 

$

1,863

 

 

$

624

 

 

$

1,903

 

 

$

541

 

v3.25.0.1
Segment and Geographic Information (Tables)
12 Months Ended
Dec. 31, 2024
Segment Reporting [Abstract]  
Schedule Of Geographic Distributions Of Revenues, Salaries And Benefits, Supplies, Other Operating Expenses, Equity In Earnings Of Affiliates, Adjusted Segment EBITDA, Depreciation And Amortization, Assets And Goodwill And Other Intangible Assets The geographic distributions of our revenues, salaries and benefits, supplies, other operating expenses, equity in earnings or losses of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets that are provided to the Chief Operating Decision Maker, which is the Chief Executive Officer, are summarized in the following tables (dollars in millions) and represent the operating segments at December 31, 2024:

 

 

 

For the Year Ended December 31, 2024

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

Revenues

 

$

19,614

 

 

$

23,171

 

 

$

24,601

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

7,483

 

 

 

8,525

 

 

 

8,529

 

Supplies

 

 

2,812

 

 

 

3,553

 

 

 

4,035

 

Other operating expenses

 

 

4,892

 

 

 

6,124

 

 

 

6,363

 

Equity in (earnings) losses of affiliates

 

 

2

 

 

 

(3

)

 

 

(62

)

 

 

 

15,189

 

 

 

18,199

 

 

 

18,865

 

Adjusted segment EBITDA

 

$

4,425

 

 

$

4,972

 

 

$

5,736

 

 

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

 

 

For the Year Ended December 31, 2023

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

Revenues

 

$

18,105

 

 

$

21,167

 

 

$

22,318

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

7,196

 

 

 

8,058

 

 

 

8,080

 

Supplies

 

 

2,658

 

 

 

3,331

 

 

 

3,616

 

Other operating expenses

 

 

4,253

 

 

 

5,289

 

 

 

5,473

 

Equity in (earnings) losses of affiliates

 

 

(2

)

 

 

(3

)

 

 

(59

)

 

 

 

14,105

 

 

 

16,675

 

 

 

17,110

 

Adjusted segment EBITDA

 

$

4,000

 

 

$

4,492

 

 

$

5,208

 

 

 

 

 

For the Year Ended December 31, 2022

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

Revenues

 

$

16,767

 

 

$

19,324

 

 

$

20,858

 

 

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

 

6,959

 

 

 

7,752

 

 

 

7,757

 

Supplies

 

 

2,569

 

 

 

3,088

 

 

 

3,331

 

Other operating expenses

 

 

3,624

 

 

 

4,606

 

 

 

4,711

 

Equity in (earnings) losses of affiliates

 

 

(1

)

 

 

(3

)

 

 

(43

)

 

 

 

13,151

 

 

 

15,443

 

 

 

15,756

 

Adjusted segment EBITDA

 

$

3,616

 

 

$

3,881

 

 

$

5,102

 

 

 

 

For the Year Ended December 31,

 

 

 

2024

 

 

2023

 

 

2022

 

Adjusted segment EBITDA:

 

 

 

 

 

 

 

 

 

National Group

 

$

4,425

 

 

$

4,000

 

 

$

3,616

 

Atlantic Group

 

 

4,972

 

 

 

4,492

 

 

 

3,881

 

American Group

 

 

5,736

 

 

 

5,208

 

 

 

5,102

 

 

 

 

15,133

 

 

 

13,700

 

 

 

12,599

 

Adjustments to reconcile Total Adjusted segment
  EBITDA to consolidated Income before income taxes:

 

 

 

 

 

 

 

 

 

Corporate and Other

 

 

1,251

 

 

 

974

 

 

 

532

 

Depreciation and amortization

 

 

3,312

 

 

 

3,077

 

 

 

2,969

 

Interest expense

 

 

2,061

 

 

 

1,938

 

 

 

1,741

 

Losses (gains) on sales of facilities

 

 

(14

)

 

 

5

 

 

 

(1,301

)

Losses on retirement of debt

 

 

 

 

 

 

 

 

78

 

Income before income taxes

 

$

8,523

 

 

$

7,706

 

 

$

8,580

 

 

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

 

 

For the Year Ended December 31,

 

 

 

2024

 

 

2023

 

 

2022

 

Revenues:

 

 

 

 

 

 

 

 

 

National Group

 

$

19,614

 

 

$

18,105

 

 

$

16,767

 

Atlantic Group

 

 

23,171

 

 

 

21,167

 

 

 

19,324

 

American Group

 

 

24,601

 

 

 

22,318

 

 

 

20,858

 

Corporate and other

 

 

3,217

 

 

 

3,378

 

 

 

3,284

 

 

 

$

70,603

 

 

$

64,968

 

 

$

60,233

 

 

 

 

 

 

 

 

 

 

 

Depreciation and amortization:

 

 

 

 

 

 

 

 

 

National Group

 

$

857

 

 

$

834

 

 

$

801

 

Atlantic Group

 

 

1,061

 

 

 

989

 

 

 

921

 

American Group

 

 

1,083

 

 

 

971

 

 

 

937

 

Corporate and other

 

 

311

 

 

 

283

 

 

 

310

 

 

 

$

3,312

 

 

$

3,077

 

 

$

2,969

 

 

 

 

 

December 31,

 

 

 

2024

 

 

2023

 

 

2022

 

Assets:

 

 

 

 

 

 

 

 

 

National Group

 

$

12,855

 

 

$

12,487

 

 

$

11,793

 

Atlantic Group

 

 

17,168

 

 

 

16,098

 

 

 

15,092

 

American Group

 

 

20,714

 

 

 

19,786

 

 

 

17,934

 

Corporate and other

 

 

8,776

 

 

 

7,840

 

 

 

7,619

 

 

 

$

59,513

 

 

$

56,211

 

 

$

52,438

 

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

 

Corporate
and Other

 

 

Total

 

Goodwill and other intangible assets:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at December 31, 2021

 

$

1,212

 

 

$

1,970

 

 

$

5,062

 

 

$

1,296

 

 

$

9,540

 

Acquisitions

 

 

75

 

 

 

90

 

 

 

90

 

 

 

7

 

 

 

262

 

Foreign currency translation, amortization and other

 

 

(43

)

 

 

(3

)

 

 

 

 

 

(103

)

 

 

(149

)

Balance at December 31, 2022

 

 

1,244

 

 

 

2,057

 

 

 

5,152

 

 

 

1,200

 

 

 

9,653

 

Acquisitions

 

 

 

 

 

8

 

 

 

326

 

 

 

28

 

 

 

362

 

Foreign currency translation, amortization and other

 

 

(3

)

 

 

(1

)

