HCA HEALTHCARE, INC., 10-K filed on 2/16/2024
Annual Report
v3.24.0.1
Cover Page - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Jan. 31, 2024
Jun. 30, 2023
Cover [Abstract]      
Document Type 10-K    
Amendment Flag false    
Document Period End Date Dec. 31, 2023    
Document Fiscal Year Focus 2023    
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   264,498,700  
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     $ 61,126
ICFR Auditor Attestation Flag true    
Auditor Firm ID 42    
Auditor Name Ernst & Young LLP    
Auditor Location Nashville, Tennessee, United States of America    
Document Financial Statement Error Correction [Flag] false    
Documents Incorporated by Reference

Portions of the Registrant’s definitive proxy materials for its 2024 Annual Meeting of Stockholders are incorporated by reference into Part III hereof.

 

    
v3.24.0.1
Consolidated Income Statements - USD ($)
shares in Thousands, $ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Statement [Abstract]      
Revenues $ 64,968 $ 60,233 $ 58,752
Salaries and benefits 29,487 27,685 26,779
Supplies 9,902 9,371 9,481
Other operating expenses 12,875 11,155 9,961
Equity in earnings of affiliates (22) (45) (113)
Depreciation and amortization 3,077 2,969 2,853
Interest expense 1,938 1,741 1,566
Losses (gains) on sales of facilities 5 (1,301) (1,620)
Losses on retirement of debt 0 78 12
Total expenses including equity in earnings of affiliates 57,262 51,653 48,919
Income before income taxes 7,706 8,580 9,833
Provision for income taxes 1,615 1,746 2,112
Net income 6,091 6,834 7,721
Net income attributable to noncontrolling interests 849 1,191 765
Net income attributable to HCA Healthcare, Inc. $ 5,242 $ 5,643 $ 6,956
Per share data:      
Basic earnings per share $ 19.25 $ 19.43 $ 21.52
Diluted earnings per share $ 18.97 $ 19.15 $ 21.16
Shares used in earnings per share calculations (in millions):      
Basic 272,404 290,348 323,315
Diluted 276,412 294,666 328,752
v3.24.0.1
Consolidated Comprehensive Income Statements - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Statement of Comprehensive Income [Abstract]      
Net income $ 6,091 $ 6,834 $ 7,721
Other comprehensive income (loss) before taxes:      
Foreign currency translation 41 (111) (9)
Unrealized gains (losses) on available-for-sale securities 11 (55) (16)
Losses (gains) included in other operating expenses (1) 1 0
Total Unrealized losses on available-for-sale securities 10 (54) (16)
Defined benefit plans 27 49 87
Pension costs included in salaries and benefits 3 9 28
Total defined benefit plans 30 58 115
Change in fair value of derivative financial instruments 0 6 1
Interest costs included in interest expense 0 2 37
Total change in fair value of derivative financial instruments 0 8 38
Other comprehensive income (loss) before taxes 81 (99) 128
Income taxes (benefits) related to other comprehensive income items 16 (13) 30
Other comprehensive income (loss) 65 (86) 98
Comprehensive income 6,156 6,748 7,819
Comprehensive income attributable to noncontrolling interests 849 1,191 765
Comprehensive income attributable to HCA Healthcare, Inc. $ 5,307 $ 5,557 $ 7,054
v3.24.0.1
Consolidated Balance Sheets - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Current assets:    
Cash and cash equivalents $ 935 $ 908
Accounts receivable 9,958 8,891
Inventories 2,021 2,068
Other 2,013 1,776
Total current assets 14,927 13,643
Property and equipment, at cost:    
Land 3,120 2,799
Buildings 21,560 20,221
Equipment 31,998 29,981
Construction in progress 1,870 1,756
Property and equipment, at cost 58,548 54,757
Accumulated depreciation (30,833) (29,182)
Property and equipment, net 27,715 25,575
Investments of insurance subsidiaries 477 381
Investments in and advances to affiliates 756 823
Goodwill and other intangible assets 9,945 9,653
Right-of-use operating lease assets 2,207 2,065
Other 184 298
Total assets 56,211 52,438
Current liabilities:    
Accounts payable 4,233 4,239
Accrued salaries 2,127 1,712
Other accrued expenses 3,871 3,581
Long-term debt due within one year 2,424 370
Total current liabilities 12,655 9,902
Long-term debt, less debt issuance costs and discounts of $333 and $301 37,169 37,714
Professional liability risks 1,557 1,528
Right-of-use operating lease obligations 1,903 1,752
Income taxes and other liabilities 1,867 1,615
Stockholders' equity (deficit):    
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 265,537,300 shares - 2023 and 277,378,300 shares - 2022 3 3
Accumulated other comprehensive loss (425) (490)
Retained deficit (1,352) (2,280)
Stockholders' deficit attributable to HCA Healthcare, Inc. (1,774) (2,767)
Noncontrolling interests 2,834 2,694
Total stockholders' equity (deficit) 1,060 (73)
Total liabilities and stockholders' equity (deficit) $ 56,211 $ 52,438
v3.24.0.1
Consolidated Balance Sheets (Parenthetical) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Statement of Financial Position [Abstract]    
Debt issuance costs $ 333 $ 301
Common stock, par value $ 0.01 $ 0.01
Common stock, shares authorized 1,800,000,000 1,800,000,000
Common stock, shares outstanding 265,537,300 277,378,300
v3.24.0.1
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, 2020 $ 2,892 $ 3 $ 294 $ (502) $ 777 $ 2,320
Balance, shares at Dec. 31, 2020   339,426,000        
Comprehensive income (loss) 7,819     98 6,956 765
Repurchase of common stock $ (8,215)   (578)   (7,637)  
Repurchase of common stock, shares (37,812,000) (37,812,000)        
Share-based benefit plans $ 280   280      
Share-based benefit plans, shares   3,863,000        
Cash dividends declared (628)       (628)  
Distributions (749)         (749)
Other 90   4     86
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)   (186)   (3,656)  
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        
v3.24.0.1
Consolidated Statements of Stockholders' Equity (Deficit) (Parenthetical) - $ / shares
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Statement of Stockholders' Equity [Abstract]      
Cash dividends declared, per share $ 2.4 $ 2.24 $ 1.92
v3.24.0.1
Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Cash flows from operating activities:      
Net income $ 6,091 $ 6,834 $ 7,721
Increase (decrease) in cash from operating assets and liabilities:      
Accounts receivable (935) (797) (962)
Inventories and other assets (126) (59) (540)
Accounts payable and accrued expenses 604 (296) 999
Depreciation and amortization 3,077 2,969 2,853
Income taxes 229 571 (70)
Losses (gains) on sales of facilities 5 (1,301) (1,620)
Losses on retirement of debt 0 78 12
Amortization of debt issuance costs and discounts 35 29 27
Share-based compensation 262 341 440
Other 189 153 99
Net cash provided by operating activities 9,431 8,522 8,959
Cash flows from investing activities:      
Purchase of property and equipment (4,744) (4,395) (3,577)
Acquisition of hospitals and health care entities (635) (224) (1,105)
Sales of hospitals and health care entities 193 1,237 2,160
Change in investments (112) 14 (117)
Other (19) (21) (4)
Net cash used in investing activities (5,317) (3,389) (2,643)
Cash flows from financing activities:      
Issuances of long-term debt 3,224 5,997 4,344
Net change in revolving credit facilities (1,020) 120 2,780
Repayment of long-term debt (909) (2,830) (3,869)
Distributions to noncontrolling interests (640) (1,025) (749)
Payment of debt issuance costs (31) (53) (38)
Payment of dividends (661) (653) (624)
Repurchase of common stock (3,811) (7,000) (8,215)
Other (246) (212) (284)
Net cash used in financing activities (4,094) (5,656) (6,655)
Effect of exchange rate changes on cash and cash equivalents 7 (20) (3)
Change in cash and cash equivalents 27 (543) (342)
Cash and cash equivalents at beginning of period 908 1,451 1,793
Cash and cash equivalents at end of period 935 908 1,451
Interest payments 1,892 1,662 1,502
Income tax payments, net $ 1,386 $ 1,175 $ 2,182
v3.24.0.1
Pay vs Performance Disclosure - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Pay vs Performance Disclosure      
Net Income (Loss) $ 5,242 $ 5,643 $ 6,956
v3.24.0.1
Insider Trading Arrangements
 3 Months Ended
Dec. 31, 2023
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
v3.24.0.1
Accounting Policies
 12 Months Ended
Dec. 31, 2023
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, 2023 these affiliates owned and operated 186 hospitals, 124 freestanding surgery centers, 24 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 $315 million, $307 million and $337 million for the years ended December 31, 2023, 2022 and 2021, 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,

 

 

 

2023

 

 

Ratio

 

 

2022

 

 

Ratio

 

 

2021

 

 

Ratio

 

Medicare

 

$

10,585

 

 

 

16.3

%

 

$

10,447

 

 

 

17.3

%

 

$

10,447

 

 

 

17.8

%

Managed Medicare

 

 

10,496

 

 

 

16.2

 

 

 

9,201

 

 

 

15.3

 

 

 

8,424

 

 

 

14.3

 

Medicaid

 

 

3,606

 

 

 

5.6

 

 

 

2,636

 

 

 

4.4

 

 

 

2,290

 

 

 

3.9

 

Managed Medicaid

 

 

3,879

 

 

 

6.0

 

 

 

3,998

 

 

 

6.6

 

 

 

3,124

 

 

 

5.3

 

Managed care and other insurers

 

 

31,819

 

 

 

49.0

 

 

 

29,120

 

 

 

48.3

 

 

 

30,295

 

 

 

51.6

 

International (managed care and other insurers)

 

 

1,509

 

 

 

2.3

 

 

 

1,317

 

 

 

2.2

 

 

 

1,336

 

 

 

2.3

 

Other

 

 

3,074

 

 

 

4.6

 

 

 

3,514

 

 

 

5.9

 

 

 

2,836

 

 

 

4.8

 

Revenues

 

$

64,968

 

 

 

100.0

%

 

$

60,233

 

 

 

100.0

%

 

$

58,752

 

 

 

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 $84 million, $56 million and $53 million in 2023, 2022 and 2021, respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in net increases to revenues of $58 million in 2023, $42 million in 2022 and $19 million in 2021.

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 attempt to 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, 2023 and 2022, estimated implicit price concessions of $7.283 billion and $6.780 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):

 

 

2023

 

 

2022

 

 

2021

 

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

 

$

55,341

 

 

$

51,180

 

 

$

49,074

 

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

 

 

10.5

%

 

 

11.0

%

 

 

11.3

%

Total uncompensated care

 

$

35,426

 

 

$

31,734

 

 

$

29,642

 

Multiply by the cost-to-charges ratio

 

 

10.5

%

 

 

11.0

%

 

 

11.3

%

Estimated cost of total uncompensated care

 

$

3,720

 

 

$

3,491

 

 

$

3,350

 

The total uncompensated care amounts include charity care of $14.425 billion, $13.615 billion and $13.644 billion for the years ended December 31, 2023, 2022 and 2021, respectively. The estimated cost of charity care was $1.515 billion, $1.498 billion and $1.542 billion for the years ended December 31, 2023, 2022 and 2021, respectively.

Recent Pronouncements

In November 2023, the FASB issued Accounting Standards Update 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures (“ASU 2023-07”), which requires enhanced disclosures for significant segment expenses. ASU 2023-07 is effective for public business entities for annual periods beginning on January 1, 2024 and interim periods beginning on January 1, 2025. We plan to adopt ASU 2023-07 on the respective annual and interim effective dates 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.

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 January 1, 2025. 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.

Our cash management system provides for daily investment of available balances and the funding of outstanding checks when presented for payment. Outstanding, but unpresented, checks totaling $600 million and $656 million at December 31, 2023 and 2022, respectively, have been included in “accounts payable” in the consolidated balance sheets. Upon presentation for payment, these checks are funded through available cash balances or our credit facility.

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 53 days, 53 days and 49 days at December 31, 2023, 2022 and 2021, respectively. Changes in general economic conditions, patient accounting 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 $3.052 billion in 2023, $2.941 billion in 2022 and $2.826 billion in 2021. 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, 2023 and 2022, 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 2023, 2022 or 2021.

During 2023, goodwill increased by $362 million related to acquisitions and declined by $50 million related to foreign currency translation and other adjustments. During 2022, goodwill increased by $262 million related to acquisitions and declined by $105 million related to foreign currency translation and other adjustments.

