Cover Page - USD ($) $ in Millions	12 Months Ended
Cover Page - USD ($) $ in Millions	Dec. 31, 2020	Jan. 31, 2021	Jun. 30, 2020
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2020
Document Fiscal Year Focus	2020
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		339,917,500
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
Security Exchange Name	NYSE
Entity Voluntary Filers	No
Entity Well-known Seasoned Issuer	Yes
Entity Public Float			$ 25,836
ICFR Auditor Attestation Flag	true

Consolidated Income Statements - USD ($) shares in Thousands, $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Statement [Abstract]
Revenues	$ 51,533	$ 51,336	$ 46,677
Salaries and benefits	23,874	23,560	21,425
Supplies	8,369	8,481	7,724
Other operating expenses	9,307	9,481	8,608
Equity in earnings of affiliates	(54)	(43)	(29)
Depreciation and amortization	2,721	2,596	2,278
Interest expense	1,584	1,824	1,755
Losses (gains) on sales of facilities	7	(18)	(428)
Losses on retirement of debt	295	211	9
Total expenses including equity in earnings of affiliates	46,103	46,092	41,342
Income before income taxes	5,430	5,244	5,335
Provision for income taxes	1,043	1,099	946
Net income	4,387	4,145	4,389
Net income attributable to noncontrolling interests	633	640	602
Net income attributable to HCA Healthcare, Inc.	$ 3,754	$ 3,505	$ 3,787
Per share data:
Basic earnings per share	$ 11.10	$ 10.27	$ 10.90
Diluted earnings per share	$ 10.93	$ 10.07	$ 10.66
Shares used in earnings per share calculations (in millions):
Basic	338,274	341,210	347,297
Diluted	343,605	348,226	355,303

Consolidated Comprehensive Income Statements - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Statement of Comprehensive Income [Abstract]
Net income	$ 4,387	$ 4,145	$ 4,389
Other comprehensive income (loss) before taxes:
Foreign currency translation	18	5	(71)
Unrealized gains (losses) on available-for-sale securities	14	15	(7)
Defined benefit plans	(71)	(63)	44
Pension costs included in salaries and benefits	28	13	21
Total defined benefit plans	(43)	(50)	65
Change in fair value of derivative financial instruments	(66)	(50)	23
Interest costs (benefits) included in interest expense	24	(17)	(10)
Total change in fair value of derivative financial instruments	(42)	(67)	13
Other comprehensive loss before taxes	(53)	(97)	0
Income taxes (benefits) related to other comprehensive income items	(11)	(18)	8
Other comprehensive loss	(42)	(79)	(8)
Comprehensive income	4,345	4,066	4,381
Comprehensive income attributable to noncontrolling interests	633	640	602
Comprehensive income attributable to HCA Healthcare, Inc.	$ 3,712	$ 3,426	$ 3,779

Consolidated Balance Sheets - USD ($) $ in Millions	Dec. 31, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 1,793	$ 621
Accounts receivable	7,051	7,380
Inventories	2,025	1,849
Other	1,464	1,346
Total current assets	12,333	11,196
Property and equipment, at cost:
Land	2,269	2,178
Buildings	18,471	17,669
Equipment	27,082	25,756
Construction in progress	1,495	1,632
Property and equipment, at cost	49,317	47,235
Accumulated depreciation	(26,118)	(24,520)
Property and equipment, net	23,199	22,715
Investments of insurance subsidiaries	388	315
Investments in and advances to affiliates	422	249
Goodwill and other intangible assets	8,578	8,269
Right-of-use operating lease assets	2,024	1,834
Other	546	480
Total assets	47,490	45,058
Current liabilities:
Accounts payable	3,535	2,905
Accrued salaries	1,720	1,775
Other accrued expenses	3,240	2,932
Long-term debt due within one year	209	145
Total current liabilities	8,704	7,757
Long-term debt, less debt issuance costs and discounts of $236 and $239	30,795	33,577
Professional liability risks	1,486	1,370
Right-of-use operating lease obligations	1,673	1,499
Income taxes and other liabilities	1,940	1,420
Stockholders' equity (deficit):
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 339,425,600 shares — 2020 and 338,445,600 shares — 2019	3	3
Capital in excess of par value	294	0
Accumulated other comprehensive loss	(502)	(460)
Retained earnings (deficit)	777	(2,351)
Stockholders' equity (deficit) attributable to HCA Healthcare, Inc.	572	(2,808)
Noncontrolling interests	2,320	2,243
Total stockholders' equity (deficit)	2,892	(565)
Total liabilities and stockholders' equity (deficit)	$ 47,490	$ 45,058

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions	Dec. 31, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Debt issuance costs	$ 236	$ 239
Common stock, par value	$ 0.01	$ 0.01
Common stock, shares authorized	1,800,000,000	1,800,000,000
Common stock, shares outstanding	339,425,600	338,445,600

Consolidated Statements of Stockholders' 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]
Balances at Dec. 31, 2017	$ (4,995)	$ 4		$ (278)	$ (6,532)	$ 1,811
Balance, shares at Dec. 31, 2017		350,092,000.000
Comprehensive income (loss)	4,381			(8)	3,787	602
Repurchase of common stock	$ (1,530)	$ (1)	$ (103)		(1,426)
Repurchase of common stock, shares	(14,070,000.000)	(14,070,000.000)
Share-based benefit plans	$ 115		115
Share-based benefit plans, shares		6,873,000
Cash dividends declared	(496)				(496)
Distributions	(441)					(441)
Reclassification of stranded tax effects				(95)	95
Other	48		(12)			60
Balance at Dec. 31, 2018	(2,918)	$ 3		(381)	(4,572)	2,032
Balance, shares at Dec. 31, 2018		342,895,000
Comprehensive income (loss)	4,066			(79)	3,505	640
Repurchase of common stock	$ (1,031)		(302)		(729)
Repurchase of common stock, shares	(7,949,000)	(7,949,000)
Share-based benefit plans	$ 313		313
Share-based benefit plans, shares		3,500,000
Cash dividends declared	(555)				(555)
Distributions	(542)					(542)
Other	102		(11)			113
Balance at Dec. 31, 2019	(565)	$ 3		(460)	(2,351)	2,243
Balance, shares at Dec. 31, 2019		338,446,000
Comprehensive income (loss)	4,345			(42)	3,754	633
Repurchase of common stock	$ (441)				(441)
Repurchase of common stock, shares	(3,287,000)	(3,287,000)
Share-based benefit plans	$ 265		300		(35)
Share-based benefit plans, shares		4,267,000
Cash dividends declared	(150)				(150)
Distributions	(626)					(626)
Other	64		(6)			70
Balance at Dec. 31, 2020	$ 2,892	$ 3	$ 294	$ (502)	$ 777	$ 2,320
Balance, shares at Dec. 31, 2020		339,426,000

Consolidated Statements of Stockholders' Deficit (Parenthetical) - $ / shares	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Statement of Stockholders' Equity [Abstract]
Cash dividends declared, per share	$ 0.43	$ 1.60	$ 1.40