 

 

 

 

 

(66

)

 

 

(70

)

Balance at December 31, 2023

 

 

1,241

 

 

 

2,064

 

 

 

5,478

 

 

 

1,162

 

 

 

9,945

 

Acquisitions

 

 

 

 

 

61

 

 

 

105

 

 

 

4

 

 

 

170

 

Foreign currency translation, amortization and other

 

 

(4

)

 

 

(1

)

 

 

3

 

 

 

(20

)

 

 

(22

)

Balance at December 31, 2024

 

$

1,237

 

 

$

2,124

 

 

$

5,586

 

 

$

1,146

 

 

$

10,093

 

v3.25.0.1
Other Comprehensive Loss (Tables)
12 Months Ended
Dec. 31, 2024
Equity [Abstract]  
Components of Accumulated Other Comprehensive Loss

The components of accumulated other comprehensive loss are as follows (dollars in millions):

 

 

 

Unrealized
Gains (Losses) on
Available-
for-Sale
Securities

 

 

Foreign
Currency
Translation
Adjustments

 

 

Defined
Benefit
Plans

 

 

Change
in Fair
Value of
Derivative
Instruments

 

 

Total

 

Balances at December 31, 2021

 

$

12

 

 

$

(278

)

 

$

(132

)

 

$

(6

)

 

$

(404

)

Unrealized losses on available-for-sale securities, net
   of $
12 income tax benefit

 

 

(43

)

 

 

 

 

 

 

 

 

 

 

 

(43

)

Foreign currency translation adjustments, net of $16
   income tax benefit

 

 

 

 

 

(95

)

 

 

 

 

 

 

 

 

(95

)

Defined benefit plans, net of $11 of income taxes

 

 

 

 

 

 

 

 

38

 

 

 

 

 

 

38

 

Change in fair value of derivative instruments, net of
   $
1 of income taxes

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

5

 

Expense reclassified into operations from other
   comprehensive income, net of none, $
2 and $1
   income tax benefits, respectively

 

 

1

 

 

 

 

 

 

7

 

 

 

1

 

 

 

9

 

Balances at December 31, 2022

 

 

(30

)

 

 

(373

)

 

 

(87

)

 

 

 

 

 

(490

)

Unrealized gains on available-for-sale securities, net
   of $
2 of income taxes

 

 

9

 

 

 

 

 

 

 

 

 

 

 

 

9

 

Foreign currency translation adjustments, net of $7
   of income taxes

 

 

 

 

 

34

 

 

 

 

 

 

 

 

 

34

 

Defined benefit plans, net of $6 of income taxes

 

 

 

 

 

 

 

 

21

 

 

 

 

 

 

21

 

Expense (benefit) reclassified into operations from
   other comprehensive income, net of
none of income
   taxes and $
1 income tax benefit, respectively

 

 

(1

)

 

 

 

 

 

2

 

 

 

 

 

 

1

 

Balances at December 31, 2023

 

 

(22

)

 

 

(339

)

 

 

(64

)

 

 

 

 

 

(425

)

Unrealized gains on available-for-sale securities

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

1

 

Foreign currency translation adjustments, net of $2
   income tax benefit

 

 

 

 

 

(14

)

 

 

 

 

 

 

 

 

(14

)

Defined benefit plans, net of $15 of income taxes

 

 

 

 

 

 

 

 

50

 

 

 

 

 

 

50

 

Expense reclassified into operations from
   other comprehensive income

 

 

 

 

 

 

 

 

1

 

 

 

 

 

 

1

 

Balances at December 31, 2024

 

$

(21

)

 

$

(353

)

 

$

(13

)

 

$

 

 

$

(387

)

v3.25.0.1
Accrued Expenses (Tables)
12 Months Ended
Dec. 31, 2024
Text Block [Abstract]  
Summary of Other Accrued Expenses

A summary of other accrued expenses at December 31 follows (dollars in millions):

 

 

2024

 

 

2023

 

Professional liability risks

 

$

587

 

 

$

532

 

Defined contribution benefit plans

 

 

704

 

 

 

668

 

Right-of-use operating leases

 

 

343

 

 

 

363

 

Taxes other than income

 

 

419

 

 

 

382

 

Interest

 

 

502

 

 

 

414

 

Employee medical benefits

 

 

206

 

 

 

199

 

Other

 

 

1,138

 

 

 

1,313

 

 

 

$

3,899

 

 

$

3,871

 