During 2023 and 2022, identifiable intangible assets declined by $20 million and $44 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, 2023 and 2022 was $274 million and accumulated amortization was $228 million and $208 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2023 and 2022 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, 2023 and 2022 were $559 million and $496 million, respectively, and accumulated amortization was $226 million and $195 million, respectively. Amortization of debt issuance costs and discounts is included in interest expense and was $35 million, $29 million and $27 million for 2023, 2022 and 2021, respectively.

 

NOTE 1 — ACCOUNTING POLICIES (continued)

Professional Liability Claims

Reserves for professional liability risks were $2.089 billion and $2.043 billion at December 31, 2023 and 2022, respectively. The current portion of the reserves, $532 million and $515 million at December 31, 2023 and 2022, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $619 million, $517 million and $453 million for 2023, 2022 and 2021, 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 reductions to the provision for professional liability risks of $55 million and $87 million for 2022 and 2021, respectively, 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 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 and 2,000 individual claims at December 31, 2023 and 2022, respectively, 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 2023 and 2022, $550 million and $497 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. 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 $34 million and $48 million at December 31, 2023 and 2022, respectively, recorded in “other assets,” and $8 million and $12 million at December 31, 2023 and 2022, 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.

v3.24.0.1
Share-Based Compensation
 12 Months Ended
Dec. 31, 2023
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, 2023 there were 11.056 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, 2023, 13.784 million shares of common stock were reserved for ESPP issuances. During 2023, 2022 and 2021, the Company recognized $17 million, $16 million and $15 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.

 

 

 

2023

 

 

2022

 

 

2021

 

Risk-free interest rate

 

 

3.69

%

 

 

1.64

%

 

 

0.68

%

Expected volatility

 

 

36

%

 

 

34

%

 

 

36

%

Expected life, in years

 

 

5.14

 

 

 

5.11

 

 

 

6.17

 

Expected dividend yield

 

 

0.95

%

 

 

0.95

%

 

 

1.10

%

 

NOTE 2 — SHARE-BASED COMPENSATION (continued)

SAR, RSU and PSU Activity (continued)

Information regarding Time SAR and Performance SAR activity during 2023, 2022 and 2021 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, 2020

 

 

7,836

 

 

 

819

 

 

 

8,655

 

 

$

91.53

 

 

 

 

 

 

Granted

 

 

877

 

 

 

—

 

 

 

877

 

 

 

174.98

 

 

 

 

 

 

Exercised

 

 

(2,443

)

 

 

(533

)

 

 

(2,976

)

 

 

67.57

 

 

 

 

 

 

Cancelled

 

 

(108

)

 

 

—

 

 

 

(108

)

 

 

138.32

 

 

 

 

 

 

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

 

 

5.5 years

 

$

667

 

SARs exercisable, December 31, 2023

 

 

3,748

 

 

 

44

 

 

 

3,792

 

 

$

118.67

 

 

4.5 years

 

$

576

 

 

The weighted average fair values of SARs granted during 2023, 2022 and 2021 were $87.47, $69.55 and $54.57 per share, respectively. The intrinsic values of SARs exercised during 2023, 2022 and 2021 were $207 million, $115 million and $404 million, respectively. As of December 31, 2023, the unrecognized compensation cost related to nonvested SARs was $46 million.

Information regarding RSU and PSU activity during 2023, 2022 and 2021 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, 2020

 

 

2,476

 

 

 

2,592

 

 

 

5,068

 

 

$

125.40

 

Granted

 

 

899

 

 

 

689

 

 

 

1,588

 

 

 

174.34

 

Performance adjustment

 

 

—

 

 

 

684

 

 

 

684

 

 

 

102.02

 

Vested

 

 

(992

)

 

 

(1,772

)

 

 

(2,764

)

 

 

106.62

 

Cancelled

 

 

(192

)

 

 

(110

)

 

 

(302

)

 

 

149.07

 

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

 

 

NOTE 2 — SHARE-BASED COMPENSATION (continued)

SAR, RSU and PSU Activity (continued)

 

The fair values of RSUs and PSUs that vested during 2023, 2022 and 2021 were $550 million, $550 million and $475 million, respectively. As of December 31, 2023, the unrecognized compensation cost related to RSUs and PSUs was $274 million.

v3.24.0.1
Acquisitions and Dispositions
 12 Months Ended
Dec. 31, 2023
Business Combinations [Abstract]  
Acquisitions and Dispositions

NOTE 3 — ACQUISITIONS AND DISPOSITIONS

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). During 2021, we paid $67 million to acquire two hospital facilities, one in southern Georgia and one in Tennessee, $594 million to acquire a network of urgent care centers in Florida and $114 million to acquire other nonhospital health care entities (noncontrolling interests of $117 million were recorded). We also paid $330 million and assumed certain liabilities to acquire an 80% interest (noncontrolling interests of $100 million were recorded) in a venture providing post-acute care services (home health and hospice). 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 $362 million, $262 million and $1.002 billion in 2023, 2022 and 2021, 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 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) related to the sale of a controlling interest in a subsidiary of our group purchasing organization. During 2021, we received proceeds of $1.502 billion and recognized a pretax gain of $1.226 billion ($920 million after tax) related to the sales of five hospital facilities in Georgia, comprised of three facilities from our northern Georgia market and two facilities from our southern Georgia market. We also received proceeds of $658 million and recognized a pretax gain of $394 million ($294 million after tax) related to sales of other health care entity investments and real estate.

v3.24.0.1
Income Taxes
 12 Months Ended
Dec. 31, 2023
Income Tax Disclosure [Abstract]  
Income Taxes

NOTE 4 — INCOME TAXES

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

 

 

2023

 

 

2022

 

 

2021

 

Current:

 

 

 

 

 

 

 

 

 

Federal

 

$

1,118

 

 

$

1,222

 

 

$

1,769

 

State

 

 

213

 

 

 

206

 

 

 

311

 

Foreign

 

 

3

 

 

 

18

 

 

 

15

 

Deferred:

 

 

 

 

 

 

 

 

 

Federal

 

 

241

 

 

 

261

 

 

 

24

 

State

 

 

21

 

 

 

27

 

 

 

(18

)

Foreign

 

 

19

 

 

 

12

 

 

 

11

 

 

 

$

1,615

 

 

$

1,746

 

 

$

2,112

 

 

Our provision for income taxes for the years ended December 31, 2023, 2022 and 2021 included tax benefits of $93 million, $77 million and $119 million, respectively, related to the settlement of employee equity awards. Our foreign pretax income was $85 million, $66 million and $64 million for the years ended December 31, 2023, 2022 and 2021, respectively.

NOTE 4 — INCOME TAXES (continued)

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

 

 

2023

 

 

2022

 

 

2021

 

Federal statutory rate

 

 

21.0

%

 

 

21.0

%

 

 

21.0

%

State income taxes, net of federal tax benefit

 

 

2.6

 

 

 

2.3

 

 

 

2.0

 

Change in liability for uncertain tax positions

 

 

0.4

 

 

 

0.7

 

 

 

0.7

 

Tax benefit from settlements of employee equity awards

 

 

(1.2

)

 

 

(0.9

)

 

 

(1.2

)

Other items, net

 

 

0.8

 

 

 

0.5

 

 

 

0.8

 

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

 

 

23.6

 

 

 

23.6

 

 

 

23.3

 

Income attributable to noncontrolling interests from consolidated partnerships

 

 

(2.6

)

 

 

(3.3

)

 

 

(1.8

)

Effective income tax rate on income before income taxes

 

 

21.0

%

 

 

20.3

%

 

 

21.5

%

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

 

 

2023

 

 

2022

 

 

 

Assets

 

 

Liabilities

 

 

Assets

 

 

Liabilities

 

Depreciation and fixed asset basis differences

 

$

—

 

 

$

1,048

 

 

$

—

 

 

$

938

 

Allowances for professional liability and other risks

 

 

452

 

 

 

—

 

 

 

430

 

 

 

—

 

Accounts receivable

 

 

363

 

 

 

—

 

 

 

368

 

 

 

—

 

Compensation

 

 

308

 

 

 

—

 

 

 

402

 

 

 

—

 

Right-of-use lease assets and obligations

 

 

506

 

 

 

492

 

 

 

451

 

 

 

438

 

Other

 

 

592

 

 

 

860

 

 

 

536

 

 

 

698

 

 

 

$

2,221

 

 

$

2,400

 

 

$

2,187

 

 

$

2,074

 

At December 31, 2023, federal and state net operating loss carryforwards (expiring in years 2024 through 2042) available to offset future taxable income approximated $28 million and $189 million, respectively. 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 of $177 million and $129 million as of December 31, 2023 and 2022, respectively (dollars in millions):

 

 

 

2023

 

 

2022

 

Balance at January 1

 

$

639

 

 

$

576

 

Additions based on tax positions related to the current year

 

 

30

 

 

 

25

 

Additions for tax positions of prior years

 

 

4

 

 

 

50

 

Reductions for tax positions of prior years

 

 

(10

)

 

 

(4

)

Settlements

 

 

—

 

 

 

(1

)

Lapse of applicable statutes of limitations

 

 

(24

)

 

 

(7

)

Balance at December 31

 

$

639

 

 

$

639

 

 

Unrecognized tax benefits of $320 million as of December 31, 2023 ($278 million as of December 31, 2022) would affect the effective rate, if recognized.

At December 31, 2023, the Internal Revenue Service (“IRS”) was conducting examinations of the Company’s 2016, 2017 and 2018 federal income tax returns and the 2019 returns of certain affiliates. We are also subject to examination by the IRS for tax years after 2019 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.

v3.24.0.1
Earnings Per Share
 12 Months Ended
Dec. 31, 2023
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 2023, 2022 and 2021, we repurchased 14.465 million shares, 30.747 million shares and 37.812 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, 2023, 2022 and 2021 (dollars and shares in millions, except per share amounts):

 

 

 

2023

 

 

2022

 

 

2021

 

Net income attributable to HCA Healthcare, Inc.

 

$

5,242

 

 

$

5,643

 

 

$

6,956

 

 

 

 

 

 

 

 

 

 

 

Weighted average common shares outstanding

 

 

272.404

 

 

 

290.348

 

 

 

323.315

 

Effect of dilutive incremental shares

 

 

4.008

 

 

 

4.318

 

 

 

5.437

 

Shares used for diluted earnings per share

 

 

276.412

 

 

 

294.666

 

 

 

328.752

 

Earnings per share:

 

 

 

 

 

 

 

 

 

Basic earnings per share

 

$

19.25

 

 

$

19.43

 

 

$

21.52

 

Diluted earnings per share

 

$

18.97

 

 

$

19.15

 

 

$

21.16

 
v3.24.0.1
Investments of Insurance Subsidiaries
 12 Months Ended
Dec. 31, 2023
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):

 

 

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

 

 

 

2022

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

415

 

 

$

—

 

 

$

(38

)

 

$

377

 

Money market funds and other

 

 

96

 

 

 

—

 

 

 

—

 

 

 

96

 

 

$

511

 

 

$

—

 

 

$

(38

)

 

 

473

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(92

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

381

 

 

At December 31, 2023 and 2022, 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).

 

NOTE 6 — INVESTMENTS OF INSURANCE SUBSIDIARIES (continued)

Scheduled maturities of investments in debt securities at December 31, 2023 were as follows (dollars in millions):

 

 

 

Amortized
Cost

 

 

Fair
Value

 

Due in one year or less

 

$

12

 

 

$

12

 

Due after one year through five years

 

 

150

 

 

 

144

 

Due after five years through ten years

 

 

165

 

 

 

148

 

Due after ten years

 

 

77

 

 

 

72

 

 

 

$

404

 

 

$

376

 

 

The average expected maturity of the investments in debt securities at December 31, 2023 was 5.1 years, compared to the average scheduled maturity of 8.8 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.

v3.24.0.1
Assets and Liabilities Measured at Fair Value
 12 Months Ended
Dec. 31, 2023
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.