Consolidated Statements of Cash Flows - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Cash flows from operating activities:
Net income	$ 4,387	$ 4,145	$ 4,389
Increase (decrease) in cash from operating assets and liabilities:
Accounts receivable	327	(326)	(423)
Inventories and other assets	(304)	(158)	(242)
Accounts payable and accrued expenses	1,255	396	698
Depreciation and amortization	2,721	2,596	2,278
Income taxes	41	250	74
Losses (gains) on sales of facilities	7	(18)	(428)
Losses on retirement of debt	295	211	9
Amortization of debt issuance costs	30	30	31
Share-based compensation	362	347	268
Other	111	129	107
Net cash provided by operating activities	9,232	7,602	6,761
Cash flows from investing activities:
Purchase of property and equipment	(2,835)	(4,158)	(3,573)
Acquisition of hospitals and health care entities	(568)	(1,682)	(1,253)
Sales of hospitals and health care entities	68	61	808
Change in investments	(20)	25	57
Other	(38)	34	60
Net cash used in investing activities	(3,393)	(5,720)	(3,901)
Cash flows from financing activities:
Issuances of long-term debt	2,700	6,451	2,000
Net change in revolving credit facilities	(2,480)	(560)	(640)
Repayment of long-term debt	(3,437)	(5,324)	(1,704)
Distributions to noncontrolling interests	(626)	(542)	(441)
Payment of debt issuance costs	(35)	(73)	(25)
Payment of dividends	(153)	(550)	(487)
Repurchase of common stock	(441)	(1,031)	(1,530)
Other	(205)	(142)	(248)
Net cash used in financing activities	(4,677)	(1,771)	(3,075)
Effect of exchange rate changes on cash and cash equivalents	10	8	(15)
Change in cash and cash equivalents	1,172	119	(230)
Cash and cash equivalents at beginning of period	621	502	732
Cash and cash equivalents at end of period	1,793	621	502
Interest payments	1,607	1,914	1,744
Income tax payments, net	$ 1,002	$ 849	$ 872

Accounting Policies

12 Months Ended

Dec. 31, 2020

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, 2020 these affiliates owned and operated 185 hospitals, 121

freestanding surgery centers, 21 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 “cost of revenue” items. Costs that could be classified as general and administrative include our corporate office costs, which were $416 million, $370 million and $344 million for the years ended December 31, 2020, 2019 and 2018, respectively.

COVID-19

Pandemic and CARES Act Funding

On March 11, 2020, the World Health Organization designated

COVID-19

as a global pandemic. Patient volumes and the related revenues for most of our services were significantly impacted during the latter portion of the first quarter and the first half of the second quarter of 2020 and have continued to be impacted as various policies that were implemented by federal, state and local governments in response to the

COVID-19

pandemic, including policies that have caused many people to remain at home, forced the closure of or limitations on certain businesses, and suspended elective surgical procedures by health care facilities. While many of these restrictions have been eased across the U.S. and most states have lifted moratoriums on

non-emergent

procedures, restrictions remain in place or may be adopted or

re-imposed,

and the possibility exists that the public, particularly segments with a high mortality risk, could remain wary of real or perceived opportunities for exposure to the virus. We are unable to predict the future impact of the pandemic on our operations.

During 2020, we received approximately $4.4 billion of accelerated Medicare payments and approximately $1.8 billion in general and targeted distributions from the Provider Relief Fund, both as provided for and established under the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act. During October 2020,

we announced our decision to return, or repay early, all of our share of the Provider Relief Fund distributions and all of the Medicare accelerated payments. During the fourth quarter of 2020, we returned, or repaid early, approximately $6.1 billion of these funds. The unreturned Provider Relief Funds of $83

million, related to amounts received by certain of our partnership entities, are recorded under the caption “other accrued

expenses” in our consolidated balance sheet at December 31, 2020. Our share of these funds will be returned in 2021 after final determination of amounts earned and distributable to the members of each respective partnership.

The CARES Act also provides for a deferral of payments of the employer portion of Social Security tax incurred during the pandemic, allowing half of such payroll taxes to be deferred until December 2021 and the remaining half until December 2022. At December 31, 2020, the Company had deferred $688 million of Social Security taxes. Additionally, the CARES Act created a payroll tax credit designed to encourage companies to retain employees during the pandemic. During the year ended December 31, 2020, the Company evaluated its eligibility for this credit and recorded $60 million of employee retention payroll tax credits pursuant to the CARES Act. These tax credits were recorded as a reduction of salaries and benefits in our consolidated income statement.

We believe the extent of the COVID-19 pandemic’s impact on our operating results and financial condition has been and will continue to be driven by many factors, most of which are beyond our control and ability to forecast. Such factors include, but are not limited to:
 the severity or duration of the pandemic, including whether there will be additional periods of increases in the number of COVID-19 cases in the areas in which we operate, the rollout and availability of effective medical treatments and vaccines, the efficacy of public health controls, including vaccines, and the impact of any mutations of the virus; the scope and duration of stay-at-home practices and business closures and restrictions; recommended or required suspensions of elective procedures; continued declines in patient volumes for an indeterminable length of time; increases in the number of uninsured and underinsured patients as a result of higher sustained rates of unemployment; incremental expenses required for supplies and personal protective equipment; and changes in professional and general liability exposure. Because of these and other uncertainties, we cannot estimate how long or how severely the pandemic will impact our business. If we experience declines in cash flows and results of operations, such declines could have an impact on the inputs and assumptions used in significant accounting estimates, including estimated implicit price concessions related to uninsured patient accounts, professional and general liability reserves, and potential impairments of goodwill and long-lived assets. 

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.

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 discounts and contractual 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,
	2020		Ratio			2019		Ratio			2018		Ratio
Medicare	$	10,420		20.2	%	$	10,798		21.0	%	$	9,831		21.1	%
Managed Medicare		6,997		13.6			6,452		12.6			5,497		11.8
Medicaid		1,965		3.8			1,572		3.1			1,358		2.9
Managed Medicaid		2,621		5.1			2,450		4.8			2,403		5.1
Managed care and other insurers		26,535		51.5			26,544		51.6			24,467		52.4
International (managed care and other insurers)		1,120		2.2			1,162		2.3			1,156		2.5
Other		1,875		3.6			2,358		4.6			1,965		4.2

Revenues	$	51,533		100.0	%	$	51,336		100.0	%	$	46,677		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 amounts and disproportionate-share funds related primarily to cost reports filed during the respective year resulted in net increases to revenues of $70 million, $51 million and $29 million in 2020, 2019 and 2018, respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in a net

reduction

to revenues of $5 million in 2020 and net increases to revenues of $13 million and $51 million in 2019 and 2018, respectively.

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, were 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, were 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.

The collection of outstanding receivables for 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, 2020 and 2019, estimated implicit price concessions of $6.108 billion and $6.953 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):


	2020			2019			2018
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization)	$	44,271		$	44,118		$	40,035

Cost-to-charges ratio (patient care costs as percentage of gross patient charges)		12.0	%		12.0	%		12.4	%

Total uncompensated care	$	29,029		$	31,105		$	26,757
Multiply by the cost-to-charges ratio		12.0	%		12.0	%		12.4	%

Estimated cost of total uncompensated care	$	3,483		$	3,733		$	3,318

The total uncompensated care amounts include charity care of $13.763 billion, $13.260 billion and $8.611 billion for the years ended December 31, 2020, 2019 and 2018, respectively. The estimated costs of charity care were $1.652 billion, $1.591 billion and $1.068 billion for the years ended December 31, 2020, 2019 and 2018, respectively.

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 $495 million and $486 million at December 31, 2020 and 2019, 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 45 days, 50 days and 51 days at December 31, 2020, 2019 and 2018,

respectively. The five-day decline from December 31, 2019 to December 31, 2020 was primarily due to the combined impact of a $329 million decline in accounts receivable at December 31, 2020, compared to December 31, 2019, and a 5.7% increase in fourth

quarter 2020 revenues per day compared to fourth quarter 2019 revenues per day. Changes in general economic conditions, patient accounting service center operations, payer mix, 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 $2.693 billion in 2020, $2.579 billion in 2019 and $2.262 billion in 2018. 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 long-lived assets 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.