v3.25.0.1
Accounting Policies - Additional Information (Detail)
1 Months Ended 12 Months Ended
Jan. 01, 2025
USD ($)
Nov. 30, 2017
Dec. 31, 2024
USD ($)
Hospital
EndoscopyCenter
SurgeryCenter
Claim
State
Dec. 31, 2023
USD ($)
Claim
Dec. 31, 2022
USD ($)
Summary Of Significant Accounting Policies [Line Items]          
Number of owned and operated hospitals | Hospital     190    
Number of freestanding surgery centers | SurgeryCenter     124    
Number of freestanding endoscopy centers | EndoscopyCenter     26    
Number of facilities locations | State     20    
General and administrative expense     $ 421,000,000 $ 353,000,000 $ 307,000,000
Adjustments to estimated reimbursement filed during respective year     42,000,000 84,000,000 56,000,000
Adjustments to estimated reimbursement filed during previous years     78,000,000 58,000,000 42,000,000
Estimated implicit price concessions recorded as reductions to revenues and accounts receivable     7,773,000,000 7,283,000,000  
Charity care amount     15,942,000,000 14,425,000,000 13,615,000,000
Estimated costs of charity care     $ 1,610,000,000 $ 1,515,000,000 $ 1,498,000,000
Days revenues in accounts receivable     54 days 53 days 53 days
Depreciation expense     $ 3,294,000,000 $ 3,052,000,000.000 $ 2,941,000,000
Goodwill impairments     0 0 0
Goodwill acquired during period     170,000,000 362,000,000  
Intangible assets decreased due to amortization and other adjustments     16,000,000 20,000,000  
Gross carrying amount of intangible assets     274,000,000 274,000,000  
Accumulated amortization of intangible assets     244,000,000 228,000,000  
Gross carrying amount of indefinite-lived intangible assets     293,000,000 293,000,000  
Deferred loan costs     608,000,000 559,000,000  
Deferred loan costs, accumulated amortization     239,000,000 226,000,000  
Amortization of debt issuance costs     35,000,000 35,000,000 29,000,000
Reserves for professional liability risks     2,131,000,000 2,089,000,000.000  
Current portion of professional liability risks reserves     587,000,000 532,000,000  
Provisions for losses related to professional liability risks     $ 627,000,000 619,000,000 517,000,000
Increase (decrease) in provisions for professional liability risks       $ 40,000,000 $ 55,000,000
Reserves for professional liability risks cover individual claims | Claim     2,100 2,100  
Net payments of professional and general liability claims     $ 600,000,000 $ 550,000,000  
Self-insured retention amount per occurrence     15,000,000    
Maximum amount losses per occurrence     80,000,000    
Reinsurance for professional liability risks retention minimum level of amount per occurrence     25,000,000    
Reinsurance for professional liability risks retention level of amount per occurrence     35,000,000    
Amounts receivable under reinsurance contracts recorded in other assets     35,000,000 34,000,000  
Amounts receivable under reinsurance contracts recorded in other current assets     45,000,000 8,000,000  
Foreign Currency Translation And Other [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Goodwill increase (decrease)     $ 6,000,000 $ 50,000,000  
Subsequent Event [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Maximum amount losses per occurrence $ 110,000,000        
Inpatient Services [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Performance obligations for inpatient/ outpatient services satisfied period     Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges    
Maximum [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Percentage of income of federal poverty level eligible for charity care   400.00%      
Finite lived intangible asset useful life     10 years    
Maximum [Member] | Outpatient Services [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Performance obligations for inpatient/ outpatient services satisfied period     Our performance obligations for outpatient services are generally satisfied over a period of less than one day    
Maximum [Member] | Building and Improvements [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Estimated useful lives in years     40 years    
Maximum [Member] | Equipment [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Estimated useful lives in years     10 years    
Minimum [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Finite lived intangible asset useful life     3 years    
Minimum [Member] | Building and Improvements [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Estimated useful lives in years     10 years    
Minimum [Member] | Equipment [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Estimated useful lives in years     4 years    
v3.25.0.1
Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Revenues From Third Party Payers [Line Items]      
Revenues $ 70,603 $ 64,968 $ 60,233
Revenues ratio from third party payers 100.00% 100.00% 100.00%
Medicare [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 10,780 $ 10,585 $ 10,447
Revenues from third party payers, Ratio 15.30% 16.30% 17.30%
Managed Medicare [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 11,987 $ 10,496 $ 9,201
Revenues from third party payers, Ratio 17.00% 16.20% 15.30%
Medicaid [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 4,678 $ 3,606 $ 2,636
Revenues from third party payers, Ratio 6.60% 5.60% 4.40%
Managed Medicaid [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 3,980 $ 3,879 $ 3,998
Revenues from third party payers, Ratio 5.60% 6.00% 6.60%
Managed Care and Other Insurers [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 34,954 $ 31,819 $ 29,120
Revenues from third party payers, Ratio 49.50% 49.00% 48.30%
International (Managed Care and Other Insurers) [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 1,682 $ 1,509 $ 1,317
Revenues from third party payers, Ratio 2.40% 2.30% 2.20%
Other [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues $ 2,542 $ 3,074 $ 3,514
Other, Ratio 3.60% 4.60% 5.90%
v3.25.0.1
Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Accounting Policies [Abstract]      
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 60,056 $ 55,341 $ 51,180
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) 10.10% 10.50% 11.00%
Total uncompensated care $ 43,231 $ 35,426 $ 31,734
Multiply by the cost-to-charges ratio 10.10% 10.50% 11.00%
Estimated cost of total uncompensated care $ 4,366 $ 3,720 $ 3,491
v3.25.0.1
Share-Based Compensation - Additional Information (Detail) - USD ($)
$ / shares in Units, $ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Employee Stock Purchase Plan ("ESPP") [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Common stock were reserved for issuance 9,618,000    
Compensation expense $ 18 $ 17 $ 16
Stock Appreciation Rights (SARs)      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Shares Available for Future Grants 7,316,000    
Weighted Average Fair Value of SARs Options Granted $ 102.65 $ 87.47 $ 69.55
Total Intrinsic Value of SARs $ 257 $ 207 $ 115
Unrecognized Compensation Cost Related to Nonvested Awards 47    