The following tables summarize the investments of our insurance subsidiaries measured at fair value on a recurring basis as of December 31, 2023 and 2022, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

 

 

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

 

 

$

—

 

 

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

 

2022

 

 

 

 

 

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

 

$

377

 

 

$

—

 

 

$

377

 

 

$

—

 

Money market funds and other

 

 

96

 

 

 

96

 

 

 

—

 

 

 

—

 

Investments of insurance subsidiaries

 

 

473

 

 

 

96

 

 

 

377

 

 

 

—

 

Less amounts classified as current assets

 

 

(92

)

 

 

(92

)

 

 

—

 

 

 

—

 

 

$

381

 

 

$

4

 

 

$

377

 

 

$

—

 

 

The estimated fair value of our long-term debt was $38.253 billion and $35.555 billion at December 31, 2023 and 2022, respectively, compared to carrying amounts, gross of debt issuance costs and discounts, aggregating $39.926 billion and $38.385 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.

v3.24.0.1
Long-Term Debt
 12 Months Ended
Dec. 31, 2023
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, 2023, follows (dollars in millions):

 

 

 

2023

 

 

2022

 

Senior secured asset-based revolving credit facility (effective interest rate of 6.7%)

 

$

1,880

 

 

$

2,900

 

Senior secured revolving credit facility

 

 

—

 

 

 

—

 

Senior secured term loan facilities (effective interest rate of 6.8%)

 

 

1,313

 

 

 

1,880

 

Other senior secured debt (effective interest rate of 4.1%)

 

 

967

 

 

 

953

 

Senior secured debt

 

 

4,160

 

 

 

5,733

 

Senior unsecured notes (effective interest rate of 5.0%)

 

 

35,766

 

 

 

32,652

 

Debt issuance costs and discounts

 

 

(333

)

 

 

(301

)

Total debt (average life of 9.4 years, rates averaging 5.1%)

 

 

39,593

 

 

 

38,084

 

Less amounts due within one year

 

 

2,424

 

 

 

370

 

 

 

$

37,169

 

 

$

37,714

 

During 2023, the availability under our senior secured revolving credit facility was increased by $1.500 billion to total $3.500 billion, the senior secured term loan B facility was fully retired and certain administrative updates were made to our credit agreements. We also issued $3.250 billion aggregate principal amount of senior notes comprised of (i) $1.000 billion aggregate principal amount of 5.200% senior notes due 2028, (ii) $1.250 billion aggregate principal amount of 5.500% senior notes due 2033 and (iii) $1.000 billion aggregate principal amount of 5.900% senior notes due 2053. We used the net proceeds to repay borrowings under our asset-based revolving credit facility.

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 ($1.880 billion outstanding at December 31, 2023) (the “ABL credit facility”); (ii) a $3.500 billion senior secured revolving credit facility maturing on June 30, 2026 (none outstanding at December 31, 2023 without giving effect to certain outstanding letters of credit); and (iii) a $1.313 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 $967 million at December 31, 2023.

 

NOTE 8 — LONG-TERM DEBT (continued)

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) $35.041 billion aggregate principal amount of senior notes with maturities ranging from 2024 to 2053; (ii) an aggregate principal amount of $125 million medium-term notes maturing 2025; and (iii) an aggregate principal amount of $600 million debentures with maturities ranging from 2024 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”).

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 2025 through 2028 are $4.672 billion, $5.350 billion, $2.408 billion and $2.545 billion, respectively.

v3.24.0.1
Leases
 12 Months Ended
Dec. 31, 2023
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.

 

NOTE 9 — LEASES (continued)

The following table presents our lease-related assets and liabilities at December 31, 2023 and 2022 (dollars in millions):

 

 

Balance Sheet Classification

 

2023

 

 

2022

 

Assets:

 

 

 

 

 

 

 

 

Operating leases

 

Right-of-use operating lease assets

 

$

2,207

 

 

$

2,065

 

Finance leases

 

Property and equipment

 

 

556

 

 

 

587

 

Total lease assets

 

 

 

$

2,763

 

 

$

2,652

 

Liabilities:

 

 

 

 

 

 

 

 

Current:

 

 

 

 

 

 

 

 

Operating leases

 

Other accrued expenses

 

$

363

 

 

$

364

 

Finance leases

 

Long-term debt due within one year

 

 

166

 

 

 

131

 

Noncurrent:

 

 

 

 

 

 

 

 

Operating leases

 

Right-of-use operating lease obligations

 

 

1,903

 

 

 

1,752

 

Finance leases

 

Long-term debt

 

 

541

 

 

 

579

 

Total lease liabilities

 

 

 

$

2,973

 

 

$

2,826

 

Weighted-average remaining term:

 

 

 

 

 

 

 

 

Operating leases

 

 

 

11.8 years

 

 

10.1 years

 

Finance leases

 

 

 

9.0 years

 

 

9.5 years

 

Weighted-average discount rate:

 

 

 

 

 

 

 

 

Operating leases

 

 

 

 

4.9

%

 

 

4.4

%

Finance leases

 

 

 

 

4.9

%

 

 

4.5

%

The following table presents certain information related to expenses for finance and operating leases for the years ended December 31, 2023, 2022 and 2021 (dollars in millions):

 

 

2023

 

 

2022

 

 

2021

 

Finance lease expense:

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 

$

164

 

 

$

163

 

 

$

135

 

Interest

 

 

31

 

 

 

29

 

 

 

29

 

Operating leases(1)

 

 

495

 

 

 

484

 

 

 

478

 

Short-term lease expense(1)

 

 

337

 

 

 

329

 

 

 

354

 

Variable lease expense(1)

 

 

162

 

 

 

163

 

 

 

157

 

 

 

$

1,189

 

 

$

1,168

 

 

$

1,153

 

(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, 2023, 2022 and 2021 (dollars in millions):

 

 

 

2023

 

 

2022

 

 

2021

 

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

 

 

 

 

 

 

 

 

 

Operating cash flows for operating leases

 

$

479

 

 

$

473

 

 

$

474

 

Operating cash flows for finance leases

 

 

31

 

 

 

29

 

 

 

29

 

Financing cash flows for finance leases

 

 

140

 

 

 

124

 

 

 

123

 

 

NOTE 9 — LEASES (continued)

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, 2023 and 2022 (dollars in millions):

 

 

 

2023

 

 

2022

 

 

 

Operating
Leases

 

 

Finance
Leases

 

 

Operating
Leases

 

 

Finance
Leases

 

Year 1

 

$

452

 

 

$

193

 

 

$

436

 

 

$

156

 

Year 2

 

 

394

 

 

 

155

 

 

 

380

 

 

 

164

 

Year 3

 

 

340

 

 

 

115

 

 

 

320

 

 

 

125

 

Year 4

 

 

288

 

 

 

60

 

 

 

269

 

 

 

89

 

Year 5

 

 

228

 

 

 

45

 

 

 

222

 

 

 

39

 

Thereafter

 

 

1,540

 

 

 

356

 

 

 

1,122

 

 

 

359

 

Total minimum lease payments

 

 

3,242

 

 

 

924

 

 

 

2,749

 

 

 

932

 

Less: amount of lease payments representing interest

 

 

(976

)

 

 

(217

)

 

 

(633

)

 

 

(222

)

Present value of future minimum lease payments

 

 

2,266

 

 

 

707

 

 

 

2,116

 

 

 

710

 

Less: current lease obligations

 

 

(363

)

 

 

(166

)

 

 

(364

)

 

 

(131

)

Long-term lease obligations

 

$

1,903

 

 

$

541

 

 

$

1,752

 

 

$

579

 
v3.24.0.1
Contingencies
 12 Months Ended
Dec. 31, 2023
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.

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.

Texas operates a state Medicaid program pursuant to a waiver from the Centers for Medicare & Medicaid Services under Section 1115 of the Social Security Act (“Program”). The Program includes uncompensated-care pools; payments from these pools are intended to defray the uncompensated costs of services provided by our and other hospitals to Medicaid eligible or uninsured individuals. Separately, we and other hospitals provide charity care services in several communities in the state. In 2018, the Civil Division of the U.S. Department of Justice and the U.S. Attorney’s Office for the Southern District of Texas requested information about whether the Program, as operated in Harris County, complied with the laws and regulations applicable to provider related donations, and the Company cooperated with that request. On May 21, 2019, a qui tam lawsuit asserting violations of the FCA and the Texas Medicaid Fraud Prevention Act related to the Program, as operated in Harris County, was unsealed by the U.S. District Court for the Southern District of Texas. Both the federal and state governments declined to intervene in the qui tam lawsuit. The Company believes that our participation is and has been consistent with the requirements of the Program and is vigorously defending against the lawsuit being pursued by the relator. We cannot predict what effect, if any, the qui tam lawsuit could have on the Company.

v3.24.0.1
Capital Stock
 12 Months Ended
Dec. 31, 2023
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 2024, January 2023, January 2022, February 2021, January 2020 and January 2019, our Board of Directors authorized share repurchase programs for up to $6 billion, $3 billion, $8 billion, $6 billion, $2 billion and $2 billion, respectively, of the Company’s outstanding common stock.

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. At December 31, 2023, we had $775 million of repurchase authorization available under 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 authorization (which was completed during 2022) and the January 2022 authorization. During 2021, we repurchased 37.812 million shares of our common stock at an average price of $217.25 per share through market purchases pursuant to the January 2019 and January 2020 authorizations (which were completed during 2021) and the February 2021 authorization.

v3.24.0.1
Employee Benefit Plans
 12 Months Ended
Dec. 31, 2023
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 $659 million for 2023, $606 million for 2022 and $560 million for 2021. 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. Amounts recognized under this plan was $40 million expense for 2023, a $27 million credit for 2022 and $38 million expense for 2021. Accrued benefits liabilities under this plan totaled $227 million at December 31, 2023 and $210 million at December 31, 2022.

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 $10 million for 2023, $22 million for 2022 and $22 million for 2021. Accrued benefits liabilities under this plan totaled $106 million at December 31, 2023 and $137 million at December 31, 2022.

We maintain defined benefit pension plans which resulted from certain hospital acquisitions in prior years. Amounts recognized under these plans was $2 million expense for 2023, $11 million credit for 2022, and $4 million expense for 2021. Accrued benefits under these plans totaled $43 million of assets at December 31, 2023 and $9 million of assets at December 31, 2022.

v3.24.0.1
Segment and Geographic Information
 12 Months Ended
Dec. 31, 2023
Segment Reporting [Abstract]  
Segment and Geographic Information

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION

We operate in one line of business, which is operating hospitals and related health care entities. Effective January 1, 2023, we reorganized our operations into three geographically organized groups: the National, American and Atlantic Groups with retrospective presentation for all periods presented. At December 31, 2023, the National Group included 57 hospitals located in Alaska, California, Idaho, Indiana, Kentucky, Nevada, New Hampshire, North Carolina, Tennessee, Utah and Virginia, the American Group included 60 hospitals located in Colorado, Central Kansas, Louisiana and Texas, and the Atlantic Group included 62 hospitals located in Florida, Georgia, Northern Kansas, Missouri and South Carolina. The seven 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, equity in earnings of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions) and represent the operating segments under the January 1, 2023 reorganized segment structure:

 

 

 

For the Year Ended December 31,

 

 

 

2023

 

 

2022

 

 

2021

 

Revenues:

 

 

 

 

 

 

 

 

 

National Group

 

$

18,105

 

 

$

16,767

 

 

$

16,329

 

Atlantic Group

 

 

21,167

 

 

 

19,324

 

 

 

19,098

 

American Group

 

 

22,318

 

 

 

20,858

 

 

 

19,636

 

Corporate and other

 

 

3,378

 

 

 

3,284

 

 

 

3,689

 

 

 

$

64,968

 

 

$

60,233

 

 

$

58,752

 

Equity in losses (earnings) of affiliates:

 

 

 

 

 

 

 

 

 

National Group

 

$

(2

)

 

$

(1

)

 

$

(33

)

Atlantic Group

 

 

(3

)

 

 

(3

)

 

 

(2

)

American Group

 

 

(59

)

 

 

(43

)

 

 

(50

)

Corporate and other

 

 

42

 

 

 

2

 

 

 

(28

)

 

 

$

(22

)

 

$

(45

)

 

$

(113

)

Adjusted segment EBITDA:

 

 

 

 

 

 

 

 

 

National Group

 

$

4,000

 

 

$

3,616

 

 

$

4,202

 

Atlantic Group

 

 

4,492

 

 

 

3,881

 

 

 

4,218

 

American Group

 

 

5,208

 

 

 

5,102

 

 

 

4,836

 

Corporate and other

 

 

(974

)

 

 

(532

)

 

 

(612

)

 

 

$

12,726

 

 

$

12,067

 

 

$

12,644

 

Depreciation and amortization:

 

 

 

 

 

 

 

 

 

National Group

 

$

834

 

 

$

801

 

 

$

754

 

Atlantic Group

 

 

989

 

 

 

921

 

 

 

848

 

American Group

 

 

971

 

 

 

937

 

 

 

897

 

Corporate and other

 

 

283

 

 

 

310

 

 

 

354

 

 

 

$

3,077

 

 

$

2,969

 

 

$

2,853

 

 

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

 

 

For the Year Ended December 31,

 

 

 

2023

 

 

2022

 

 

2021

 

Adjusted segment EBITDA

 