Long-lived assets 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

At December 31, 2020 and 2019, the investments of our 100% owned 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 2020, 2019 or 2018.

During 2020, goodwill increased by $279

million related to acquisitions, including the finalization of the accounting for certain prior year acquisitions, and declined

by $9 million related to foreign currency translation and other adjustments. During 2019, goodwill increased by $332 million related to acquisitions and declined by $4 million related to foreign currency translation and other adjustments.

During 2020, identifiable intangible assets increased by $65 million related to acquisitions, including the finalization of the accounting for certain prior year acquisitions, and declined by

$26 million due to amortization and other adjustments. During 2019, identifiable intangible assets declined by $12 million due to amortization, foreign currency translation and other adjustments. Identifiable intangible assets are amortized over estimated lives ranging generally from three to 10 years.

The gross carrying amounts of identifiable intangible assets at December 31, 2020 and 2019 were

$249 million and $184 million, respectively, and accumulated amortization was $149 million and $123 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2020 and 2019 was $269 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 amount of debt issuance costs and discounts at December 31, 2020 and 2019 was $411 million and $413 million, respectively, and accumulated amortization was $175 million and $174 million, respectively. Amortization of debt issuance costs and discounts is included in interest expense and was $30 million, $30 million and $31 million for 2020, 2019 and 2018, respectively.

Professional Liability Claims

Reserves for professional liability risks were $1.963 billion and $1.827 billion at December 31, 2020 and 2019, respectively. The current portion of the reserves, $477 million and $457

million at December 31, 2020 and 2019, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were

$435 million, $497 million and $447

million for 2020, 2019 and 2018, 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. During 2020, 2019 and 2018, we recorded reductions to the provision for professional liability risks of

$112 million

,

$50

million and $70 million,

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 2,300 individual claims at both December 31, 2020 and 2019 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 2020 and 2019, $292 million and $408 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 a 100% owned insurance subsidiary. Subject, in most cases, to a $15 million per occurrence self-insured retention, our facilities are insured by our 100% owned insurance subsidiary for losses up to $50

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 include $31 million and $37 million at December 31, 2020 and 2019, respectively, recorded in “other assets,” and $8 million and $9 million at December 31, 2020 and 2019, respectively, recorded in “other current assets.”

Financial Instruments

Derivative financial instruments are employed to manage interest rate risks, and are not used for trading or speculative purposes. We recognize our interest rate swap derivative instruments in the consolidated balance sheets at fair value. Changes in the fair value of derivatives are recognized periodically in stockholders’ equity, as a component of other comprehensive income (loss), provided the derivative financial instrument qualifies for hedge accounting. Gains and losses on derivatives designated as cash flow hedges, to the extent they are effective, are recorded in other comprehensive income (loss), and subsequently reclassified to earnings to offset the impact of the forecasted transactions when they occur. In the event the forecasted transaction to which a cash flow hedge relates is no longer likely, the amount in other comprehensive income is recognized in earnings and generally the derivative is terminated.

The net interest paid or received on interest rate swaps is recognized as adjustments to interest expense. Gains and losses resulting from the early termination of interest rate swap agreements are deferred and amortized as adjustments to interest expense over the remaining term of the debt originally associated with the terminated swap.

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.

Share-Based Compensation

12 Months Ended

Dec. 31, 2020

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Share-Based Compensation

NOTE 2 — SHARE-BASED COMPENSATION

Reclassifications

Certain prior year amounts have been reclassified to conform to the 2020 presentation.

Stock Incentive Plans

In May 2020, the 2020 Stock Incentive Plan for Key Employees of HCA Healthcare, Inc. and its

Affiliates

(the “2020 Plan”) was established to replace the 2006 Stock Incentive Plan for Key Employees of HCA

Holdings

, Inc. and its

Affiliates (the “2006 Plan”).

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 through opportunities for stock-based compensation and stock ownership in the Company. Stock option, stock appreciation right (“SARs”) and restricted share unit (“RSUs”) grants vest solely based upon continued employment over a specific period of time, and performance share unit (“PSUs”) grants vest based upon both continued employment over a specific period of time and the achievement of predetermined financial targets over time.

No further grants will be made under the 2006 Plan, and no shares under the 2006 Plan are available for grant under the 2020 Plan.

At December 31, 2020 there were 20.274 million shares available for future grants under the 2020 Plan.

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, 2020, 5.865 million shares of common stock were reserved for issuance under the ESPP provisions. During 2020, 2019 and 2018, the Company recognized $13 million, $12 million and $10 million, respectively, of compensation expense related to the ESPP.

Stock Option, SAR, RSU and PSU Activity – All Plans

The fair value of each stock option and 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 Stock Options and SARs” and “Time RSUs”) and based upon continued employment and the achievement of certain financial targets (“Performance Stock Options and SARs”, “Performance RSUs” 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 for 2020 and 2019 grants and less than 80% of target for 2018 and prior grants) to two times the original PSU grant (for actual performance of 110% or more of target for 2020 and 2019 grants and 120% or more of target for 2018 and prior grants). 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 options and 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.


	2020			2019			2018
Risk-free interest rate		1.44	%		2.50	%		2.62	%
Expected volatility		27	%		27	%		29	%
Expected life, in years		6.15			6.18			6.15
Expected dividend yield		1.19	%		1.16	%		1.37	%

Information regarding Time Stock Options and SARs and Performance Stock Options and SARs activity during 2020, 2019 and 2018 is summarized below (share amounts in thousands):


	Time Stock Options and SARs			Performance Stock Options and SARs			Total Stock Options and SARs			Weighted Average Exercise Price		Weighted Average Remaining Contractual Term		Aggregate Intrinsic Value (dollars in millions)
Options and SARs outstanding, December 31, 2017		11,156			4,586			15,742		$	43.47
Granted		2,342			—			2,342			101.96
Exercised		(3,917	)		(1,774	)		(5,691	)		27.86
Cancelled		(221	)		(145	)		(366	)		68.43

Options and SARs outstanding, December 31, 2018		9,360			2,667			12,027			61.49
Granted		1,349			—			1,349			138.31
Exercised		(1,137	)		(523	)		(1,660	)		44.45
Cancelled		(522	)		—			(522	)		93.26

Options and SARs outstanding, December 31, 2019		9,050			2,144			11,194			71.79
Granted		1,120			—			1,120			144.47
Exercised		(2,159	)		(1,325	)		(3,484	)		44.07
Cancelled		(175	)		—			(175	)		111.69

Options and SARs outstanding, December 31, 2020		7,836			819			8,655		$	91.53		6.0 years	$	631

Options and SARs exercisable, December 31, 2020		4,562			819			5,381		$	71.25		4.8 years	$	502

The weighted average fair values of stock options and SARs granted during 2020, 2019 and 2018 were $35.98, $38.21 and $28.90 per share, respectively. The total intrinsic value of stock options and SARs exercised during 2020, 2019 and 2018 was $328 million, $153 million and $456 million, respectively. As of December 31, 2020, the unrecognized compensation cost related to nonvested stock options and SARs was $53 million.