Restricted Stock Units and Performance Stock Units [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
RSUs and PSUs, Vested, value 539 $ 550 $ 550
Unrecognized Compensation Cost Related to Nonvested Awards $ 383    
v3.25.0.1
Share-Based Compensation - Schedule of Fair Value of Each Stock Option Award is Estimated on Grant Date, Using Option Valuation Models (Detail)
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]      
Risk-free interest rate 3.94% 3.69% 1.64%
Expected volatility 33.00% 36.00% 34.00%
Expected life, in years 5 years 2 months 23 days 5 years 1 month 20 days 5 years 1 month 9 days
Expected dividend yield 0.87% 0.95% 0.95%
v3.25.0.1
Share-Based Compensation - Schedule of Stock Appreciation Rights Activity (Detail) - USD ($)
$ / shares in Units, shares in Thousands, $ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
SARs Options outstanding, Weighted Average Exercise Price, Beginning Balance $ 146.46 $ 126.38 $ 113.15
Granted, Weighted Average Exercise Price 305.44 253.49 236
Exercised, Weighted Average Exercise Price 111.02 95.29 90.84
Cancelled, Weighted Average Exercise Price 246.78 202.05 182.87
SARs Options outstanding, Weighted Average Exercise Price, Ending Balance 170.31 $ 146.46 $ 126.38
SARs Options exercisable, Weighted Average Exercise Price $ 136.86    
SARs Options outstanding, Weighted Average Remaining Contractual Term 5 years 3 months 18 days    
SARs Options exercisable, Weighted Average Remaining Contractual Term 4 years 3 months 18 days    
SARs Options outstanding, Aggregate Intrinsic Value $ 598    
SARs Options exercisable, Aggregate Intrinsic Value $ 542    
Time SARs [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
SARs Options Outstanding, Beginning Balance 5,325 5,960 6,162
Granted, SARs Options 491 580 570
Exercised, SARs Options (1,128) (1,156) (660)
Cancelled, SARs Options (101) (59) (112)
SARs Options Outstanding, Ending Balance 4,587 5,325 5,960
SARs Options Exercisable, Ending Balance 3,322    
Performance SARs [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
SARs Options Outstanding, Beginning Balance 44 127 286
Granted, SARs Options 0 0 0
Exercised, SARs Options (44) (83) (159)
Cancelled, SARs Options 0 0 0
SARs Options Outstanding, Ending Balance 0 44 127
SARs Options Exercisable, Ending Balance 0    
Total SARs [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
SARs Options Outstanding, Beginning Balance 5,369 6,087 6,448
Granted, SARs Options 491 580 570
Exercised, SARs Options (1,172) (1,239) (819)
Cancelled, SARs Options (101) (59) (112)
SARs Options Outstanding, Ending Balance 4,587 5,369 6,087
SARs Options Exercisable, Ending Balance 3,322    
v3.25.0.1
Share-Based Compensation - Schedule of Restricted Stock Units Activity (Detail) - $ / shares
shares in Thousands
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Restricted Stock Units (RSUs) [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
RSUs and PSUs Outstanding, Beginning Balance 1,551 1,784 2,191
RSUs and PSUs, Granted 582 609 611
Performance adjustment 0 0 0
RSUs and PSUs, Vested (639) (717) (878)
RSUs and PSUs, Cancelled (138) (125) (140)
RSUs and PSUs Outstanding, Ending Balance 1,356 1,551 1,784
Performance Shares PSUs [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
RSUs and PSUs Outstanding, Beginning Balance 1,410 1,715 2,083
RSUs and PSUs, Granted 434 479 455
Performance adjustment 566 697 699
RSUs and PSUs, Vested (1,132) (1,393) (1,399)
RSUs and PSUs, Cancelled (103) (88) (123)
RSUs and PSUs Outstanding, Ending Balance 1,175 1,410 1,715
Restricted Stock Units and Performance Stock Units [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
RSUs and PSUs Outstanding, Beginning Balance 2,961 3,499 4,274
RSUs and PSUs, Granted 1,016 1,088 1,066
Performance adjustment 566 697 699
RSUs and PSUs, Vested (1,771) (2,110) (2,277)
RSUs and PSUs, Cancelled (241) (213) (263)
RSUs and PSUs Outstanding, Ending Balance 2,531 2,961 3,499
Weighted Average Grant Date Fair Value, RSUs and PSUs, Beginning balance $ 214.71 $ 179.18 $ 150.32
Weighted Average Grant Date Fair Value, RSUs and PSUs, Granted 305.97 253.85 235.71
Performance adjustment 174.55 144.42 138.45
Weighted Average Grant Date Fair Value, RSUs and PSUs, Vested 181.81 152.5 138.41
Weighted Average Grant Date Fair Value, RSUs and PSUs, Cancelled 260.96 217.78 183.86
Weighted Average Grant Date Fair Value, RSUs and PSUs, Ending balance $ 260.95 $ 214.71 $ 179.18
v3.25.0.1
Acquisitions and Dispositions - Additional Information (Detail)
$ in Millions
12 Months Ended
Dec. 31, 2024
USD ($)
Hospital
Dec. 31, 2023
USD ($)
Hospital
Dec. 31, 2022
USD ($)
Business Acquisition [Line Items]      
Pretax gain (loss) before tax   $ (5)  
Proceeds from sale of business $ 328 193 $ 1,237
Real Estate and Other Investments [Member]      
Business Acquisition [Line Items]      
Pretax gain (loss) before tax (5)   274
Gain (loss) after tax $ (4)   $ 200
Discontinued Operation, Gain (Loss) on Disposal, Statement of Income or Comprehensive Income [Extensible Enumeration] Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property   Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property
Proceeds from sale of business $ 33 31 $ 326
Discontinued Operations, Disposed of by Sale [Member]      
Business Acquisition [Line Items]      
Pretax gain (loss) before tax     1,027
Gain (loss) after tax     $ 527
Discontinued Operation, Gain (Loss) on Disposal, Statement of Income or Comprehensive Income [Extensible Enumeration]     Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property
Proceeds from sale of business     $ 911
Hospital Facility [Member]      
Business Acquisition [Line Items]      
Aggregate purchase price $ 112 $ 229  
Number of hospitals purchased | Hospital 3 4  
Proceeds from sale of business $ 295 $ 162  
Number of hospitals sold | Hospital 1 2  
Hospital Facility One [Member] | Discontinued Operations, Disposed of by Sale [Member] | CALIFORNIA      
Business Acquisition [Line Items]      
Pretax gain (loss) before tax $ 189    
Gain (loss) after tax $ 145    
Discontinued Operation, Gain (Loss) on Disposal, Statement of Income or Comprehensive Income [Extensible Enumeration] Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property    
Hospital Facility Two [Member] | Discontinued Operations, Disposed of by Sale [Member] | CALIFORNIA      
Business Acquisition [Line Items]      
Pretax gain (loss) before tax $ (170)    
Gain (loss) after tax $ (130)    
Discontinued Operation, Gain (Loss) on Disposal, Statement of Income or Comprehensive Income [Extensible Enumeration] Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property    
Nonhospital Health Care [Member]      
Business Acquisition [Line Items]      
Aggregate purchase price $ 154 $ 406 224
Fair value of the noncontrolling interest in the acquiree at the acquisition date     72
Other [Member]      
Business Acquisition [Line Items]      
Goodwill $ 170 $ 362 $ 262
v3.25.0.1
Income Taxes - Schedule of Provision for Income Taxes (Detail) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Income Tax Disclosure [Abstract]      