$

12,726

 

 

$

12,067

 

 

$

12,644

 

Depreciation and amortization

 

 

3,077

 

 

 

2,969

 

 

 

2,853

 

Interest expense

 

 

1,938

 

 

 

1,741

 

 

 

1,566

 

Losses (gains) on sales of facilities

 

 

5

 

 

 

(1,301

)

 

 

(1,620

)

Losses on retirement of debt

 

 

—

 

 

 

78

 

 

 

12

 

Income before income taxes

 

$

7,706

 

 

$

8,580

 

 

$

9,833

 

 

 

 

December 31,

 

 

 

2023

 

 

2022

 

 

2021

 

Assets:

 

 

 

 

 

 

 

 

 

National Group

 

$

12,487

 

 

$

11,793

 

 

$

11,236

 

Atlantic Group

 

 

16,098

 

 

 

15,092

 

 

 

13,944

 

American Group

 

 

19,786

 

 

 

17,934

 

 

 

17,224

 

Corporate and other

 

 

7,840

 

 

 

7,619

 

 

 

8,338

 

 

 

$

56,211

 

 

$

52,438

 

 

$

50,742

 

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

 

Corporate
and Other

 

 

Total

 

Goodwill and other intangible assets:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at December 31, 2020

 

$

1,089

 

 

$

1,375

 

 

$

4,996

 

 

$

1,118

 

 

$

8,578

 

Acquisitions

 

 

126

 

 

 

610

 

 

 

66

 

 

 

260

 

 

 

1,062

 

Foreign currency translation, amortization and other

 

 

(3

)

 

 

(15

)

 

 

—

 

 

 

(82

)

 

 

(100

)

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

 
v3.24.0.1
Other Comprehensive Loss
 12 Months Ended
Dec. 31, 2023
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, 2020

 

$

25

 

 

$

(271

)

 

$

(220

)

 

$

(36

)

 

$

(502

)

Unrealized losses on available-for-sale securities, net
   of $3 income tax benefit

 

 

(13

)

 

 

 

 

 

 

 

 

 

 

 

(13

)

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

 

 

 

 

 

(7

)

 

 

 

 

 

 

 

 

(7

)

Defined benefit plans, net of $20 of income taxes

 

 

 

 

 

 

 

 

67

 

 

 

 

 

 

67

 

Change in fair value of derivative instruments

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

1

 

Expense reclassified into operations from other
   comprehensive income, net of $7 and $8 income
   tax benefits, respectively

 

 

 

 

 

 

 

 

21

 

 

 

29

 

 

 

50

 

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

)
v3.24.0.1
Accrued Expenses
 12 Months Ended
Dec. 31, 2023
Text Block [Abstract]  
Accrued Expenses

NOTE 15 — ACCRUED EXPENSES

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

 

 

2023

 

 

2022

 

Professional liability risks

 

$

532

 

 

$

515

 

Defined contribution benefit plans

 

 

668

 

 

 

612

 

Right-of-use operating leases

 

 

363

 

 

 

364

 

Taxes other than income

 

 

382

 

 

 

371

 

Interest

 

 

414

 

 

 

402

 

Employee medical benefits

 

 

199

 

 

 

182

 

Other

 

 

1,313

 

 

 

1,135

 

 

 

$

3,871

 

 

$

3,581

 
v3.24.0.1
Accounting Policies (Policies)
 12 Months Ended
Dec. 31, 2023
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 $315 million, $307 million and $337 million for the years ended December 31, 2023, 2022 and 2021, 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,

 

 

 

2023

 

 

Ratio

 

 

2022

 

 

Ratio

 

 

2021

 

 

Ratio

 

Medicare

 

$

10,585

 

 

 

16.3

%

 

$

10,447

 

 

 

17.3

%

 

$

10,447

 

 

 

17.8

%

Managed Medicare

 

 

10,496

 

 

 

16.2

 

 

 

9,201

 

 

 

15.3

 

 

 

8,424

 

 

 

14.3

 

Medicaid

 

 

3,606

 

 

 

5.6

 

 

 

2,636

 

 

 

4.4

 

 

 

2,290

 

 

 

3.9

 

Managed Medicaid

 

 

3,879

 

 

 

6.0

 

 

 

3,998

 

 

 

6.6

 

 

 

3,124

 

 

 

5.3

 

Managed care and other insurers

 

 

31,819

 

 

 

49.0

 

 

 

29,120

 

 

 

48.3

 

 

 

30,295

 

 

 

51.6

 

International (managed care and other insurers)

 

 

1,509

 

 

 

2.3

 

 

 

1,317

 

 

 

2.2

 

 

 

1,336

 

 

 

2.3

 

Other

 

 

3,074

 

 

 

4.6

 

 

 

3,514

 

 

 

5.9

 

 

 

2,836

 

 

 

4.8

 

Revenues

 

$

64,968

 

 

 

100.0

%

 

$

60,233

 

 

 

100.0

%

 

$

58,752

 

 

 

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 $84 million, $56 million and $53 million in 2023, 2022 and 2021, respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in net increases to revenues of $58 million in 2023, $42 million in 2022 and $19 million in 2021.

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 attempt to 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, 2023 and 2022, estimated implicit price concessions of $7.283 billion and $6.780 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):

 

 

2023

 

 

2022

 

 

2021

 

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

 

$

55,341

 

 

$

51,180

 

 

$

49,074

 

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

 

 

10.5

%

 

 

11.0

%

 

 

11.3

%

Total uncompensated care

 

$

35,426

 

 

$

31,734

 

 

$

29,642

 

Multiply by the cost-to-charges ratio

 

 

10.5

%

 

 

11.0

%

 

 

11.3

%

Estimated cost of total uncompensated care

 

$

3,720

 

 

$

3,491

 

 

$

3,350

 

The total uncompensated care amounts include charity care of $14.425 billion, $13.615 billion and $13.644 billion for the years ended December 31, 2023, 2022 and 2021, respectively. The estimated cost of charity care was $1.515 billion, $1.498 billion and $1.542 billion for the years ended December 31, 2023, 2022 and 2021, respectively.

Recent Pronouncements

Recent Pronouncements

In November 2023, the FASB issued Accounting Standards Update 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures (“ASU 2023-07”), which requires enhanced disclosures for significant segment expenses. ASU 2023-07 is effective for public business entities for annual periods beginning on January 1, 2024 and interim periods beginning on January 1, 2025. We plan to adopt ASU 2023-07 on the respective annual and interim effective dates 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.

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 January 1, 2025. 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.

Our cash management system provides for daily investment of available balances and the funding of outstanding checks when presented for payment. Outstanding, but unpresented, checks totaling $600 million and $656 million at December 31, 2023 and 2022, respectively, have been included in “accounts payable” in the consolidated balance sheets. Upon presentation for payment, these checks are funded through available cash balances or our credit facility.

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 53 days, 53 days and 49 days at December 31, 2023, 2022 and 2021, respectively. Changes in general economic conditions, patient accounting 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 $3.052 billion in 2023, $2.941 billion in 2022 and $2.826 billion in 2021. 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, 2023 and 2022, 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 2023, 2022 or 2021.

During 2023, goodwill increased by $362 million related to acquisitions and declined by $50 million related to foreign currency translation and other adjustments. During 2022, goodwill increased by $262 million related to acquisitions and declined by $105 million related to foreign currency translation and other adjustments.

During 2023 and 2022, identifiable intangible assets declined by $20 million and $44 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, 2023 and 2022 was $274 million and accumulated amortization was $228 million and $208 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2023 and 2022 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, 2023 and 2022 were $559 million and $496 million, respectively, and accumulated amortization was $226 million and $195 million, respectively. Amortization of debt issuance costs and discounts is included in interest expense and was $35 million, $29 million and $27 million for 2023, 2022 and 2021, respectively.

Professional Liability Claims

Professional Liability Claims

Reserves for professional liability risks were $2.089 billion and $2.043 billion at December 31, 2023 and 2022, respectively. The current portion of the reserves, $532 million and $515 million at December 31, 2023 and 2022, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $619 million, $517 million and $453 million for 2023, 2022 and 2021, 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 reductions to the provision for professional liability risks of $55 million and $87 million for 2022 and 2021, respectively, 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 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 and 2,000 individual claims at December 31, 2023 and 2022, respectively, 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 2023 and 2022, $550 million and $497 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. 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 $34 million and $48 million at December 31, 2023 and 2022, respectively, recorded in “other assets,” and $8 million and $12 million at December 31, 2023 and 2022, 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.

v3.24.0.1
Accounting Policies (Tables)
 12 Months Ended
Dec. 31, 2023
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,

 

 

 

2023

 

 

Ratio

 

 

2022

 

 

Ratio

 

 

2021

 

 

Ratio

 

Medicare

 

$

10,585

 

 

 

16.3

%

 

$

10,447

 

 

 

17.3

%

 

$

10,447

 

 

 

17.8

%

Managed Medicare

 

 

10,496

 

 

 

16.2

 

 

 

9,201

 

 

 

15.3

 

 

 

8,424

 

 

 

14.3

 

Medicaid

 

 

3,606

 

 

 

5.6

 

 

 

2,636

 

 

 

4.4

 

 

 

2,290

 

 

 

3.9

 

Managed Medicaid

 

 

3,879

 

 

 

6.0

 

 

 

3,998

 

 

 

6.6

 

 

 

3,124

 

 

 

5.3

 

Managed care and other insurers

 

 

31,819

 

 

 

49.0

 

 

 

29,120

 

 

 

48.3

 

 

 

30,295

 

 

 

51.6

 

International (managed care and other insurers)

 

 

1,509

 

 

 

2.3

 

 

 

1,317

 

 

 

2.2

 

 

 

1,336

 

 

 

2.3

 

Other

 

 

3,074

 

 

 

4.6

 

 

 

3,514

 

 

 

5.9

 

 

 

2,836

 

 

 

4.8

 

Revenues

 

$

64,968

 

 

 

100.0

%

 

$

60,233

 

 

 

100.0

%

 

$

58,752

 

 

 

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):

 

 

2023

 

 

2022

 

 

2021

 

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

 

$

55,341

 

 

$

51,180

 

 

$

49,074

 

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

 

 

10.5

%

 

 

11.0

%

 

 

11.3

%

Total uncompensated care

 

$

35,426

 

 

$

31,734

 

 

$

29,642

 

Multiply by the cost-to-charges ratio

 

 

10.5

%

 

 

11.0

%

 

 

11.3

%

Estimated cost of total uncompensated care

 

$

3,720

 

 

$

3,491

 

 

$

3,350

 
v3.24.0.1
Share-Based Compensation (Tables)
 12 Months Ended
Dec. 31, 2023
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.

 

 

 

2023

 

 

2022

 

 

2021

 

Risk-free interest rate

 

 

3.69

%

 

 

1.64

%

 

 

0.68

%

Expected volatility

 

 

36

%

 

 

34

%

 

 

36

%

Expected life, in years

 

 

5.14

 

 

 

5.11

 

 

 

6.17

 

Expected dividend yield

 

 

0.95

%

 

 

0.95

%

 

 

1.10

%

 
Schedule of Stock Appreciation Rights Activity

Information regarding Time SAR and Performance SAR activity during 2023, 2022 and 2021 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, 2020

 

 

7,836

 

 

 

819

 

 

 

8,655

 

 

$

91.53

 

 

 

 

 

 

Granted

 

 

877

 

 

 

—

 

 

 

877

 

 

 

174.98

 

 

 

 

 

 

Exercised

 

 

(2,443

)

 

 

(533

)

 

 

(2,976

)

 

 

67.57

 

 

 

 

 

 

Cancelled

 

 

(108

)

 

 

—

 

 

 

(108

)

 

 

138.32

 

 

 

 

 

 

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

 

 

5.5 years

 

$

667

 

SARs exercisable, December 31, 2023

 

 

3,748

 

 

 

44

 

 

 

3,792

 

 

$

118.67

 

 

4.5 years

 

$

576

 
Schedule of Restricted Stock Units Activity

Information regarding RSU and PSU activity during 2023, 2022 and 2021 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, 2020

 

 

2,476

 

 

 

2,592

 

 

 

5,068

 

 

$

125.40

 

Granted

 

 

899

 

 

 

689

 

 

 

1,588

 

 

 

174.34

 

Performance adjustment

 

 

—

 

 

 

684

 

 

 

684

 

 

 

102.02

 

Vested

 

 

(992

)

 

 

(1,772

)

 

 

(2,764

)

 

 

106.62

 

Cancelled

 

 

(192

)

 

 

(110

)

 

 

(302

)

 

 

149.07

 