Stock Option, SAR, RSU and PSU Activity – All Plans (continued)

Information regarding Time RSUs, Performance RSUs and PSUs activity during 2020, 2019 and 2018 is summarized below (share amounts in thousands):


	Time RSUs			Performance RSUs			PSUs			Total RSUs and PSUs			Weighted Average Grant Date Fair Value
RSUs and PSUs outstanding, December 31, 2017		3,465			227			3,562			7,254		$	72.05
Granted		1,464			—			1,261			2,725			101.85
Performance adjustment		—			—			1,250			1,250			69.27
Vested		(1,487	)		(136	)		(2,500	)		(4,123	)		67.33
Cancelled		(319	)		(91	)		(151	)		(561	)		78.82

RSUs and PSUs outstanding, December 31, 2018		3,123			—			3,422			6,545			86.32
Granted		973			—			796			1,769			138.45
Performance adjustment		—			—			227			227			69.94
Vested		(1,216	)		—			(1,251	)		(2,467	)		75.97
Cancelled		(260	)		—			(159	)		(419	)		103.27

RSUs and PSUs outstanding, December 31, 2019		2,620			—			3,035			5,655			105.23
Granted		1,048			—			808			1,856			144.17
Performance adjustment		—			—			206			206			81.89
Vested		(1,030	)		—			(1,364	)		(2,394	)		88.63
Cancelled		(162	)		—			(93	)		(255	)		124.50

RSUs and PSUs outstanding, December 31, 2020		2,476			—			2,592			5,068		$	125.40

The total fair value of RSUs and PSUs that vested during 2020, 2019 and 2018 was $349 million, $346 million and $413 million, respectively. As of December 31, 2020, the unrecognized compensation cost related to RSUs and PSUs was $330 million.

Acquisitions and Dispositions	12 Months Ended
Acquisitions and Dispositions	Dec. 31, 2020
Business Combinations [Abstract]
Acquisitions and Dispositions	NOTE 3 — ACQUISITIONS AND DISPOSITIONS During 2020, we paid $568 million to acquire a hospital in New Hampshire and other nonhospital health care entities. During 2019, we paid $1.384 billion to acquire a seven-hospital health system in North Carolina and $298 million to acquire nonhospital health care entities. During 2018, we paid $792 million to acquire two hospital facilities and $461 million to acquire nonhospital health care entities. 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 $279 million, $332 million and $636 million in 2020, 2019 and 2018, 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 2020, we received proceeds of $68 million and recognized a pretax loss of $7 million ($9 million after tax) related to the sale of a hospital facility from our American Group (Mississippi market) and sales of real estate and other investments. During 2019, we received proceeds of $61 million and recognized a pretax gain of $18 million ($13 million after tax) related to the sale of a hospital facility from our American Group (a Louisiana market) and sales of real estate and other investments. During 2018, we received proceeds of $ 758 million and recognized a pretax gain of $353 million ($265 million after tax) related to the sale of two hospital facilities from our American Group (Oklahoma market). During 2018, we also received proceeds of $50 million and recognized pretax gains of $75 million ($59 million after tax) related to sales of real estate and other investments.

Income Taxes

12 Months Ended

Dec. 31, 2020

Income Tax Disclosure [Abstract]

Income Taxes

NOTE 4 — INCOME TAXES

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


	2020			2019			2018
Current:
Federal	$	1,021		$	670		$	759
State		126			134			149
Foreign		5			17			23
Deferred:
Federal		(73	)		254			9
State		(39	)		29			13
Foreign		3			(5	)		(7	)

	$	1,043		$	1,099		$	946

The 2017 Tax Cuts and Jobs Act (“Tax Act”) significantly revised U.S. corporate income taxes, including lowering the statutory corporate tax rate from 35% to 21% beginning in 2018. We completed our analysis of the impact of the Tax Act during 2018, reducing our provision for income taxes for the year ended December 31, 2018 by $67 million related to a remeasurement of certain deferred tax assets and liabilities for which we were unable to make reasonable estimates in 2017.

Our provision for income taxes for the years ended December 31, 2020, 2019 and 2018 included tax benefits of $92 million, $65 million and $124 million, respectively, related to the settlement of employee equity awards. During 2018, we recorded a reduction to our provision for income taxes of $28 million for tax credits related to certain 2017 hurricane-related expenses. Our foreign pretax income was $9 million, $50 million and $86 million for the years ended December 31, 2020, 2019 and 2018, respectively.

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


	2020			2019			2018
Federal statutory rate		21.0	%		21.0	%		21.0	%
State income taxes, net of federal tax benefit		1.9			2.7			2.9
Change in liability for uncertain tax positions		(0.2	)		0.4			(0.1	)
Tax benefit from settlements of employee equity awards		(1.8	)		(1.3	)		(2.4	)
Impact of Tax Act on deferred tax balances		—			—			(1.6	)
Other items, net		0.8			1.1			0.2

Effective income tax rate on income attributable to HCA Healthcare, Inc.		21.7			23.9			20.0
Income attributable to noncontrolling interests from consolidated partnerships		(2.5	)		(2.9	)		(2.3	)

Effective income tax rate on income before income taxes		19.2	%		21.0	%		17.7	%

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


	2020				2019
	Assets		Liabilities		Assets		Liabilities
Depreciation and fixed asset basis differences	$	—	$	678	$	—	$	601
Allowances for professional liability and other risks		407		—		376		—
Accounts receivable		283		—		307		—
Compensation		487		—		292		—
Right-of-use lease assets and obligations		416		409		369		366
Other		485		606		461		538

	$	2,078	$	1,693	$	1,805	$	1,505

At December 31, 2020, federal and state net operating loss carryforwards (expiring in years 2023 through 2039) available to offset future taxable income approximated $56 million and $127 million, respectively. Utilization of net operating loss carryforwards in any one year may be limited.

The following table summarizes the activity related to our unrecognized tax benefits (dollars in millions):


	2020			2019
Balance at January 1	$	522		$	390
Additions (reductions) based on tax positions related to the current year		(3	)		29
Additions for tax positions of prior years		13			119
Reductions for tax positions of prior years		(30	)		(3	)
Settlements		(22	)		—
Lapse of applicable statutes of limitations		(11	)		(13	)

Balance at December 31	$	469		$	522

Our liability for unrecognized tax benefits was $508 million, including accrued interest of $73 million and excluding $34 million that was recorded as reductions of the related deferred tax assets, as of December 31, 2020 ($550 million, $62 million and $34 million, respectively, as of December 31, 2019). Unrecognized tax benefits of $157 million as of December 31, 2020 ($160 million as of December 31, 2019) would affect the effective rate, if recognized.

The Internal Revenue Service (“IRS”) was conducting an examination of the Company’s 2016, 2017 and 2018 federal income tax returns at December 31, 2020. We are also subject to examination 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.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References + Details

Earnings Per Share

12 Months Ended

Dec. 31, 2020

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 stock options, SARs, RSUs and PSUs, computed using the treasury stock method.

During 2020, 2019 and 2018, we repurchased 3.287 million shares, 7.949 million shares and 14.070 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, 2020, 2019 and 2018 (dollars and shares in millions, except per share amounts):


	2020		2019		2018
Net income attributable to HCA Healthcare, Inc.	$	3,754	$	3,505	$	3,787

Weighted average common shares outstanding		338.274		341.210		347.297
Effect of dilutive incremental shares		5.331		7.016		8.006

Shares used for diluted earnings per share		343.605		348.226		355.303

Earnings per share:
Basic earnings per share	$	11.10	$	10.27	$	10.90
Diluted earnings per share	$	10.93	$	10.07	$	10.66

Investments of Insurance Subsidiaries

12 Months Ended

Dec. 31, 2020

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):


	2020
	Amortized Cost		Unrealized Amounts				Fair Value
	Amortized Cost		Gains		Losses		Fair Value
Debt securities	$	384	$	32	$	—	$	416
Money market funds and other		88		—		—		88

	$	472	$	32	$	—		504

Amounts classified as current assets								(116	)

Investment carrying value							$	388


	2019
	Amortized Cost		Unrealized Amounts				Fair Value
	Amortized Cost		Gains		Losses		Fair Value
Debt securities	$	359	$	18	$	—	$	377
Money market funds and other		85		—		—		85

	$	444	$	18	$	—		462

Amounts classified as current assets								(147	)

Investment carrying value							$	315

At December 31, 2020 and 2019, the investments in debt securities of our insurance subsidiaries were classified as

“available-for-sale.”