Current, Federal $ 1,202 $ 1,118 $ 1,222
Current, State 212 213 206
Current, Foreign 20 3 18
Deferred, Federal 394 241 261
Deferred, State 31 21 27
Deferred, Foreign 7 19 12
Provision for income taxes $ 1,866 $ 1,615 $ 1,746
v3.25.0.1
Income Taxes - Additional Information (Detail) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Income Tax Contingency [Line Items]      
Provision for tax benefits related to settlement of employee awards $ 102 $ 93 $ 77
Income taxes interest and penalty expense 61 36 23
Increase in tax provision, due to internal restructuring of certain affiliates 276    
Foreign pretax income 79 85 $ 66
State net operating loss carryforwards 167    
Unrecognized tax benefits, accrued interest 115 177  
Unrecognized tax benefits that would impact effective tax rate 295 $ 320  
Reduced Tax Provision 254    
Income tax examination interest expense net of tax 118    
Tax cuts and jobs act of 2017 income tax examination change in tax rate 181    
Tax cuts and jobs act of 2017 income tax examination interest expense net of tax $ 47    
State and Local Jurisdiction [Member] | Minimum [Member]      
Income Tax Contingency [Line Items]      
Net operating loss carryforwards, expiration date 2025    
State and Local Jurisdiction [Member] | Maximum [Member]      
Income Tax Contingency [Line Items]      
Net operating loss carryforwards, expiration date 2042    
v3.25.0.1
Income Taxes - Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate (Detail)
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Income Tax Disclosure [Abstract]      
Federal statutory rate 21.00% 21.00% 21.00%
State income taxes, net of federal tax benefit 2.70% 2.60% 2.30%
Change in liability for uncertain tax positions (2.30%) 0.40% 0.70%
Tax benefit from settlements of employee equity awards (1.20%) (1.20%) (0.90%)
Internal restructuring of affiliates 3.50% 0.00% 0.00%
Other items, net 0.80% 0.80% 0.50%
Effective income tax rate on income attributable to HCA Healthcare, Inc. 24.50% 23.60% 23.60%
Income attributable to noncontrolling interests from consolidated partnerships (2.60%) (2.60%) (3.30%)
Effective income tax rate on income before income taxes 21.90% 21.00% 20.30%
v3.25.0.1
Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Detail) - USD ($)
$ in Millions
Dec. 31, 2024
Dec. 31, 2023
Income Tax Disclosure [Abstract]    
Depreciation and fixed asset basis differences, Assets $ 0 $ 0
Allowances for professional liability and other risks, Assets 395 452
Accounts receivable, Assets 418 363
Compensation, Assets 285 308
Right-of-use lease obligations 478 506
Other, Assets 297 592
Deferred tax assets 1,873 2,221
Depreciation and fixed asset basis differences, Liabilities 1,139 1,048
Allowances for professional liability and other risks, Liabilities 0 0
Accounts receivable, Liabilities 0 0
Compensation, Liabilities 0 0
Right-of-use lease assets and obligations 462 492
Other, Liabilities 932 860
Deferred tax liabilities $ 2,533 $ 2,400
v3.25.0.1
Income Taxes - Schedule of Activity Related to Unrecognized Tax Benefits (Detail) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Income Tax Disclosure [Abstract]    
Beginning Balance $ 639 $ 639
Additions based on tax positions related to the current year 40 30
Additions for tax positions of prior years 63 4
Reductions for tax positions of prior years (206) (10)
Settlements (17) 0
Lapse of applicable statutes of limitations (15) (24)
Ending Balance $ 504 $ 639
v3.25.0.1
Earnings Per Share - Additional information (Detail) - shares
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Earnings Per Share [Abstract]      
Repurchase of common stock, shares 17,798,000 14,465,000 30,747,000
v3.25.0.1
Earnings Per Share - Schedule of Computations of Basic and Diluted Earnings Per Share (Detail) - USD ($)
$ / shares in Units, shares in Thousands, $ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Earnings Per Share [Abstract]      
Net income attributable to HCA Healthcare, Inc. $ 5,760 $ 5,242 $ 5,643
Weighted average common shares outstanding 258,603 272,404 290,348
Effect of dilutive incremental shares 3,203 4,008 4,318
Shares used for diluted earnings per share 261,806 276,412 294,666
Basic earnings per share $ 22.27 $ 19.25 $ 19.43
Diluted earnings per share $ 22 $ 18.97 $ 19.15
v3.25.0.1
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($)
$ in Millions
Dec. 31, 2024
Dec. 31, 2023
Debt Securities, Available-for-sale [Line Items]    
Amounts classified as current assets $ (88) $ (87)
Investment carrying value 569 477
Money market funds and other, Amortized Cost 296 188
Money market funds and other, Unrealized Gains 0 0
Money market funds and other, Unrealized Losses 0 0
Money market funds and other, Fair Value 296 188
Investment Owned, at Cost, Total 684 592
Investment Gains 0 1
Investment Losses (27) (29)
Investment Fiar Value 657 564
Debt Securities [Member]    
Debt Securities, Available-for-sale [Line Items]    
Amortized Cost 388 404
Unrealized Amounts, Gains 0 1
Unrealized Amounts, Losses (27) (29)
Fair Value $ 361 $ 376
v3.25.0.1
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail)
$ in Millions
Dec. 31, 2024
USD ($)
Investments, Debt and Equity Securities [Abstract]  
Due in one year or less, Amortized Cost $ 31
Due after one year through five years, Amortized Cost 145
Due after five years through ten years, Amortized Cost 147
Due after ten years, Amortized Cost 65
Amortized Cost, Total 388
Due in one year or less, Fair Value 31
Due after one year through five years, Fair Value 140
Due after five years through ten years, Fair Value 130
Due after ten years, Fair Value 60
Fair Value, Total $ 361
v3.25.0.1
Investments of Insurance Subsidiaries - Additional Information (Detail)
12 Months Ended
Dec. 31, 2024
Investments, Debt and Equity Securities [Abstract]  
Available for sale securities expected maturity of debt securities 4 years 4 months 24 days
Available for sale securities average scheduled maturity 8 years 1 month 6 days
v3.25.0.1
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Derivative Instruments, Gain (Loss) [Line Items]      
Amount of Loss Recognized in OCI on Derivatives, Net of Tax $ 0 $ 0 $ (6)
v3.25.0.1
Assets and Liabilities Measured at Fair Value - Summary of Investments of Insurance Subsidiaries Measured at Fair Value on Recurring Basis (Detail) - USD ($)
$ in Millions
Dec. 31, 2024
Dec. 31, 2023
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Money market funds and other $ 296 $ 188
Investments of insurance subsidiaries 657 564
Less amounts classified as current assets (88) (87)
Asset fair value 569 477
Quoted Prices in Active Markets for Identical Assets (Level 1) [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Money market funds and other 296 188
Investments of insurance subsidiaries 296 188
Less amounts classified as current assets (88) (87)
Asset fair value 208 101
Significant Other Observable Inputs (Level 2) [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Investments of insurance subsidiaries 361 376