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

 

 
v3.24.0.1
Income Taxes (Tables)
 12 Months Ended
Dec. 31, 2023
Income Tax Disclosure [Abstract]  
Schedule of Provision for Income Taxes

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

 

 

2023

 

 

2022

 

 

2021

 

Current:

 

 

 

 

 

 

 

 

 

Federal

 

$

1,118

 

 

$

1,222

 

 

$

1,769

 

State

 

 

213

 

 

 

206

 

 

 

311

 

Foreign

 

 

3

 

 

 

18

 

 

 

15

 

Deferred:

 

 

 

 

 

 

 

 

 

Federal

 

 

241

 

 

 

261

 

 

 

24

 

State

 

 

21

 

 

 

27

 

 

 

(18

)

Foreign

 

 

19

 

 

 

12

 

 

 

11

 

 

 

$

1,615

 

 

$

1,746

 

 

$

2,112

 
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:

 

 

2023

 

 

2022

 

 

2021

 

Federal statutory rate

 

 

21.0

%

 

 

21.0

%

 

 

21.0

%

State income taxes, net of federal tax benefit

 

 

2.6

 

 

 

2.3

 

 

 

2.0

 

Change in liability for uncertain tax positions

 

 

0.4

 

 

 

0.7

 

 

 

0.7

 

Tax benefit from settlements of employee equity awards

 

 

(1.2

)

 

 

(0.9

)

 

 

(1.2

)

Other items, net

 

 

0.8

 

 

 

0.5

 

 

 

0.8

 

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

 

 

23.6

 

 

 

23.6

 

 

 

23.3

 

Income attributable to noncontrolling interests from consolidated partnerships

 

 

(2.6

)

 

 

(3.3

)

 

 

(1.8

)

Effective income tax rate on income before income taxes

 

 

21.0

%

 

 

20.3

%

 

 

21.5

%
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):

 

 

2023

 

 

2022

 

 

 

Assets

 

 

Liabilities

 

 

Assets

 

 

Liabilities

 

Depreciation and fixed asset basis differences

 

$

—

 

 

$

1,048

 

 

$

—

 

 

$

938

 

Allowances for professional liability and other risks

 

 

452

 

 

 

—

 

 

 

430

 

 

 

—

 

Accounts receivable

 

 

363

 

 

 

—

 

 

 

368

 

 

 

—

 

Compensation

 

 

308

 

 

 

—

 

 

 

402

 

 

 

—

 

Right-of-use lease assets and obligations

 

 

506

 

 

 

492

 

 

 

451

 

 

 

438

 

Other

 

 

592

 

 

 

860

 

 

 

536

 

 

 

698

 

 

 

$

2,221

 

 

$

2,400

 

 

$

2,187

 

 

$

2,074

 
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 of $177 million and $129 million as of December 31, 2023 and 2022, respectively (dollars in millions):

 

 

 

2023

 

 

2022

 

Balance at January 1

 

$

639

 

 

$

576

 

Additions based on tax positions related to the current year

 

 

30

 

 

 

25

 

Additions for tax positions of prior years

 

 

4

 

 

 

50

 

Reductions for tax positions of prior years

 

 

(10

)

 

 

(4

)

Settlements

 

 

—

 

 

 

(1

)

Lapse of applicable statutes of limitations

 

 

(24

)

 

 

(7

)

Balance at December 31

 

$

639

 

 

$

639

 

 
v3.24.0.1
Earnings Per Share (Tables)
 12 Months Ended
Dec. 31, 2023
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, 2023, 2022 and 2021 (dollars and shares in millions, except per share amounts):

 

 

 

2023

 

 

2022

 

 

2021

 

Net income attributable to HCA Healthcare, Inc.

 

$

5,242

 

 

$

5,643

 

 

$

6,956

 

 

 

 

 

 

 

 

 

 

 

Weighted average common shares outstanding

 

 

272.404

 

 

 

290.348

 

 

 

323.315

 

Effect of dilutive incremental shares

 

 

4.008

 

 

 

4.318

 

 

 

5.437

 

Shares used for diluted earnings per share

 

 

276.412

 

 

 

294.666

 

 

 

328.752

 

Earnings per share:

 

 

 

 

 

 

 

 

 

Basic earnings per share

 

$

19.25

 

 

$

19.43

 

 

$

21.52

 

Diluted earnings per share

 

$

18.97

 

 

$

19.15

 

 

$

21.16

 
v3.24.0.1
Investments of Insurance Subsidiaries (Tables)
 12 Months Ended
Dec. 31, 2023
Investments, Debt and Equity Securities [Abstract]  
Schedule of Investments

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

 

 

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

 

 

 

2022

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

415

 

 

$

—

 

 

$

(38

)

 

$

377

 

Money market funds and other

 

 

96

 

 

 

—

 

 

 

—

 

 

 

96

 

 

$

511

 

 

$

—

 

 

$

(38

)

 

 

473

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(92

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

381

 
Schedule of Maturities of Investments

Scheduled maturities of investments in debt securities at December 31, 2023 were as follows (dollars in millions):

 

 

 

Amortized
Cost

 

 

Fair
Value

 

Due in one year or less

 

$

12

 

 

$

12

 

Due after one year through five years

 

 

150

 

 

 

144

 

Due after five years through ten years

 

 

165

 

 

 

148

 

Due after ten years

 

 

77

 

 

 

72

 

 

 

$

404

 

 

$

376

 
v3.24.0.1
Assets and Liabilities Measured at Fair Value (Tables)
 12 Months Ended
Dec. 31, 2023
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, 2023 and 2022, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

 

 

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

 

 

$

—

 

 

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

 

2022

 

 

 

 

 

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

 

$

377

 

 

$

—

 

 

$

377

 

 

$

—

 

Money market funds and other

 

 

96

 

 

 

96

 

 

 

—

 

 

 

—

 

Investments of insurance subsidiaries

 

 

473

 

 

 

96

 

 

 

377

 

 

 

—

 

Less amounts classified as current assets

 

 

(92

)

 

 

(92

)

 

 

—

 

 

 

—

 

 

$

381

 

 

$

4

 

 

$

377

 

 

$

—

 
v3.24.0.1
Long-Term Debt (Tables)
 12 Months Ended
Dec. 31, 2023
Debt Disclosure [Abstract]  
Schedule of Long-Term Debt

A summary of long-term debt at December 31, including related interest rates at December 31, 2023, follows (dollars in millions):

 

 

 

2023

 

 

2022

 

Senior secured asset-based revolving credit facility (effective interest rate of 6.7%)

 

$

1,880

 

 

$

2,900

 

Senior secured revolving credit facility

 

 

—

 

 

 

—

 

Senior secured term loan facilities (effective interest rate of 6.8%)

 

 

1,313

 

 

 

1,880

 

Other senior secured debt (effective interest rate of 4.1%)

 

 

967

 

 

 

953

 

Senior secured debt

 

 

4,160

 

 

 

5,733

 

Senior unsecured notes (effective interest rate of 5.0%)

 

 

35,766

 

 

 

32,652

 

Debt issuance costs and discounts

 

 

(333

)

 

 

(301

)

Total debt (average life of 9.4 years, rates averaging 5.1%)

 

 

39,593

 

 

 

38,084

 

Less amounts due within one year

 

 

2,424

 

 

 

370

 

 

 

$

37,169

 

 

$

37,714

 
v3.24.0.1
Leases (Tables)
 12 Months Ended
Dec. 31, 2023
Leases [Abstract]  
Schedule of lease-related assets and liabilities

The following table presents our lease-related assets and liabilities at December 31, 2023 and 2022 (dollars in millions):

 

 

Balance Sheet Classification

 

2023

 

 

2022

 

Assets:

 

 

 

 

 

 

 

 

Operating leases

 

Right-of-use operating lease assets

 

$

2,207

 

 

$

2,065

 

Finance leases

 

Property and equipment

 

 

556

 

 

 

587

 

Total lease assets

 

 

 

$

2,763

 

 

$

2,652

 

Liabilities:

 

 

 

 

 

 

 

 

Current:

 

 

 

 

 

 

 

 

Operating leases

 

Other accrued expenses

 

$

363

 

 

$

364

 

Finance leases

 

Long-term debt due within one year

 

 

166

 

 

 

131

 

Noncurrent:

 

 

 

 

 

 

 

 

Operating leases

 

Right-of-use operating lease obligations

 

 

1,903

 

 

 

1,752

 

Finance leases

 

Long-term debt

 

 

541

 

 

 

579

 

Total lease liabilities

 

 

 

$

2,973

 

 

$

2,826

 

Weighted-average remaining term:

 

 

 

 

 

 

 

 

Operating leases

 

 

 

11.8 years

 

 

10.1 years

 

Finance leases

 

 

 

9.0 years

 

 

9.5 years

 

Weighted-average discount rate:

 

 

 

 

 

 

 

 

Operating leases

 

 

 

 

4.9

%

 

 

4.4

%

Finance leases

 

 

 

 

4.9

%

 

 

4.5

%
Schedule of lease expense for finance and operating leases

 

 

2023

 

 

2022

 

 

2021

 

Finance lease expense:

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 

$

164

 

 

$

163

 

 

$

135

 

Interest

 

 

31

 

 

 

29

 

 

 

29

 

Operating leases(1)

 

 

495

 

 

 

484

 

 

 

478

 

Short-term lease expense(1)

 

 

337

 

 

 

329

 

 

 

354

 

Variable lease expense(1)

 

 

162

 

 

 

163

 

 

 

157

 

 

 

$

1,189

 

 

$

1,168

 

 

$

1,153

 

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, 2023, 2022 and 2021 (dollars in millions):

 

 

 

2023

 

 

2022

 

 

2021

 

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

 

 

 

 

 

 

 

 

 

Operating cash flows for operating leases

 

$

479

 

 

$

473

 

 

$

474

 

Operating cash flows for finance leases

 

 

31

 

 

 

29

 

 

 

29

 

Financing cash flows for finance leases

 

 

140

 

 

 

124

 

 

 

123

 

 

NOTE 9 — LEASES (continued)
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, 2023 and 2022 (dollars in millions):

 

 

 

2023

 

 

2022

 

 

 

Operating
Leases

 

 

Finance
Leases

 

 

Operating
Leases

 

 

Finance
Leases

 

Year 1

 

$

452

 

 

$

193

 

 

$

436

 

 

$

156

 

Year 2

 

 

394

 

 

 

155

 

 

 

380

 

 

 

164

 

Year 3

 

 

340

 

 

 

115

 

 

 

320

 

 

 

125

 

Year 4

 

 

288

 

 

 

60

 

 

 

269

 

 

 

89

 

Year 5

 

 

228

 

 

 

45

 

 

 

222

 

 

 

39

 

Thereafter

 

 

1,540

 

 

 

356

 

 

 

1,122

 

 

 

359

 

Total minimum lease payments

 

 

3,242

 

 

 

924

 

 

 

2,749

 

 

 

932

 

Less: amount of lease payments representing interest

 

 

(976

)

 

 

(217

)

 

 

(633

)

 

 

(222

)

Present value of future minimum lease payments

 

 

2,266

 

 

 

707

 

 

 

2,116

 

 

 

710

 

Less: current lease obligations

 

 

(363

)

 

 

(166

)

 

 

(364

)

 

 

(131

)

Long-term lease obligations

 

$

1,903

 

 

$

541

 

 

$

1,752

 

 

$

579

 
v3.24.0.1
Segment and Geographic Information (Tables)
 12 Months Ended
Dec. 31, 2023
Segment Reporting [Abstract]  
Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization, Assets and Goodwill and Other Intangible Assets The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions) and represent the operating segments under the January 1, 2023 reorganized segment structure:

 

 

 

For the Year Ended December 31,

 

 

 

2023

 

 

2022

 

 

2021

 

Revenues:

 

 

 

 

 

 

 

 

 

National Group

 

$

18,105

 

 

$

16,767

 

 

$

16,329

 

Atlantic Group

 

 

21,167

 

 

 

19,324

 

 

 

19,098

 

American Group

 

 

22,318

 

 

 

20,858

 

 

 

19,636

 

Corporate and other

 

 

3,378

 

 

 

3,284

 

 

 

3,689

 

 

 

$

64,968

 

 

$

60,233

 

 

$

58,752

 

Equity in losses (earnings) of affiliates:

 

 

 

 

 

 

 

 

 

National Group

 

$

(2

)

 

$

(1

)

 

$

(33

)

Atlantic Group

 

 

(3

)

 

 

(3

)

 

 

(2

)

American Group

 

 

(59

)

 

 

(43

)

 

 

(50

)