Changes in unrealized gains and losses are recorded as adjustments to other comprehensive income (loss).

Scheduled maturities of investments in debt securities at December 31, 2020 were as follows (dollars in millions):


	Amortized Cost		Fair Value
Due in one year or less	$	4	$	4
Due after one year through five years		147		156
Due after five years through ten years		157		174
Due after ten years		76		82

	$	384	$	416

The average expected maturity of the investments in debt securities at December 31, 2020 was 5.2 years, compared to the average scheduled maturity of 9.4 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.

Financial Instruments

12 Months Ended

Dec. 31, 2020

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Financial Instruments

NOTE 7 — FINANCIAL INSTRUMENTS

Interest Rate Swap Agreements

We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between us and our counterparties based on common notional principal amounts and maturity dates.

Pay-fixed

interest rate swaps effectively convert variable rate obligations to fixed interest rate obligations. The interest payments under these agreements are settled on a net basis. The net interest payments, based on the notional amounts in these agreements, generally match the timing of the related liabilities for the interest rate swap agreements which have been designated as cash flow hedges. The notional amounts of the swap agreements represent amounts used to calculate the exchange of cash flows and are not our assets or liabilities. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions.

The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at December 31, 2020 (dollars in millions):


	Notional Amount		Maturity Date		Fair Value
Pay-fixed interest rate swaps	$	2,000		December 2021	$	(27	)
Pay-fixed interest rate swaps		500		December 2022		(19	)

During the next 12 months, we estimate $37 million will be reclassified from accumulated other comprehensive income (“OCI”) and will be included in interest expense.

Derivatives — Results of Operations

The following table presents the effect of our interest rate swaps on our results of operations for the year ended December 31, 2020 (dollars in millions):


Derivatives in Cash Flow Hedging Relationships	Amount of Loss Recognized in OCI on Derivatives, Net of Tax		Location of Loss Reclassified from Accumulated OCI into Operations		Amount of Loss Reclassified from Accumulated OCI into Operations
Interest rate swaps	$	51		Interest expense	$	24

Credit-risk-related Contingent Features

We have agreements with each of our derivative counterparties that contain a provision where we could be declared in default on our derivative obligations if repayment of the underlying indebtedness is accelerated by the lender due to our default on the indebtedness. As of December 31, 2020, we have not been required to post any collateral related to these agreements. If we had breached these provisions at December 31, 2020, we would have been required to settle our obligations under the agreements at their aggregate, estimated termination value of $46 million.

Assets and Liabilities Measured at Fair Value

12 Months Ended

Dec. 31, 2020

Fair Value Disclosures [Abstract]

Assets and Liabilities Measured at Fair Value

NOTE 8 — 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.

Cash Traded Investments

Our cash traded investments 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.

Derivative Financial Instruments

We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments.

The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of December 31, 2020 and 2019, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):


	December 31, 2020
	Fair Value			Fair Value Measurements Using
	Fair Value			Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1)			Significant Other Observable Inputs (Level 2)			Significant Unobservable Inputs (Level 3)
Assets:
Investments of insurance subsidiaries:
Debt securities	$	416		$	—		$	416		$	—
Money market funds and other		88			88			—			—

Investments of insurance subsidiaries		504			88			416			—
Less amounts classified as current assets		(116	)		(87	)		(29	)		—

	$	388			1		$	387		$	—

Liabilities:
Interest rate swaps (Income taxes and other liabilities)	$	46		$	—		$	46		$	—


	December 31, 2019
	Fair Value			Fair Value Measurements Using
	Fair Value			Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1)			Significant Other Observable Inputs (Level 2)			Significant Unobservable Inputs (Level 3)
Assets:
Investments of insurance subsidiaries:
Debt securities	$	377		$	—		$	377		$	—
Money market funds and other		85			85			—			—

Investments of insurance subsidiaries		462			85			377			—
Less amounts classified as current assets		(147	)		(83	)		(64	)		—

	$	315			2		$	313		$	—

Interest rate swaps (Other)	$	3		$	—		$	3		$	—
Liabilities:
Interest rate swaps (Income taxes and other liabilities)	$	7		$	—		$	7		$	—

The estimated fair value of our long-term debt was $35.814 billion and $37.026 billion at December 31, 2020 and 2019, respectively, compared to carrying amounts, excluding debt issuance costs and discounts, aggregating $31.240 billion and $33.961 billion, respectively. The estimates of fair value are generally based upon the quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities.

- Definition

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

+ References + Details

Long-Term Debt

12 Months Ended

Dec. 31, 2020

Debt Disclosure [Abstract]

Long-Term Debt

NOTE 9 — LONG-TERM DEBT

A summary of long-term debt at December 31, including related interest rates at December 31, 2020, follows (dollars in millions):


	2020			2019
Senior secured asset-based revolving credit facility	$	—		$	2,480
Senior secured revolving credit facility		—			—
Senior secured 364-day term loan facility		—			—
Senior secured term loan facilities (effective interest rate of 2.8%)		3,671			3,725
Senior secured notes (effective interest rate of 5.1%)		13,850			13,850
Other senior secured debt (effective interest rate of 4.7%)		767			654

Senior secured debt		18,288			20,709
Senior unsecured notes (effective interest rate of 5.5%)		12,952			13,252
Net debt issuance costs		(236	)		(239	)

Total debt (average life of 8.9 years, rates averaging 5.0%)		31,004			33,722
Less amounts due within one year		209			145

	$	30,795		$	33,577

During February 2020, we issued $2.700 billion aggregate principal amount of 3.50% senior notes due 2030. During March 2020, we used the net proceeds for the redemption of all $1.000 billion outstanding aggregate principal amount of HCA Healthcare, Inc.’s 6.25% senior notes due 2021 and, together with available funds, for the redemption of all $2.000 billion outstanding aggregate principal amount of HCA Inc.’s 7.50% senior notes due 2022. The pretax loss on retirement of debt was $295 million.

During March 2020 in response to the risks the COVID-19 pandemic presents to our business, we entered into a credit agreement that provides for a 364-day secured term loan facility for an aggregate principal amount of up to $2.000

billion. As of December 31, 2020 there was no amount outstanding or draw notices pending under the facility. We terminated this credit agreement during January 2021.

Senior Secured Credit Facilities And Other Senior Secured Debt

We have entered into the following senior secured credit facilities:

(i) a $3.750

billion asset-based revolving credit facility maturing on

June 28, 2022

with a borrowing base of

85%

of eligible accounts receivable, subject to customary reserves and eligibility criteria

(none

outstanding at December 31, 2020) (the “ABL credit facility”); (ii) a $2.000 billion senior secured revolving credit facility maturing on June 28, 2022 (none

outstanding at December 31, 2020 without giving effect to certain outstanding letters of credit); (iii) a

$2.000

billion senior secured 364-day term loan facility maturing on March 18, 2021 (none

outstanding at December 31, 2020 and

the

facility was

terminated during January 2021); (iv) a

$1.078

billion senior secured term loan A-6 facility maturing on

July 16, 2024; (v) a $1.459

billion senior secured term loan B-12 facility maturing on

March 13, 2025; and (vi) a $1.134

billion senior secured term loan B-13 facility maturing on

March 18, 2026.

We refer to the facilities described under (ii) through (vi) above, collectively, as the “cash flow credit facility” and, together with the ABL credit facility, the “senior secured credit facilities.”