Asset fair value 361 376
Debt Securities [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Debt securities 361 376
Debt Securities [Member] | Significant Other Observable Inputs (Level 2) [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Debt securities $ 361 $ 376
v3.25.0.1
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($)
$ in Millions
Dec. 31, 2024
Dec. 31, 2023
Fair Value Disclosures [Abstract]    
Estimated fair value of long-term debt $ 40,845 $ 38,253
Carrying amounts of long-term debt $ 43,400 $ 39,926
v3.25.0.1
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($)
$ in Millions
Dec. 31, 2024
Dec. 31, 2023
Debt Instrument [Line Items]    
Senior secured debt $ 2,284 $ 4,160
Debt issuance costs and discounts (369) (333)
Total debt (average life of 9.4 years, rates averaging 5.1%) 43,031 39,593
Less amounts due within one year 4,698 2,424
Long-term debt 38,333 37,169
Senior Secured Asset-Based Revolving Credit Facility [Member]    
Debt Instrument [Line Items]    
Long-term line of credit 0 1,880
Senior Secured Revolving Credit Facility [Member]    
Debt Instrument [Line Items]    
Long-term line of credit 0 0
Senior Secured Term Loan Facilities [Member]    
Debt Instrument [Line Items]    
Senior secured debt 1,238 1,313
Other Senior Secured Debt [Member]    
Debt Instrument [Line Items]    
Other senior secured debt 1,046 967
Senior Unsecured Notes [Member]    
Debt Instrument [Line Items]    
Senior unsecured notes $ 41,116 $ 35,766
v3.25.0.1
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail)
12 Months Ended
Dec. 31, 2024
Debt Instrument [Line Items]  
Total debt average term 10 years 10 months 24 days
Total debt average rate 5.10%
Senior Secured Term Loan Facilities [Member]  
Debt Instrument [Line Items]  
Effective interest rate 5.80%
Other Senior Secured Debt [Member]  
Debt Instrument [Line Items]  
Effective interest rate 4.60%
Senior Unsecured Notes [Member]  
Debt Instrument [Line Items]  
Effective interest rate 5.10%
v3.25.0.1
Long-Term Debt - Additional Information (Detail) - USD ($)
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Aug. 31, 2024
Feb. 29, 2024
Debt Instrument [Line Items]          
Repayments of debt $ 2,410,000,000 $ 909,000,000 $ 2,830,000,000    
Debt instrument basis spread 0.50%        
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration] Federal Fund Rate [Member]        
Maturity of long-term debt in 2026 $ 5,386,000,000        
Maturity of long-term debt in 2027 2,460,000,000        
Maturity of long-term debt in 2028 2,606,000,000        
Maturity of long-term debt in 2029 $ 3,563,000,000        
Minimum [Member]          
Debt Instrument [Line Items]          
Debt instrument, maturities range 2026        
Maximum [Member]          
Debt Instrument [Line Items]          
Debt instrument, maturities range 2029        
Asset-Based Revolving Credit Facility Maturing on June 28, 2022 [Member]          
Debt Instrument [Line Items]          
Maximum borrowing capacity $ 4,500,000,000        
Percentage of senior secured credit facility over eligible accounts receivable 85.00%        
Senior Secured Revolving Credit Facility Maturing On June 28, 2022 [Member]          
Debt Instrument [Line Items]          
Maximum borrowing capacity $ 3,500,000,000        
Asset Based Revolving Credit Facility Maturing On June Thirty Two Thousand Twenty Six [Member]          
Debt Instrument [Line Items]          
Debt instrument maturity date Jun. 30, 2026        
Senior Secured Revolving Credit Facility Maturing On June Thirty Two Thousand Twenty Six [Member]          
Debt Instrument [Line Items]          
Debt instrument maturity date Jun. 30, 2026        
Line of credit outstanding $ 0        
Asset Based Revolving Credit Facility Maturing On June Thirty Two Thousand Twenty Six One [Member]          
Debt Instrument [Line Items]          
Maximum borrowing capacity $ 1,238,000,000        
Debt instrument maturity date Jun. 30, 2026        
Senior Unsecured Note Maturities Ranging 2025 to 2064 [Member] | Minimum [Member]          
Debt Instrument [Line Items]          
Debt instrument, maturities range 2025        
Senior Unsecured Note Maturities Ranging 2025 to 2064 [Member] | Maximum [Member]          
Debt Instrument [Line Items]          
Debt instrument, maturities range 2064        
Medium-term Notes Maturity Year 2025 [Member]          
Debt Instrument [Line Items]          
Debt instrument, principal amount $ 125,000,000        
Debentures Maturities Ranging 2027 to 2095 [Member]          
Debt Instrument [Line Items]          
Debt instrument, principal amount $ 450,000,000        
Debentures Maturities Ranging 2027 to 2095 [Member] | Minimum [Member]          
Debt Instrument [Line Items]          
Debt instrument, maturities range 2027        
Debentures Maturities Ranging 2027 to 2095 [Member] | Maximum [Member]          
Debt Instrument [Line Items]          
Debt instrument, maturities range 2095        
Senior Notes [Member]          
Debt Instrument [Line Items]          
Debt instrument, principal amount       $ 3,000,000,000 $ 4,500,000,000
Senior Notes [Member] | Senior Secured Notes Due 2024 [Member]          
Debt Instrument [Line Items]          
Debt instrument, stated interest 5.00%        
Repayments of debt $ 2,000,000,000        
Senior Notes [Member] | Senior Secured Notes Due 2031 [Member]          
Debt Instrument [Line Items]          
Debt instrument, principal amount 1,750,000,000     $ 750,000,000 $ 1,000,000,000
Debt instrument, stated interest       5.45% 5.45%
Senior Notes [Member] | Senior Secured Notes Due 2034 [Member]          
Debt Instrument [Line Items]          
Debt instrument, principal amount       $ 1,250,000,000 $ 1,300,000,000
Debt instrument, stated interest       5.45% 5.60%
Senior Notes [Member] | Senior Secured Notes Due 2054 [Member]          
Debt Instrument [Line Items]          
Debt instrument, principal amount       $ 1,000,000,000 $ 1,500,000,000
Debt instrument, stated interest       5.95% 6.00%
Senior Notes [Member] | Senior Secured Notes Due 2064 [Member]          
Debt Instrument [Line Items]          
Debt instrument, principal amount         $ 700,000,000
Debt instrument, stated interest         6.10%
Senior Notes [Member] | Senior Unsecured Note Maturities Ranging 2025 to 2064 [Member]          
Debt Instrument [Line Items]          
Debt instrument, principal amount 40,541,000,000        
Other Senior Secured Debt [Member]          
Debt Instrument [Line Items]          
Finance leases and other secured debt $ 1,046,000,000.000        
v3.25.0.1
Leases - Schedule Of Lease-Related Assets And Liabilities (Detail) - USD ($)
$ in Millions
Dec. 31, 2024
Dec. 31, 2023
Assets:    
Operating leases $ 2,131 $ 2,207
Finance leases 646 556
Total lease assets $ 2,777 $ 2,763
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration] Property, Plant and Equipment, Net Property, Plant and Equipment, Net
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration] Operating leases Operating leases
Liabilities    
Operating leases $ 343 $ 363