Corporate and other

 

 

42

 

 

 

2

 

 

 

(28

)

 

 

$

(22

)

 

$

(45

)

 

$

(113

)

Adjusted segment EBITDA:

 

 

 

 

 

 

 

 

 

National Group

 

$

4,000

 

 

$

3,616

 

 

$

4,202

 

Atlantic Group

 

 

4,492

 

 

 

3,881

 

 

 

4,218

 

American Group

 

 

5,208

 

 

 

5,102

 

 

 

4,836

 

Corporate and other

 

 

(974

)

 

 

(532

)

 

 

(612

)

 

 

$

12,726

 

 

$

12,067

 

 

$

12,644

 

Depreciation and amortization:

 

 

 

 

 

 

 

 

 

National Group

 

$

834

 

 

$

801

 

 

$

754

 

Atlantic Group

 

 

989

 

 

 

921

 

 

 

848

 

American Group

 

 

971

 

 

 

937

 

 

 

897

 

Corporate and other

 

 

283

 

 

 

310

 

 

 

354

 

 

 

$

3,077

 

 

$

2,969

 

 

$

2,853

 

 

NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued)

 

 

For the Year Ended December 31,

 

 

 

2023

 

 

2022

 

 

2021

 

Adjusted segment EBITDA

 

$

12,726

 

 

$

12,067

 

 

$

12,644

 

Depreciation and amortization

 

 

3,077

 

 

 

2,969

 

 

 

2,853

 

Interest expense

 

 

1,938

 

 

 

1,741

 

 

 

1,566

 

Losses (gains) on sales of facilities

 

 

5

 

 

 

(1,301

)

 

 

(1,620

)

Losses on retirement of debt

 

 

—

 

 

 

78

 

 

 

12

 

Income before income taxes

 

$

7,706

 

 

$

8,580

 

 

$

9,833

 

 

 

 

December 31,

 

 

 

2023

 

 

2022

 

 

2021

 

Assets:

 

 

 

 

 

 

 

 

 

National Group

 

$

12,487

 

 

$

11,793

 

 

$

11,236

 

Atlantic Group

 

 

16,098

 

 

 

15,092

 

 

 

13,944

 

American Group

 

 

19,786

 

 

 

17,934

 

 

 

17,224

 

Corporate and other

 

 

7,840

 

 

 

7,619

 

 

 

8,338

 

 

 

$

56,211

 

 

$

52,438

 

 

$

50,742

 

 

 

 

National
Group

 

 

Atlantic
Group

 

 

American
Group

 

 

Corporate
and Other

 

 

Total

 

Goodwill and other intangible assets:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at December 31, 2020

 

$

1,089

 

 

$

1,375

 

 

$

4,996

 

 

$

1,118

 

 

$

8,578

 

Acquisitions

 

 

126

 

 

 

610

 

 

 

66

 

 

 

260

 

 

 

1,062

 

Foreign currency translation, amortization and other

 

 

(3

)

 

 

(15

)

 

 

—

 

 

 

(82

)

 

 

(100

)

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

 
v3.24.0.1
Other Comprehensive Loss (Tables)
 12 Months Ended
Dec. 31, 2023
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, 2020

 

$

25

 

 

$

(271

)

 

$

(220

)

 

$

(36

)

 

$

(502

)

Unrealized losses on available-for-sale securities, net
   of $3 income tax benefit

 

 

(13

)

 

 

 

 

 

 

 

 

 

 

 

(13

)

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

 

 

 

 

 

(7

)

 

 

 

 

 

 

 

 

(7

)

Defined benefit plans, net of $20 of income taxes

 

 

 

 

 

 

 

 

67

 

 

 

 

 

 

67

 

Change in fair value of derivative instruments

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

1

 

Expense reclassified into operations from other
   comprehensive income, net of $7 and $8 income
   tax benefits, respectively

 

 

 

 

 

 

 

 

21

 

 

 

29

 

 

 

50

 

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

)
v3.24.0.1
Accrued Expenses (Tables)
 12 Months Ended
Dec. 31, 2023
Text Block [Abstract]  
Summary of Other Accrued Expenses

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

 

 

2023

 

 

2022

 

Professional liability risks

 

$

532

 

 

$

515

 

Defined contribution benefit plans

 

 

668

 

 

 

612

 

Right-of-use operating leases

 

 

363

 

 

 

364

 

Taxes other than income

 

 

382

 

 

 

371

 

Interest

 

 

414

 

 

 

402

 

Employee medical benefits

 

 

199

 

 

 

182

 

Other

 

 

1,313

 

 

 

1,135

 

 

 

$

3,871

 

 