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 LIBOR rate for the currency of such borrowing 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 secured notes consists of (i) $1.250 billion aggregate principal amount of 4.75% first lien notes due 2023; (ii) $2.000 billion aggregate principal amount of 5.00% first lien notes due 2024; (iii) $1.400 billion aggregate principal amount of 5.25% first lien notes due 2025; (iv) $1.500 billion aggregate principal amount of 5.25% first lien notes due 2026; (v) $1.200 billion aggregate principal amount of 4.50% first lien notes due 2027; (vi) $2.000 billion aggregate principal amount of 4 1/8% first lien notes due 2029; (vii) $1.000 billion aggregate principal amount of 5 1/8% first lien notes due 2039; (viii) $1.500 billion aggregate principal amount of 5.50% first lien notes due 2047; and (ix) $2.000 billion aggregate principal amount of 5 1/4% first lien notes due 2049. Finance leases and other secured debt totaled $767 million at December 31, 2020.

We use interest rate swap agreements to manage the variable rate exposure of our debt portfolio. At December 31, 2020, we had entered into effective interest rate swap agreements, in a total notional amount of $2.500 billion, in order to hedge a portion of our exposure to variable rate interest payments associated with the senior secured credit facilities. The effect of the interest rate swaps is reflected in the effective interest rates for the senior secured credit facilities.

Senior Unsecured Notes

Senior unsecured notes consist of (i) $12.091 billion aggregate principal amount of senior notes with maturities ranging from 2023 to 2033; (ii) an aggregate principal amount of $125 million medium-term notes maturing 2025; and (iii) an aggregate principal amount of $736 million debentures with maturities ranging from 2023 to 2095.

General Debt Information

The senior secured credit facilities and senior secured notes 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.

Our senior secured notes and the related guarantees are secured by first-priority liens, subject to permitted liens, on our and our subsidiary guarantors’ assets, subject to certain exceptions, that secure our cash flow credit facility on a first-priority basis and are secured by second-priority liens, subject to permitted liens, on our and our subsidiary guarantors’ assets that secure our ABL credit facility on a first-priority basis and our other cash flow credit facility on a second-priority basis.

Maturities of long-term debt in years 2022 through 2025 are $233 million, $2.799 billion, $3.163 billion and $5.872 billion, respectively.

Leases

12 Months Ended

Dec. 31, 2020

Leases [Abstract]

Leases

NOTE 10 — LEASES

We adopted ASU

No. 2016-02,

Leases (Topic 842)

, which requires leases with durations greater than 12 months to be recognized on the balance sheet, effective January 1, 2019, using the modified retrospective approach. We lease property and equipment under finance and operating leases. For leases with terms greater than 12 months, we record the related assets and obligations at the present value of lease payments over the term. Many of our leases include rental escalation clauses and renewal options that are factored into our determination of lease payments, when appropriate. We do not separate lease and nonlease components of contracts. Generally, we use our estimated incremental borrowing rate to discount the lease payments, as most of our leases do not provide a readily determinable implicit interest rate.

The following table presents our lease-related assets and liabilities at December 31, 2020 and 2019 (dollars in millions):


	Balance Sheet Classification		2020			2019
Assets:
Operating leases		Right-of-use operating lease assets	$	2,024		$	1,834
Finance leases		Property and equipment		553			520

Total lease assets			$	2,577		$	2,354

Liabilities:
Current:
Operating leases		Other accrued expenses	$	379		$	350
Finance leases		Long-term debt due within one year		128			87
Noncurrent:
Operating leases		Right-of-use operating lease obligations		1,673			1,499
Finance leases		Long-term debt		494			470

Total lease liabilities			$	2,674		$	2,406

Weighted-average remaining term:
Operating leases				10.4 years			10.8 years
Finance leases				11.5 years			12.0 years
Weighted-average discount rate:
Operating leases				4.8	%		5.3	%
Finance leases				5.4	%		6.0	%

The following table presents certain information related to lease expense for finance and operating leases for the years ended December 31, 2020 and 2019 (dollars in millions):


	2020		2019
Finance lease expense:
Depreciation and amortization	$	106	$	93
Interest		31		32
Operating leases( 1 )		447		389
Short-term lease expense( 1 )		322		316
Variable lease expense( 1 )		154		150

	$	1,060	$	980

(

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, 2020 and 2019 (dollars in millions):


	2020		2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows for operating leases	$	445	$	404
Operating cash flows for finance leases		31		32
Financing cash flows for finance leases		86		79

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, 2020 and 2019 (dollars in millions):


	2020						2019
	Operating Leases			Finance Leases			Operating Leases			Finance Leases
Year 1	$	431		$	155		$	411		$	110
Year 2		366			125			350			105
Year 3		307			81			285			99
Year 4		255			82			228			58
Year 5		207			51			182			60
Thereafter		1,136			353			1,074			368

Total minimum lease payments		2,702			847			2,530			800
Less: amount of lease payments representing interest		(650	)		(225	)		(681	)		(243	)

Present value of future minimum lease payments		2,052			622			1,849			557
Less: current lease obligations		(379	)		(128	)		(350	)		(87	)

Long-term lease obligations	$	1,673		$	494		$	1,499		$	470

Contingencies	12 Months Ended
Contingencies	Dec. 31, 2020
Commitments and Contingencies Disclosure [Abstract]
Contingencies	NOTE 11 — 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.

Capital Stock	12 Months Ended
Capital Stock	Dec. 31, 2020
Federal Home Loan Banks [Abstract]
Capital Stock	NOTE 12 — 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 2020, January 2019 and October 2017, our Board of Directors authorized share repurchase programs for up to $6 billion ($2 billion for each authorization) of our outstanding common stock. During March 2020 in response to the risks the COVID-19 pandemic presents to our business, we announced the suspension of our share repurchase programs. During February 2021, our Board of Directors authorized the resumption of the share repurchase program, pursuant to which $2.8 billion of pre-suspension authorization remained available, and an additional $6 billion was authorized for repurchases of the Company’s outstanding common stock ($8.8 billion of total repurchase authorization). During 2020, we repurchased 3.287 million shares of our common stock at an average price of $134.18 per share through market purchases pursuant to the $ 2.0 billion share repurchase program authorized during January 2019. At December 31, 2020, we had $2.800 billion of repurchase authorization available under the January 2019 and 2020 authorizations. During 2019, we repurchased 7.949 million shares of our common stock at an average price of $129.71 per share through market purchases pursuant to the October 2017 authorization (which was completed during the first quarter of 2019) and the January 2019 authorization. During 2018, we repurchased 14.070 million shares of our common stock at an average price of $108.74 per share through market purchases pursuant to the October 2017 authorization.

Employee Benefit Plans	12 Months Ended
Employee Benefit Plans	Dec. 31, 2020
Retirement Benefits [Abstract]
Employee Benefit Plans	NOTE 13 — EMPLOYEE BENEFIT PLANS We maintain defined contribution benefit plans that are available to employees who meet certain minimum requirements. Certain of the plans require that we match specified percentages of 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). The cost of these plans totaled $552 million for 2020, $532 million for 20 19 and $499 million for 2018. Our matching contributions are funded during the year following the participant contributions. We maintain the noncontributory, nonqualified Restoration Plan to provide certain 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. Benefits expense under this plan was $35 million for 2020, $44 million for 2019 and $22 million for 2018. Accrued benefits liabilities under this plan totaled $242 million at December 31, 2020 and $227 million at December 31, 2019. 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 $24 million for 2020, $19 million for 2019 and $26 million for 2018. Accrued benefits liabilities under this plan totaled $204 million at December 31, 2020 and $192 million at December 31, 2019. We maintain defined benefit pension plans which resulted from certain hospital acquisitions in prior years. Benefits expense under these plans was $8 million for 2020, $11 million for 2019, and $9 million for 2018. Accrued benefits liabilities under these plans totaled $96 million at December 31, 2020 and $63 million at December 31, 2019.