Finance leases 162 166
Right-of-use operating lease obligations 1,863 1,903
Finance leases 624 541
Total lease liabilities $ 2,992 $ 2,973
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration] Less amounts due within one year Less amounts due within one year
Operating Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration] Other Accrued Liabilities, Current Other Accrued Liabilities, Current
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration] Long-Term Debt, Excluding Current Maturities Long-Term Debt, Excluding Current Maturities
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration] Right-of-use operating lease obligations Right-of-use operating lease obligations
Weighted-average remaining term:    
Operating leases 11 years 3 months 18 days 11 years 9 months 18 days
Finance leases 10 years 6 months 9 years
Weighted-average discount rate:    
Operating leases 5.10% 4.90%
Finance leases 5.30% 4.90%
v3.25.0.1
Leases - Schedule Of Lease Expense For Finance And Operating Leases (Detail) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Finance lease expense:      
Depreciation and amortization $ 159 $ 164 $ 163
Interest 37 31 29
Operating leases [1] 503 495 484
Short-term lease expense [1] 365 337 329
Variable lease expense [1] 181 162 163
Total lease expense $ 1,245 $ 1,189 $ 1,168
[1] Expenses are included in “other operating expenses” in our consolidated income statements.
v3.25.0.1
Leases - Schedule Of Supplemental Cash Flow Information (Detail) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Cash Paid For Amounts Included In Measurement Of Lease Liabilities [Abstract]      
Operating cash flows for operating leases $ 490 $ 479 $ 473
Operating cash flows for finance leases 37 31 29
Financing cash flows for finance leases $ 172 $ 140 $ 124
v3.25.0.1
Leases - Schedule of undiscounted cash flows to the finance lease liabilities and operating lease liabilities (Detail) - USD ($)
$ in Millions
Dec. 31, 2024
Dec. 31, 2023
Operating Lease Liabilities, Payments Due [Abstract]    
Year 1 $ 455 $ 452
Year 2 405 394
Year 3 344 340
Year 4 281 288
Year 5 221 228
Thereafter 1,460 1,540
Total minimum lease payments 3,166 3,242
Less: amount of lease payments representing interest (960) (976)
Present value of future minimum lease payments 2,206 2,266
Less: current obligations under leases (343) (363)
Long-term lease obligations 1,863 1,903
Finance Lease Liabilities, Payments, Due [Abstract]    
Year 1 197 193
Year 2 146 155
Year 3 99 115
Year 4 81 60
Year 5 71 45
Thereafter 497 356
Total minimum lease payments 1,091 924
Less: amount of lease payments representing interest (305) (217)
Present value of future minimum lease payments 786 707
Less: current obligations under leases (162) (166)
Long-term lease obligations $ 624 $ 541
v3.25.0.1
Capital Stock - Additional Information (Detail)
$ / shares in Units, $ in Millions
12 Months Ended
Dec. 31, 2024
USD ($)
$ / shares
Directors
shares
Dec. 31, 2023
$ / shares
shares
Dec. 31, 2022
$ / shares
shares
Jan. 31, 2025
USD ($)
Jan. 31, 2024
USD ($)
Jan. 31, 2023
USD ($)
Jan. 31, 2022
USD ($)
Feb. 28, 2021
USD ($)
Capital Structure [Line Items]                
Common stock, shares authorized | shares 1,800,000,000 1,800,000,000            
Repurchase of common stock, shares | shares 17,798,000 14,465,000 30,747,000          
Repurchase price of common stock, per share | $ / shares $ 337.74 $ 263.47 $ 227.67          
Board of Directors Chairman [Member]                
Capital Structure [Line Items]                
Share repurchase program authorized amount | $ $ 764       $ 6,000 $ 3,000 $ 8,000 $ 6,000
Subsequent Event [Member] | Board of Directors Chairman [Member]                
Capital Structure [Line Items]                
Share repurchase program authorized amount | $       $ 10,000        
Minimum [Member]                
Capital Structure [Line Items]                
Number of directors as per the amended and restated by-laws | Directors 3              
v3.25.0.1
Employee Benefit Plans - Additional Information (Detail) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Defined Contribution Benefit Plans [Member]      
Pension Plans, Postretirement and Other Employee Benefits [Line Items]      
Percentage of employer contribution to match participant contribution in defined contribution plan, net 100.00%    
Benefits expense of defined benefit plans $ 689 $ 659 $ 606
Defined benefit plan cost (credit) (6) 2 (11)
Defined benefit plan, projected benefit obligation in excess of plan assets $ 118 43  
Defined Contribution Benefit Plans [Member] | Minimum [Member]      
Pension Plans, Postretirement and Other Employee Benefits [Line Items]      
Percentage of employer contribution to match participant contribution in defined contribution plan 3.00%    
Defined Contribution Benefit Plans [Member] | Maximum [Member]      
Pension Plans, Postretirement and Other Employee Benefits [Line Items]      
Percentage of employer contribution to match participant contribution in defined contribution plan 9.00%    
Restoration Plan [Member]      
Pension Plans, Postretirement and Other Employee Benefits [Line Items]      
Number of hours of service required to qualify for the plan 1,000 or more    
Noncontributory and nonqualified plan, benefit expense (credit) $ 31 40 (27)
Noncontributory and nonqualified plan, accrued benefits liabilities 229 227  
Supplemental Executive Retirement Plan [Member]      
Pension Plans, Postretirement and Other Employee Benefits [Line Items]      
Defined benefit plan cost (credit) 7 10 $ 22
Defined benefit plan obligation $ 109 $ 106  
v3.25.0.1
Segment and Geographic Information - Additional Information (Detail)
12 Months Ended
Dec. 31, 2024
Hospital
Segment Reporting Information [Line Items]  
Number of geographically organized groups 3
Number of owned and operated hospitals 190
Accounting Standards Update 2023-07 [Member]  
Segment Reporting Information [Line Items]  
Change in Accounting Principle, Accounting Standards Update, Adoption Date Jan. 01, 2024
Reorganization Group [Member] | National Group [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 55
Reorganization Group [Member] | American Group [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 65
Reorganization Group [Member] | Atlantic Group [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 62
Reorganization Group [Member] | Corporate and Other [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 8
v3.25.0.1
Segment and Geographic Information - Schedule Of Geographic Distributions Of Revenues, Salaries And Benefits, Supplies, Other Operating Expenses, Equity In Earnings Of Affiliates, Adjusted Segment EBITDA, Depreciation And Amortization, Assets And Goodwill And Other Intangible Assets (Detail) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Segment Reporting Information [Line Items]      
Revenues $ 70,603 $ 64,968 $ 60,233
Salaries and benefits 31,170 29,487 27,685
Supplies 10,755 9,902 9,371
Other operating expenses 14,819 12,875 11,155
Equity in (earnings) losses of affiliates (23) (22) (45)