$

3,581

 
v3.24.0.1
Accounting Policies - Additional Information (Detail)
 1 Months Ended 12 Months Ended
Nov. 30, 2017
Dec. 31, 2023
USD ($)
Hospital
EndoscopyCenter
SurgeryCenter
Claim
State
Dec. 31, 2022
USD ($)
Claim
Dec. 31, 2021
USD ($)
Summary Of Significant Accounting Policies [Line Items]        
Number of owned and operated hospitals | Hospital   186    
Number of freestanding surgery centers | SurgeryCenter   124    
Number of freestanding endoscopy centers | EndoscopyCenter   24    
Number of facilities locations | State   20    
General and administrative expense   $ 315,000,000 $ 307,000,000 $ 337,000,000
Adjustments to estimated reimbursement filed during respective year   84,000,000 56,000,000 53,000,000
Adjustments to estimated reimbursement filed during previous years   58,000,000 42,000,000 19,000,000
Estimated implicit price concessions recorded as reductions to revenues and accounts receivable   7,283,000,000 6,780,000,000  
Charity care amount   14,425,000,000 13,615,000,000 13,644,000,000
Estimated costs of charity care   1,515,000,000 1,498,000,000 $ 1,542,000,000
Outstanding checks unpresented for payment   $ 600,000,000 $ 656,000,000  
Days revenues in accounts receivable   53 days 53 days 49 days
Depreciation expense   $ 3,052,000,000.000 $ 2,941,000,000 $ 2,826,000,000
Goodwill impairments   0 0 0
Goodwill acquired during period   362,000,000 262,000,000  
Intangible assets decreased due to amortization and other adjustments   20,000,000 44,000,000  
Gross carrying amount of intangible assets   274,000,000 274,000,000  
Accumulated amortization of intangible assets   228,000,000 208,000,000  
Gross carrying amount of indefinite-lived intangible assets   293,000,000 293,000,000  
Deferred loan costs   559,000,000 496,000,000  
Deferred loan costs, accumulated amortization   226,000,000 195,000,000  
Amortization of debt issuance costs   35,000,000 29,000,000 27,000,000
Reserves for professional liability risks   2,089,000,000.000 2,043,000,000.000  
Current portion of professional liability risks reserves   532,000,000 515,000,000  
Provisions for losses related to professional liability risks   619,000,000 517,000,000 453,000,000
Increase (decrease) in provisions for professional liability risks   $ 40,000,000 $ (55,000,000) $ (87,000,000)
Reserves for professional liability risks cover individual claims | Claim   2,100 2,000  
Net payments of professional and general liability claims   $ 550,000,000 $ 497,000,000  
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   34,000,000 48,000,000  
Amounts receivable under reinsurance contracts recorded in other current assets   8,000,000 12,000,000  
Foreign Currency Translation And Other [Member]        
Summary Of Significant Accounting Policies [Line Items]        
Goodwill increase (decrease)   $ 50,000,000 $ 105,000,000  
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    
v3.24.0.1
Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Revenues From Third Party Payers [Line Items]      
Revenues $ 64,968 $ 60,233 $ 58,752
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 $ 10,585 $ 10,447 $ 10,447
Revenues from third party payers, Ratio 16.30% 17.30% 17.80%
Managed Medicare [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 10,496 $ 9,201 $ 8,424
Revenues from third party payers, Ratio 16.20% 15.30% 14.30%
Medicaid [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 3,606 $ 2,636 $ 2,290
Revenues from third party payers, Ratio 5.60% 4.40% 3.90%
Managed Medicaid [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 3,879 $ 3,998 $ 3,124
Revenues from third party payers, Ratio 6.00% 6.60% 5.30%
Managed Care and Other Insurers [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 31,819 $ 29,120 $ 30,295
Revenues from third party payers, Ratio 49.00% 48.30% 51.60%
International (Managed Care and Other Insurers) [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues from third party payers $ 1,509 $ 1,317 $ 1,336
Revenues from third party payers, Ratio 2.30% 2.20% 2.30%
Other [Member]      
Revenues From Third Party Payers [Line Items]      
Revenues $ 3,074 $ 3,514 $ 2,836
Other, Ratio 4.60% 5.90% 4.80%
v3.24.0.1
Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Accounting Policies [Abstract]      
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 55,341 $ 51,180 $ 49,074
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) 10.50% 11.00% 11.30%
Total uncompensated care $ 35,426 $ 31,734 $ 29,642
Multiply by the cost-to-charges ratio 10.50% 11.00% 11.30%
Estimated cost of total uncompensated care $ 3,720 $ 3,491 $ 3,350
v3.24.0.1
Share-Based Compensation - Additional Information (Detail) - USD ($)
$ / shares in Units, $ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Employee Stock Purchase Plan ("ESPP") [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Common stock were reserved for issuance 13,784,000    
Compensation expense $ 17 $ 16 $ 15
Stock Appreciation Rights (SARs)      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Shares Available for Future Grants 11,056,000.000    
Weighted Average Fair Value of SARs Options Granted $ 87.47 $ 69.55 $ 54.57
Total Intrinsic Value of SARs $ 207 $ 115 $ 404
Unrecognized Compensation Cost Related to Nonvested Awards 46    
Restricted Stock Units and Performance Stock Units [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
RSUs and PSUs, Vested, value 550 $ 550 $ 475
Unrecognized Compensation Cost Related to Nonvested Awards $ 274    
v3.24.0.1
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, 2023
Dec. 31, 2022
Dec. 31, 2021
Share-Based Payment Arrangement [Abstract]      
Risk-free interest rate 3.69% 1.64% 0.68%
Expected volatility 36.00% 34.00% 36.00%
Expected life, in years 5 years 1 month 20 days 5 years 1 month 9 days 6 years 2 months 1 day
Expected dividend yield 0.95% 0.95% 1.10%
v3.24.0.1
Share-Based Compensation - Schedule of Stock Appreciation Rights Activity (Detail) - USD ($)
$ / shares in Units, shares in Thousands, $ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
SARs Options outstanding, Weighted Average Exercise Price, Beginning Balance $ 126.38 $ 113.15 $ 91.53
Granted, Weighted Average Exercise Price 253.49 236 174.98
Exercised, Weighted Average Exercise Price 95.29 90.84 67.57
Cancelled, Weighted Average Exercise Price 202.05 182.87 138.32
SARs Options outstanding, Weighted Average Exercise Price, Ending Balance 146.46 $ 126.38 $ 113.15
SARs Options exercisable, Weighted Average Exercise Price $ 118.67    
SARs Options outstanding, Weighted Average Remaining Contractual Term 5 years 6 months    
SARs Options exercisable, Weighted Average Remaining Contractual Term 4 years 6 months    
SARs Options outstanding, Aggregate Intrinsic Value $ 667    
SARs Options exercisable, Aggregate Intrinsic Value $ 576    
Time SARs [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
SARs Options Outstanding, Beginning Balance 5,960 6,162 7,836
Granted, SARs Options 580 570 877
Exercised, SARs Options (1,156) (660) (2,443)
Cancelled, SARs Options (59) (112) (108)
SARs Options Outstanding, Ending Balance 5,325 5,960 6,162
SARs Options Exercisable, Ending Balance 3,748    
Performance SARs [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
SARs Options Outstanding, Beginning Balance 127 286 819
Granted, SARs Options 0 0 0
Exercised, SARs Options (83) (159) (533)
Cancelled, SARs Options 0 0 0
SARs Options Outstanding, Ending Balance 44 127 286
SARs Options Exercisable, Ending Balance 44    
Total SARs [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
SARs Options Outstanding, Beginning Balance 6,087 6,448 8,655
Granted, SARs Options 580 570 877
Exercised, SARs Options (1,239) (819) (2,976)
Cancelled, SARs Options (59) (112) (108)
SARs Options Outstanding, Ending Balance 5,369 6,087 6,448
SARs Options Exercisable, Ending Balance 3,792    
v3.24.0.1
Share-Based Compensation - Schedule of Restricted Stock Units Activity (Detail) - $ / shares
shares in Thousands
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Restricted Stock Units (RSUs) [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
RSUs and PSUs Outstanding, Beginning Balance 1,784 2,191 2,476
RSUs and PSUs, Granted 609 611 899
Performance adjustment 0 0 0
RSUs and PSUs, Vested (717) (878) (992)
RSUs and PSUs, Cancelled (125) (140) (192)
RSUs and PSUs Outstanding, Ending Balance 1,551 1,784 2,191
Performance Shares PSUs [Member]      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
RSUs and PSUs Outstanding, Beginning Balance 1,715 2,083 2,592
RSUs and PSUs, Granted 479 455 689
Performance adjustment 697 699 684
RSUs and PSUs, Vested (1,393) (1,399) (1,772)
RSUs and PSUs, Cancelled (88) (123) (110)
RSUs and PSUs Outstanding, Ending Balance 1,410 1,715 2,083
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 3,499 4,274 5,068
RSUs and PSUs, Granted 1,088 1,066 1,588
Performance adjustment 697 699 684
RSUs and PSUs, Vested (2,110) (2,277) (2,764)
RSUs and PSUs, Cancelled (213) (263) (302)
RSUs and PSUs Outstanding, Ending Balance 2,961 3,499 4,274
Weighted Average Grant Date Fair Value, RSUs and PSUs, Beginning balance $ 179.18 $ 150.32 $ 125.4
Weighted Average Grant Date Fair Value, RSUs and PSUs, Granted 253.85 235.71 174.34
Performance adjustment 144.42 138.45 102.02
Weighted Average Grant Date Fair Value, RSUs and PSUs, Vested 152.5 138.41 106.62
Weighted Average Grant Date Fair Value, RSUs and PSUs, Cancelled 217.78 183.86 149.07
Weighted Average Grant Date Fair Value, RSUs and PSUs, Ending balance $ 214.71 $ 179.18 $ 150.32
v3.24.0.1
Acquisitions and Dispositions - Additional Information (Detail)
$ in Millions
 12 Months Ended
Dec. 31, 2023
USD ($)
Hospital
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Hospital
Business Acquisition [Line Items]      
Pretax gain (loss) before tax $ (5)    
Proceeds from sale of business 193 $ 1,237 $ 2,160
Real Estate and Other Investments [Member]      
Business Acquisition [Line Items]      
Pretax gain (loss) before tax   274 394
Pretax gain (loss) after tax   $ 200 $ 294
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 31 $ 326 $ 658
Discontinued Operations, Disposed of by Sale [Member]      
Business Acquisition [Line Items]      
Pretax gain (loss) before tax   1,027  
Pretax 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 $ 229   $ 67
Number of hospitals purchased | Hospital 4   2
Proceeds from sale of business $ 162    
Number of hospitals sold | Hospital 2    
Hospital Facility [Member] | Southern Georgia [Member]      
Business Acquisition [Line Items]      
Number of hospitals purchased | Hospital     1
Hospital Facility [Member] | TENNESSEE      
Business Acquisition [Line Items]      
Number of hospitals purchased | Hospital     1
Hospital Facility [Member] | Discontinued Operations, Disposed of by Sale [Member] | Southern Georgia [Member]      
Business Acquisition [Line Items]      
Number of hospitals sold | Hospital     2
Hospital Facility [Member] | Discontinued Operations, Disposed of by Sale [Member] | GEORGIA      
Business Acquisition [Line Items]      
Pretax gain (loss) before tax     $ 1,226
Pretax gain (loss) after tax     $ 920
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     $ 1,502
Number of hospitals sold | Hospital     5
Hospital Facility [Member] | Discontinued Operations, Disposed of by Sale [Member] | Northern Georgia [Member]      
Business Acquisition [Line Items]      
Number of hospitals sold | Hospital     3
Nonhospital Health Care [Member]      
Business Acquisition [Line Items]      
Aggregate purchase price $ 406 224 $ 114
Fair value of the noncontrolling interest in the acquiree at the acquisition date   72 117
Other [Member]      
Business Acquisition [Line Items]      
Goodwill $ 362 $ 262 1,002
Urgent Care Centers [Member]      
Business Acquisition [Line Items]      
Aggregate purchase price     594
Home Health and Hospice [Member]      
Business Acquisition [Line Items]      
Fair value of the noncontrolling interest in the acquiree at the acquisition date     100
Payment to acquire venture providing post acute care services     $ 330
Business acquisition percentage of voting interests acquired     80.00%
v3.24.0.1
Income Taxes - Schedule of Provision for Income Taxes (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Tax Disclosure [Abstract]      
Current, Federal $ 1,118 $ 1,222 $ 1,769
Current, State 213 206 311
Current, Foreign 3 18 15
Deferred, Federal 241 261 24
Deferred, State 21 27 (18)
Deferred, Foreign 19 12 11
Provision for income taxes $ 1,615 $ 1,746 $ 2,112
v3.24.0.1
Income Taxes - Additional Information (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Tax Contingency [Line Items]      
Provision for tax benefits related to settlement of employee awards $ 93 $ 77 $ 119
Foreign pretax income 85 66 $ 64
State net operating loss carryforwards 28    
Federal net operating loss carryforwards 189    
Unrecognized tax benefits, accrued interest 177 129  
Unrecognized tax benefits that would impact effective tax rate $ 320 $ 278  
State and Local Jurisdiction [Member] | Minimum [Member]      
Income Tax Contingency [Line Items]      
Net operating loss carryforwards, expiration date 2024    
State and Local Jurisdiction [Member] | Maximum [Member]      
Income Tax Contingency [Line Items]      
Net operating loss carryforwards, expiration date 2042    
v3.24.0.1
Income Taxes - Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate (Detail)
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Tax Disclosure [Abstract]      
Federal statutory rate 21.00% 21.00% 21.00%
State income taxes, net of federal tax benefit 2.60% 2.30% 2.00%
Change in liability for uncertain tax positions 0.40% 0.70% 0.70%
Tax benefit from settlements of employee equity awards (1.20%) (0.90%) (1.20%)
Other items, net 0.80% 0.50% 0.80%
Effective income tax rate on income attributable to HCA Healthcare, Inc. 23.60% 23.60% 23.30%
Income attributable to noncontrolling interests from consolidated partnerships (2.60%) (3.30%) (1.80%)
Effective income tax rate on income before income taxes 21.00% 20.30% 21.50%
v3.24.0.1
Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Detail) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Income Tax Disclosure [Abstract]    
Depreciation and fixed asset basis differences, Assets $ 0 $ 0
Allowances for professional liability and other risks, Assets 452 430
Accounts receivable, Assets 363 368
Compensation, Assets 308 402
Right-of-use lease obligations 506 451
Other, Assets 592 536
Deferred tax assets 2,221 2,187
Depreciation and fixed asset basis differences, Liabilities 1,048 938
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 492 438
Other, Liabilities 860 698
Deferred tax liabilities $ 2,400 $ 2,074
v3.24.0.1
Income Taxes - Schedule of Activity Related to Unrecognized Tax Benefits (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Income Tax Disclosure [Abstract]    
Beginning Balance $ 639 $ 576
Additions based on tax positions related to the current year 30 25
Additions for tax positions of prior years 4 50
Reductions for tax positions of prior years (10) (4)
Settlements 0 (1)
Lapse of applicable statutes of limitations (24) (7)
Ending Balance $ 639 $ 639
v3.24.0.1
Earnings Per Share - Additional information (Detail) - shares
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Earnings Per Share [Abstract]      
Repurchase of common stock, shares 14,465,000 30,747,000 37,812,000
v3.24.0.1
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, 2023
Dec. 31, 2022
Dec. 31, 2021
Earnings Per Share [Abstract]      
Net income attributable to HCA Healthcare, Inc. $ 5,242 $ 5,643 $ 6,956
Weighted average common shares outstanding 272,404 290,348 323,315
Effect of dilutive incremental shares 4,008 4,318 5,437
Shares used for diluted earnings per share 276,412 294,666 328,752
Basic earnings per share $ 19.25 $ 19.43 $ 21.52
Diluted earnings per share $ 18.97 $ 19.15 $ 21.16
v3.24.0.1
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Debt Securities, Available-for-sale [Line Items]    
Amounts classified as current assets $ (87) $ (92)
Investment carrying value 477 381
Money market funds and other, Amortized Cost 188 96
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 188 96
Investment Owned, at Cost, Total 592 511
Investment Gains 1 0
Investment Losses 29 38
Investment Fiar Value 564 473
Debt Securities [Member]    
Debt Securities, Available-for-sale [Line Items]    
Amortized Cost 404 415
Unrealized Amounts, Gains 1 0
Unrealized Amounts, Losses (29) (38)
Fair Value $ 376 $ 377
v3.24.0.1
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail)
$ in Millions
Dec. 31, 2023
USD ($)
Investments, Debt and Equity Securities [Abstract]  