- Definition

The entire disclosure for retirement benefits.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 715
-SubTopic 20
-Section 55
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-Name Accounting Standards Codification
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+ Details

Segment and Geographic Information

12 Months Ended

Dec. 31, 2020

Segment Reporting [Abstract]

Segment and Geographic Information

NOTE 14 — SEGMENT AND GEOGRAPHIC INFORMATION

We operate in one line of business, which is operating hospitals and related health care entities. We operate in two geographically organized groups: the National and American Groups. At December 31, 2020, the National Group included 96 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, North Carolina, South Carolina, Utah and Virginia, and the American Group included 82 hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, Missouri, Tennessee and Texas. We also operate seven hospitals in England, and these facilities 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):


	For the Years Ended December 31,
	2020			2019			2018
Revenues:
National Group	$	25,694		$	25,913		$	22,581
American Group		23,593			23,173			21,959
Corporate and other		2,246			2,250			2,137

	$	51,533		$	51,336		$	46,677

Equity in earnings of affiliates:
National Group	$	(28	)	$	(2	)	$	(4	)
American Group		(42	)		(44	)		(40	)
Corporate and other		16			3			15

	$	(54	)	$	(43	)	$	(29	)

Adjusted segment EBITDA:
National Group	$	5,532		$	5,634		$	4,980
American Group		5,333			4,904			4,593
Corporate and other		(828	)		(681	)		(624	)

	$	10,037		$	9,857		$	8,949

Depreciation and amortization:
National Group	$	1,216		$	1,161		$	946
American Group		1,164			1,117			1,027
Corporate and other		341			318			305

	$	2,721		$	2,596		$	2,278


	For the Years Ended December 31,
	2020		2019			2018
Adjusted segment EBITDA	$	10,037	$	9,857		$	8,949
Depreciation and amortization		2,721		2,596			2,278
Interest expense		1,584		1,824			1,755
Losses (gains) on sales of facilities		7		(18	)		(428	)
Losses on retirement of debt		295		211			9

Income before income taxes	$	5,430	$	5,244		$	5,335


	December 31,
	2020		2019			2018
Assets:
National Group	$	18,913	$	18,290		$	14,839
American Group		20,760		20,608			19,122
Corporate and other		7,817		6,160			5,246

	$	47,490	$	45,058		$	39,207


	National Group			American Group			Corporate and Other			Total
Goodwill and other intangible assets:
Balance at December 31, 2017	$	1,474		$	5,265		$	655		$	7,394
Acquisitions		132			504			—			636
Foreign currency translation, amortization and other		(9	)		(40	)		(28	)		(77	)

Balance at December 31, 2018		1,597			5,729			627			7,953
Acquisitions		155			39			138			332
Foreign currency translation, amortization and other		(13	)		(3	)		—			(16	)

Balance at December 31, 2019		1,739			5,765			765			8,269
Acquisitions		38			27			279			344
Foreign currency translation, amortization and other		(2	)		(17	)		(16	)		(35	)

Balance at December 31, 2020	$	1,775		$	5,775		$	1,028		$	8,578

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
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+ Details

Other Comprehensive Loss

12 Months Ended

Dec. 31, 2020

Equity [Abstract]

Other Comprehensive Loss

NOTE 15 — OTHER COMPREHENSIVE LOSS

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


	Unrealized Gains on Available- for-Sale Securities			Foreign Currency Translation Adjustments			Defined Benefit Plans			Change in Fair Value of Derivative Instruments			Total
Balances at December 31, 2017	$	7		$	(149	)	$	(168	)	$	32		$	(278	)
Unrealized losses on available-for-sale securities, net of $2 income tax benefit		(5	)		—			—			—			(5	)
Foreign currency translation adjustments, net of $8 income tax benefit		—			(63	)		—			—			(63	)
Defined benefit plans, net of $10 of income taxes		—			—			34			—			34
Change in fair value of derivative instruments, net of $5 of income taxes		—			—			—			18			18
Expense (income) reclassified into operations from other comprehensive income, net of $5 income tax benefit and $2 of income taxes, respectively		—			—			16			(8	)		8
Reclassification of stranded tax effects		1			(71	)		(30	)		5			(95	)

Balances at December 31, 2018		3			(283	)		(148	)		47			(381	)
Unrealized gains on available-for-sale securities, net of $4 of income taxes		11			—			—			—			11
Foreign currency translation adjustments, net of $5 of income taxes		—			—			—			—			—
Defined benefit plans, net of $14 income tax benefit		—			—			(49	)		—			(49	)
Change in fair value of derivative instruments, net of $13 income tax benefit		—			—			—			(37	)		(37	)
Expense (income) reclassified into operations from other comprehensive income, net of $3 income tax benefit and $3 of income taxes, respectively		—			—			10			(14	)		(4	)

Balances at December 31, 2019		14			(283	)		(187	)		(4	)		(460	)
Unrealized gains on available-for-sale securities, net of $3 of income taxes		11			—			—			—			11
Foreign currency translation adjustments, net of $6 of income taxes		—			12			—			—			12
Defined benefit plans, net of $16 income tax benefit		—			—			(55	)		—			(55	)
Change in fair value of derivative instruments, net of $15 income tax benefit		—			—			—			(51	)		(51	)
Expense reclassified into operations from other comprehensive income, net of $6 and $5 income tax benefits, respectively		—			—			22			19			41

Balances at December 31, 2020	$	25		$	(271	)	$	(220	)	$	(36	)	$	(502	)

Accrued Expenses

12 Months Ended

Dec. 31, 2020

Text Block [Abstract]

Accrued Expenses

NOTE 16 — ACCRUED EXPENSES

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


	2020		2019
Professional liability risks	$	477	$	457
Defined contribution benefit plan		547		528
Right-of-use operating lease		379		350
Taxes other than income		343		325
Interest		315		368
Government stimulus refund liability		83		—
Other		1,096		904

	$	3,240	$	2,932

Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2020

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 “cost of revenue” items. Costs that could be classified as general and administrative include our corporate office costs, which were $416 million, $370 million and $344 million for the years ended December 31, 2020, 2019 and 2018, respectively.

COVID-19

Pandemic and CARES Act Funding

On March 11, 2020, the World Health Organization designated

COVID-19

as a global pandemic. Patient volumes and the related revenues for most of our services were significantly impacted during the latter portion of the first quarter and the first half of the second quarter of 2020 and have continued to be impacted as various policies that were implemented by federal, state and local governments in response to the

COVID-19

pandemic, including policies that have caused many people to remain at home, forced the closure of or limitations on certain businesses, and suspended elective surgical procedures by health care facilities. While many of these restrictions have been eased across the U.S. and most states have lifted moratoriums on

non-emergent

procedures, restrictions remain in place or may be adopted or

re-imposed,

and the possibility exists that the public, particularly segments with a high mortality risk, could remain wary of real or perceived opportunities for exposure to the virus. We are unable to predict the future impact of the pandemic on our operations.

During 2020, we received approximately $4.4 billion of accelerated Medicare payments and approximately $1.8 billion in general and targeted distributions from the Provider Relief Fund, both as provided for and established under the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act. During October 2020,

we announced our decision to return, or repay early, all of our share of the Provider Relief Fund distributions and all of the Medicare accelerated payments. During the fourth quarter of 2020, we returned, or repaid early, approximately $6.1 billion of these funds. The unreturned Provider Relief Funds of $83

million, related to amounts received by certain of our partnership entities, are recorded under the caption “other accrued

expenses” in our consolidated balance sheet at December 31, 2020. Our share of these funds will be returned in 2021 after final determination of amounts earned and distributable to the members of each respective partnership.