Depreciation and amortization 3,312 3,077 2,969
Interest expense 2,061 1,938 1,741
Losses (gains) on sales of facilities (14) 5 (1,301)
Losses on retirement of debt 0 0 78
Income before income taxes 8,523 7,706 8,580
Assets 59,513 56,211 52,438
Goodwill and other intangible assets, Beginning Balance 9,945 9,653 9,540
Goodwill and other intangible assets, Acquisitions 170 362 262
Foreign Currency Translation Amortization And Other (22) (70) (149)
Goodwill and other intangible assets, Ending Balance 10,093 9,945 9,653
Operating Segments [Member]      
Segment Reporting Information [Line Items]      
Adjusted segment EBITDA 15,133 13,700 12,599
Eliminations and Reconciling Items [Member]      
Segment Reporting Information [Line Items]      
Corporate and Other 1,251 974 532
Depreciation and amortization 3,312 3,077 2,969
Interest expense 2,061 1,938 1,741
Losses (gains) on sales of facilities (14) 5 (1,301)
Losses on retirement of debt 0 0 (78)
Income before income taxes 8,523 7,706 8,580
National Group [Member]      
Segment Reporting Information [Line Items]      
Goodwill and other intangible assets, Beginning Balance 1,241 1,244 1,212
Goodwill and other intangible assets, Acquisitions 0 0 75
Foreign Currency Translation Amortization And Other (4) (3) (43)
Goodwill and other intangible assets, Ending Balance 1,237 1,241 1,244
National Group [Member] | Operating Segments [Member]      
Segment Reporting Information [Line Items]      
Revenues 19,614 18,105 16,767
Salaries and benefits 7,483 7,196 6,959
Supplies 2,812 2,658 2,569
Other operating expenses 4,892 4,253 3,624
Equity in (earnings) losses of affiliates 2 (2) (1)
Operating expenses 15,189 14,105 13,151
Adjusted segment EBITDA 4,425 4,000 3,616
Depreciation and amortization 857 834 801
Assets 12,855 12,487 11,793
Atlantic Group [Member]      
Segment Reporting Information [Line Items]      
Goodwill and other intangible assets, Beginning Balance 2,064 2,057 1,970
Goodwill and other intangible assets, Acquisitions 61 8 90
Foreign Currency Translation Amortization And Other (1) (1) (3)
Goodwill and other intangible assets, Ending Balance 2,124 2,064 2,057
Atlantic Group [Member] | Operating Segments [Member]      
Segment Reporting Information [Line Items]      
Revenues 23,171 21,167 19,324
Salaries and benefits 8,525 8,058 7,752
Supplies 3,553 3,331 3,088
Other operating expenses 6,124 5,289 4,606
Equity in (earnings) losses of affiliates (3) (3) (3)
Operating expenses 18,199 16,675 15,443
Adjusted segment EBITDA 4,972 4,492 3,881
Depreciation and amortization 1,061 989 921
Assets 17,168 16,098 15,092
American Group [Member]      
Segment Reporting Information [Line Items]      
Goodwill and other intangible assets, Beginning Balance 5,478 5,152 5,062
Goodwill and other intangible assets, Acquisitions 105 326 90
Foreign Currency Translation Amortization And Other 3 0 0
Goodwill and other intangible assets, Ending Balance 5,586 5,478 5,152
American Group [Member] | Operating Segments [Member]      
Segment Reporting Information [Line Items]      
Revenues 24,601 22,318 20,858
Salaries and benefits 8,529 8,080 7,757
Supplies 4,035 3,616 3,331
Other operating expenses 6,363 5,473 4,711
Equity in (earnings) losses of affiliates (62) (59) (43)
Operating expenses 18,865 17,110 15,756
Adjusted segment EBITDA 5,736 5,208 5,102
Depreciation and amortization 1,083 971 937
Assets 20,714 19,786 17,934
Corporate and Other [Member]      
Segment Reporting Information [Line Items]      
Revenues 3,217 3,378 3,284
Depreciation and amortization 311 283 310
Assets 8,776 7,840 7,619
Goodwill and other intangible assets, Beginning Balance 1,162 1,200 1,296
Goodwill and other intangible assets, Acquisitions 4 28 7
Foreign Currency Translation Amortization And Other (20) (66) (103)
Goodwill and other intangible assets, Ending Balance $ 1,146 $ 1,162 $ 1,200
v3.25.0.1
Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Equity [Abstract]      
Unrealized gains (losses) on available-for-sale securities, beginning balances $ (22) $ (30) $ 12
Unrealized gains (losses) on available-for-sale securities, net of income taxes 1 9 (43)
Unrealized gains (losses) on available-for-sale securities, expense (benefit) reclassified into operations from other comprehensive income, net of income tax benefit   (1) 1
Unrealized gains (losses) on available-for-sale securities, ending balances (21) (22) (30)
Foreign currency translation adjustments, beginning balances (339) (373) (278)
Foreign currency translation adjustments, net of income tax benefit (14) 34 (95)
Foreign currency translation adjustments, ending balances (353) (339) (373)
Defined benefit plans, beginning balances (64) (87) (132)
Defined benefit plans, net of income taxes 50 21 38
Defined benefit plans, expense (benefit) reclassified into operations from other comprehensive income 1 2 7
Defined benefit plans, ending balances (13) (64) (87)
Change in fair value of derivative instruments, beginning balances 0 0 (6)
Change in fair value of derivative instruments, net of income taxes     5
Change in fair value of derivatives instruments, (income) expense (benefit) reclassified into operations from other comprehensive income     1
Change in fair value of derivative instruments, ending balances 0 0 0
Accumulated other comprehensive loss, net of tax, beginning balances (425) (490) (404)
Unrealized gains (losses) on available-for-sale securities, net of income taxes 1 9 (43)
Foreign currency translation adjustments, net of income tax benefit (14) 34 (95)
Change in fair value of derivative instruments, net of income tax benefit     5
Defined benefit plans, net of income tax benefit 50 21 38
Expense (benefit) reclassified into operations from other comprehensive income, Total 1 1 9
Accumulated other comprehensive loss, net of tax, ending balances $ (387) $ (425) $ (490)
v3.25.0.1
Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Equity [Abstract]      
Unrealized losses on available-for-sale securities, tax benefit     $ 12
Foreign currency translation adjustments, income tax benefit $ 2   16
Foreign currency translation adjustments, income tax expense   $ 7  
Unrealized gains on available-for-sale securities, tax expense   2  
Foreign currency translation adjustments, income tax expense   7  
Defined benefit plans, income tax expense $ 15 6 11
Change in fair value of derivative instruments, income tax expense     1
Defined benefit plans, benefit reclassified into operations from other comprehensive income   0 2
Interest expense on derivative instruments, benefit reclassified into operations from other comprehensive income   $ 1 $ 1
v3.25.0.1
Other Accrued Expenses - Summary of Other Accrued Expenses (Detail) - USD ($)
$ in Millions
Dec. 31, 2024
Dec. 31, 2023
Payables and Accruals [Abstract]    
Professional liability risks $ 587 $ 532
Defined contribution benefit plans 704 668
Right-of-use operating leases 343 363
Taxes other than income 419 382
Interest 502 414
Employee medical benefits 206 199
Other 1,138 1,313
Other accrued expenses $ 3,899 $ 3,871