Due in one year or less, Amortized Cost $ 12
Due after one year through five years, Amortized Cost 150
Due after five years through ten years, Amortized Cost 165
Due after ten years, Amortized Cost 77
Amortized Cost, Total 404
Due in one year or less, Fair Value 12
Due after one year through five years, Fair Value 144
Due after five years through ten years, Fair Value 148
Due after ten years, Fair Value 72
Fair Value, Total $ 376
v3.24.0.1
Investments of Insurance Subsidiaries - Additional Information (Detail)
 12 Months Ended
Dec. 31, 2023
Investments, Debt and Equity Securities [Abstract]  
Available for sale securities expected maturity of debt securities 5 years 1 month 6 days
Available for sale securities average scheduled maturity 8 years 9 months 18 days
v3.24.0.1
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Derivative Instruments, Gain (Loss) [Line Items]      
Amount of Loss Recognized in OCI on Derivatives, Net of Tax $ 0 $ (6) $ (1)
v3.24.0.1
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, 2023
Dec. 31, 2022
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Money market funds and other $ 188 $ 96
Investments of insurance subsidiaries 564 473
Less amounts classified as current assets (87) (92)
Asset fair value 477 381
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 188 96
Investments of insurance subsidiaries 188 96
Less amounts classified as current assets (87) (92)
Asset fair value 101 4
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 376 377
Asset fair value 376 377
Debt Securities [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Debt securities 376 377
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 $ 376 $ 377
v3.24.0.1
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Fair Value Disclosures [Abstract]    
Estimated fair value of long-term debt $ 38,253 $ 35,555
Carrying amounts of debt $ 39,926 $ 38,385
v3.24.0.1
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Debt Instrument [Line Items]    
Senior secured debt $ 4,160 $ 5,733
Debt issuance costs and discounts (333) (301)
Total debt (average life of 9.4 years, rates averaging 5.1%) 39,593 38,084
Less amounts due within one year 2,424 370
Long-term debt 37,169 37,714
Senior Secured Asset-Based Revolving Credit Facility [Member]    
Debt Instrument [Line Items]    
Long-term line of credit 1,880 2,900
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 1,313 1,880
Other Senior Secured Debt [Member]    
Debt Instrument [Line Items]    
Other senior secured debt 967 953
Senior Unsecured Notes [Member]    
Debt Instrument [Line Items]    
Senior unsecured notes $ 35,766 $ 32,652
v3.24.0.1
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail)
 12 Months Ended
Dec. 31, 2023
Debt Instrument [Line Items]  
Total debt average term 9 years 4 months 24 days
Total debt average rate 5.10%
Senior Secured Asset-Based Revolving Credit Facility [Member]  
Debt Instrument [Line Items]  
Effective interest rate 6.70%
Senior Secured Term Loan Facilities [Member]  
Debt Instrument [Line Items]  
Effective interest rate 6.80%
Other Senior Secured Debt [Member]  
Debt Instrument [Line Items]  
Effective interest rate 4.10%
Senior Unsecured Notes [Member]  
Debt Instrument [Line Items]  
Effective interest rate 5.00%
v3.24.0.1
Long-Term Debt - Additional Information (Detail)
 12 Months Ended
Dec. 31, 2023
USD ($)
Debt Instrument [Line Items]  
Maturity of long-term debt in 2025 $ 4,672,000,000
Maturity of long-term debt in 2026 5,350,000,000
Maturity of long-term debt in 2027 2,408,000,000
Maturity of long-term debt in 2028 $ 2,545,000,000
Minimum [Member]  
Debt Instrument [Line Items]  
Debt instrument, maturities range 2025
Maximum [Member]  
Debt Instrument [Line Items]  
Debt instrument, maturities range 2028
Federal Fund Rate [Member]  
Debt Instrument [Line Items]  
Debt instrument basis spread 0.50%
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
Line of credit outstanding $ 1,880,000,000
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 facility $ 3,500,000,000
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 $ 1,313,000,000
Debt instrument maturity date Jun. 30, 2026
Senior Secured Term Loan B Facility [Member]  
Debt Instrument [Line Items]  
Increase in revolving credit facility $ 1,500,000,000
Senior Unsecured Note Maturities Ranging 2024 to 2053 [Member]  
Debt Instrument [Line Items]  
Debt instrument, principal amount $ 35,041,000,000.000
Senior Unsecured Note Maturities Ranging 2024 to 2053 [Member] | Minimum [Member]  
Debt Instrument [Line Items]  
Debt instrument, maturities range 2024
Senior Unsecured Note Maturities Ranging 2024 to 2053 [Member] | Maximum [Member]  
Debt Instrument [Line Items]  
Debt instrument, maturities range 2053
Medium-term Notes Maturity Year 2025 [Member]  
Debt Instrument [Line Items]  
Debt instrument, principal amount $ 125,000,000
Debentures Maturities Ranging 2024 to 2095 [Member]  
Debt Instrument [Line Items]  
Debt instrument, principal amount $ 600,000,000
Debentures Maturities Ranging 2024 to 2095 [Member] | Minimum [Member]  
Debt Instrument [Line Items]  
Debt instrument, maturities range 2024
Debentures Maturities Ranging 2024 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 $ 3,250,000,000
Senior Notes [Member] | Senior Notes Due 2028 [Member]  
Debt Instrument [Line Items]  
Debt instrument, principal amount $ 1,000,000,000
Debt instrument, stated interest 5.20%
Senior Notes [Member] | Senior Notes Due 2033 [Member]  
Debt Instrument [Line Items]  
Debt instrument, principal amount $ 1,250,000,000
Debt instrument, stated interest 5.50%
Senior Notes [Member] | Senior Notes Due 2053 [Member]  
Debt Instrument [Line Items]  
Debt instrument, principal amount $ 1,000,000,000
Debt instrument, stated interest 5.90%
Other Senior Secured Debt [Member]  
Debt Instrument [Line Items]  
Finance leases and other secured debt $ 967,000,000
v3.24.0.1
Leases - Schedule Of Lease-Related Assets And Liabilities (Detail) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Assets:    
Operating leases $ 2,207 $ 2,065
Finance leases 556 587
Total lease assets $ 2,763 $ 2,652
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 $ 363 $ 364
Finance leases 166 131
Right-of-use operating lease obligations 1,903 1,752
Finance leases 541 579
Total lease liabilities $ 2,973 $ 2,826
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 9 months 18 days 10 years 1 month 6 days
Finance leases 9 years 9 years 6 months
Weighted-average discount rate:    
Operating leases 4.90% 4.40%
Finance leases 4.90% 4.50%
v3.24.0.1
Leases - Schedule Of Lease Expense For Finance And Operating Leases (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Finance lease expense:      
Depreciation and amortization $ 164 $ 163 $ 135
Interest 31 29 29
Operating leases [1] 495 484 478
Short-term lease expense [1] 337 329 354
Variable lease expense [1] 162 163 157
Total lease expense $ 1,189 $ 1,168 $ 1,153
[1] Expenses are included in “other operating expenses” in our consolidated income statements.
v3.24.0.1
Leases - Schedule Of Supplemental Cash Flow Information (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Cash Paid For Amounts Included In Measurement Of Lease Liabilities [Abstract]      
Operating cash flows for operating leases $ 479 $ 473 $ 474
Operating cash flows for finance leases 31 29 29
Financing cash flows for finance leases $ 140 $ 124 $ 123
v3.24.0.1
Leases - Schedule of undiscounted cash flows to the finance lease liabilities and operating lease liabilities (Detail) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Operating Lease Liabilities, Payments Due [Abstract]    
Year 1 $ 452 $ 436
Year 2 394 380
Year 3 340 320
Year 4 288 269
Year 5 228 222
Thereafter 1,540 1,122
Total minimum lease payments 3,242 2,749
Less: amount of lease payments representing interest (976) (633)
Present value of future minimum lease payments 2,266 2,116
Less: current obligations under leases (363) (364)
Long-term lease obligations 1,903 1,752
Finance Lease Liabilities, Payments, Due [Abstract]    
Year 1 193 156
Year 2 155 164
Year 3 115 125
Year 4 60 89
Year 5 45 39
Thereafter 356 359
Total minimum lease payments 924 932
Less: amount of lease payments representing interest (217) (222)
Present value of future minimum lease payments 707 710
Less: current obligations under leases (166) (131)
Long-term lease obligations $ 541 $ 579
v3.24.0.1
Capital Stock - Additional Information (Detail)
$ / shares in Units, $ in Millions
 12 Months Ended
Dec. 31, 2023
USD ($)
$ / shares
Directors
shares
Dec. 31, 2022
$ / shares
shares
Dec. 31, 2021
$ / shares
shares
Jan. 31, 2024
USD ($)
Jan. 31, 2023
USD ($)
Jan. 31, 2022
USD ($)
Feb. 28, 2021
USD ($)
Jan. 31, 2020
USD ($)
Jan. 31, 2019
USD ($)
Capital Structure [Line Items]                  
Common stock, shares authorized | shares 1,800,000,000 1,800,000,000              
Repurchase of common stock, shares | shares 14,465,000 30,747,000 37,812,000            
Repurchase price of common stock, per share | $ / shares $ 263.47 $ 227.67 $ 217.25            
Board of Directors Chairman [Member]                  
Capital Structure [Line Items]                  
Share repurchase program authorized amount | $ $ 775       $ 3,000 $ 8,000 $ 6,000 $ 2,000 $ 2,000
Subsequent Event [Member] | Board of Directors Chairman [Member]                  
Capital Structure [Line Items]                  
Share repurchase program authorized amount | $       $ 6,000          
Minimum [Member]                  
Capital Structure [Line Items]                  
Number of directors as per the amended and restated by-laws | Directors 3                
v3.24.0.1
Employee Benefit Plans - Additional Information (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
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 $ 659 $ 606 $ 560
Defined benefit plan cost (credit) 2 (11) 4
Defined benefit plan, assets $ 43 9  
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 $ 40 (27) 38
Noncontributory and nonqualified plan, accrued benefits liabilities 227 210  
Supplemental Executive Retirement Plan [Member]      
Pension Plans, Postretirement and Other Employee Benefits [Line Items]      
Defined benefit plan cost (credit) 10 22 $ 22
Defined benefit plan obligation $ 106 $ 137  
v3.24.0.1
Segment and Geographic Information - Additional Information (Detail)
Dec. 31, 2023
Hospital
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 186
Reorganization Group [Member] | National Group [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 57
Reorganization Group [Member] | American Group [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 60
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 7
v3.24.0.1
Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, 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, 2023
Dec. 31, 2022
Dec. 31, 2021
Segment Reporting Information [Line Items]      
Revenues $ 64,968 $ 60,233 $ 58,752
Equity in losses (earnings) of affiliates (22) (45) (113)
Adjusted segment EBITDA 12,726 12,067 12,644
Depreciation and amortization 3,077 2,969 2,853
Interest expense 1,938 1,741 1,566
Losses (gains) on sales of facilities 5 (1,301) (1,620)
Losses on retirement of debt 0 78 12
Income before income taxes 7,706 8,580 9,833
Assets 56,211 52,438 50,742
Goodwill and other intangible assets, Beginning Balance 9,653 9,540 8,578
Goodwill and other intangible assets, Acquisitions 362 262 1,062
Foreign Currency Translation Amortization And Other (70) (149) (100)
Goodwill and other intangible assets, Ending Balance 9,945 9,653 9,540
National Group [Member]      
Segment Reporting Information [Line Items]      
Revenues 18,105 16,767 16,329
Equity in losses (earnings) of affiliates (2) (1) (33)
Adjusted segment EBITDA 4,000 3,616 4,202
Depreciation and amortization 834 801 754
Assets 12,487 11,793 11,236
Goodwill and other intangible assets, Beginning Balance 1,244 1,212 1,089
Goodwill and other intangible assets, Acquisitions 0 75 126
Foreign Currency Translation Amortization And Other (3) (43) (3)
Goodwill and other intangible assets, Ending Balance 1,241 1,244 1,212
Atlantic Group [Member]      
Segment Reporting Information [Line Items]      
Revenues 21,167 19,324 19,098
Equity in losses (earnings) of affiliates (3) (3) (2)
Adjusted segment EBITDA 4,492 3,881 4,218
Depreciation and amortization 989 921 848
Assets 16,098 15,092 13,944
Goodwill and other intangible assets, Beginning Balance 2,057 1,970 1,375
Goodwill and other intangible assets, Acquisitions 8 90 610
Foreign Currency Translation Amortization And Other (1) (3) (15)
Goodwill and other intangible assets, Ending Balance 2,064 2,057 1,970
American Group [Member]      
Segment Reporting Information [Line Items]      
Revenues 22,318 20,858 19,636
Equity in losses (earnings) of affiliates (59) (43) (50)
Adjusted segment EBITDA 5,208 5,102 4,836
Depreciation and amortization 971 937 897
Assets 19,786 17,934 17,224
Goodwill and other intangible assets, Beginning Balance 5,152 5,062 4,996
Goodwill and other intangible assets, Acquisitions 326 90 66
Foreign Currency Translation Amortization And Other 0 0 0
Goodwill and other intangible assets, Ending Balance 5,478 5,152 5,062
Corporate and Other [Member]      
Segment Reporting Information [Line Items]      
Revenues 3,378 3,284 3,689
Equity in losses (earnings) of affiliates 42 2 (28)
Adjusted segment EBITDA (974) (532) (612)
Depreciation and amortization 283 310 354
Assets 7,840 7,619 8,338
Goodwill and other intangible assets, Beginning Balance 1,200 1,296 1,118
Goodwill and other intangible assets, Acquisitions 28 7 260
Foreign Currency Translation Amortization And Other (66) (103) (82)
Goodwill and other intangible assets, Ending Balance $ 1,162 $ 1,200 $ 1,296
v3.24.0.1
Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Equity [Abstract]      
Unrealized gains (losses) on available-for-sale securities, beginning balances $ (30) $ 12 $ 25
Unrealized gains (losses) on available-for-sale securities, net of income taxes 9 (43) (13)
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 (22) (30) 12
Foreign currency translation adjustments, beginning balances (373) (278) (271)
Foreign currency translation adjustments, net of income tax benefit 34 (95) (7)
Foreign currency translation adjustments, ending balances (339) (373) (278)
Defined benefit plans, beginning balances (87) (132) (220)
Defined benefit plans, net of income taxes 21 38 67
Defined benefit plans, expense (benefit) reclassified into operations from other comprehensive income 2 7 21
Defined benefit plans, ending balances (64) (87) (132)
Change in fair value of derivative instruments, beginning balances 0 (6) (36)
Change in fair value of derivative instruments, net of income taxes   5 1
Change in fair value of derivatives instruments, (income) expense (benefit) reclassified into operations from other comprehensive income   1 29
Change in fair value of derivative instruments, ending balances 0 0 (6)
Accumulated other comprehensive loss, net of tax, beginning balances (490) (404) (502)
Unrealized gains (losses) on available-for-sale securities, net of income taxes 9 (43) (13)
Foreign currency translation adjustments, net of income tax benefit 34 (95) (7)
Change in fair value of derivative instruments, net of income tax benefit   5 1
Defined benefit plans, net of income tax benefit 21 38 67
Expense (benefit) reclassified into operations from other comprehensive income, Total 1 9 50
Accumulated other comprehensive loss, net of tax, ending balances $ (425) $ (490) $ (404)
v3.24.0.1
Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Equity [Abstract]      
Unrealized gains (losses) on available-for-sale securities, tax benefit   $ 12 $ 3
Unrealized gains (losses) on available-for-sale securities, tax expense $ 2    
Foreign currency translation adjustments, income tax benefit   16 2
Foreign currency translation adjustments, income tax expense 7    
Defined benefit plans, income tax expense 6 11 20
Change in fair value of derivative instruments, income tax expense   1  
Defined benefit plans, benefit reclassified into operations from other comprehensive income 0 2 7
Interest expense on derivative instruments, benefit reclassified into operations from other comprehensive income $ 1 $ 1 $ 8
v3.24.0.1
Accrued Expenses - Summary of Other Accrued Expenses (Detail) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Payables and Accruals [Abstract]    
Professional liability risks $ 532 $ 515
Defined contribution benefit plans 668 612
Right-of-use operating leases 363 364
Taxes other than income 382 371
Interest 414 402
Employee medical benefits 199 182
Other 1,313 1,135
Other accrued expenses $ 3,871 $ 3,581