The CARES Act also provides for a deferral of payments of the employer portion of Social Security tax incurred during the pandemic, allowing half of such payroll taxes to be deferred until December 2021 and the remaining half until December 2022. At December 31, 2020, the Company had deferred $688 million of Social Security taxes. Additionally, the CARES Act created a payroll tax credit designed to encourage companies to retain employees during the pandemic. During the year ended December 31, 2020, the Company evaluated its eligibility for this credit and recorded $60 million of employee retention payroll tax credits pursuant to the CARES Act. These tax credits were recorded as a reduction of salaries and benefits in our consolidated income statement.

We believe the extent of the COVID-19 pandemic’s impact on our operating results and financial condition has been and will continue to be driven by many factors, most of which are beyond our control and ability to forecast. Such factors include, but are not limited to:
 the severity or duration of the pandemic, including whether there will be additional periods of increases in the number of COVID-19 cases in the areas in which we operate, the rollout and availability of effective medical treatments and vaccines, the efficacy of public health controls, including vaccines, and the impact of any mutations of the virus; the scope and duration of stay-at-home practices and business closures and restrictions; recommended or required suspensions of elective procedures; continued declines in patient volumes for an indeterminable length of time; increases in the number of uninsured and underinsured patients as a result of higher sustained rates of unemployment; incremental expenses required for supplies and personal protective equipment; and changes in professional and general liability exposure. Because of these and other uncertainties, we cannot estimate how long or how severely the pandemic will impact our business. If we experience declines in cash flows and results of operations, such declines could have an impact on the inputs and assumptions used in significant accounting estimates, including estimated implicit price concessions related to uninsured patient accounts, professional and general liability reserves, and potential impairments of goodwill and long-lived assets. 

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.

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 discounts and contractual 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,
	2020		Ratio			2019		Ratio			2018		Ratio
Medicare	$	10,420		20.2	%	$	10,798		21.0	%	$	9,831		21.1	%
Managed Medicare		6,997		13.6			6,452		12.6			5,497		11.8
Medicaid		1,965		3.8			1,572		3.1			1,358		2.9
Managed Medicaid		2,621		5.1			2,450		4.8			2,403		5.1
Managed care and other insurers		26,535		51.5			26,544		51.6			24,467		52.4
International (managed care and other insurers)		1,120		2.2			1,162		2.3			1,156		2.5
Other		1,875		3.6			2,358		4.6			1,965		4.2

Revenues	$	51,533		100.0	%	$	51,336		100.0	%	$	46,677		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 amounts and disproportionate-share funds related primarily to cost reports filed during the respective year resulted in net increases to revenues of $70 million, $51 million and $29 million in 2020, 2019 and 2018, respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in a net

reduction

to revenues of $5 million in 2020 and net increases to revenues of $13 million and $51 million in 2019 and 2018, respectively.

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, were 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, were 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.

The collection of outstanding receivables for 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, 2020 and 2019, estimated implicit price concessions of $6.108 billion and $6.953 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):


	2020			2019			2018
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization)	$	44,271		$	44,118		$	40,035

Cost-to-charges ratio (patient care costs as percentage of gross patient charges)		12.0	%		12.0	%		12.4	%

Total uncompensated care	$	29,029		$	31,105		$	26,757
Multiply by the cost-to-charges ratio		12.0	%		12.0	%		12.4	%

Estimated cost of total uncompensated care	$	3,483		$	3,733		$	3,318

The total uncompensated care amounts include charity care of $13.763 billion, $13.260 billion and $8.611 billion for the years ended December 31, 2020, 2019 and 2018, respectively. The estimated costs of charity care were $1.652 billion, $1.591 billion and $1.068 billion for the years ended December 31, 2020, 2019 and 2018, respectively.

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 $495 million and $486 million at December 31, 2020 and 2019, 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 45 days, 50 days and 51 days at December 31, 2020, 2019 and 2018,

respectively. The five-day decline from December 31, 2019 to December 31, 2020 was primarily due to the combined impact of a $329 million decline in accounts receivable at December 31, 2020, compared to December 31, 2019, and a 5.7% increase in fourth

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 $2.693 billion in 2020, $2.579 billion in 2019 and $2.262 billion in 2018. 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 long-lived assets 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.

Long-lived assets 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

At December 31, 2020 and 2019, the investments of our 100% owned 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 2020, 2019 or 2018.

During 2020, goodwill increased by $279

million related to acquisitions, including the finalization of the accounting for certain prior year acquisitions, and declined

by $9 million related to foreign currency translation and other adjustments. During 2019, goodwill increased by $332 million related to acquisitions and declined by $4 million related to foreign currency translation and other adjustments.

During 2020, identifiable intangible assets increased by $65 million related to acquisitions, including the finalization of the accounting for certain prior year acquisitions, and declined by

$26 million due to amortization and other adjustments. During 2019, identifiable intangible assets declined by $12 million due to amortization, foreign currency translation and other adjustments. Identifiable intangible assets are amortized over estimated lives ranging generally from three to 10 years.

The gross carrying amounts of identifiable intangible assets at December 31, 2020 and 2019 were

$249 million and $184 million, respectively, and accumulated amortization was $149 million and $123 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2020 and 2019 was $269 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

Debt Issuance Costs and Discounts

Debt issuance costs and discounts are amortized based upon the terms of the respective debt obligations. The gross carrying amount of debt issuance costs and discounts at December 31, 2020 and 2019 was $411 million and $413 million, respectively, and accumulated amortization was $175 million and $174 million, respectively. Amortization of debt issuance costs and discounts is included in interest expense and was $30 million, $30 million and $31 million for 2020, 2019 and 2018, respectively.

Professional Liability Claims

Reserves for professional liability risks were $1.963 billion and $1.827 billion at December 31, 2020 and 2019, respectively. The current portion of the reserves, $477 million and $457

million at December 31, 2020 and 2019, respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were

$435 million, $497 million and $447

million for 2020, 2019 and 2018, 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. During 2020, 2019 and 2018, we recorded reductions to the provision for professional liability risks of

$112 million

,

$50

million and $70 million,

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 2,300 individual claims at both December 31, 2020 and 2019 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 2020 and 2019, $292 million and $408 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 a 100% owned insurance subsidiary. Subject, in most cases, to a $15 million per occurrence self-insured retention, our facilities are insured by our 100% owned insurance subsidiary for losses up to $50

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 include $31 million and $37 million at December 31, 2020 and 2019, respectively, recorded in “other assets,” and $8 million and $9 million at December 31, 2020 and 2019, respectively, recorded in “other current assets.”

Financial Instruments

Derivative financial instruments are employed to manage interest rate risks, and are not used for trading or speculative purposes. We recognize our interest rate swap derivative instruments in the consolidated balance sheets at fair value. Changes in the fair value of derivatives are recognized periodically in stockholders’ equity, as a component of other comprehensive income (loss), provided the derivative financial instrument qualifies for hedge accounting. Gains and losses on derivatives designated as cash flow hedges, to the extent they are effective, are recorded in other comprehensive income (loss), and subsequently reclassified to earnings to offset the impact of the forecasted transactions when they occur. In the event the forecasted transaction to which a cash flow hedge relates is no longer likely, the amount in other comprehensive income is recognized in earnings and generally the derivative is terminated.

The net interest paid or received on interest rate swaps is recognized as adjustments to interest expense. Gains and losses resulting from the early termination of interest rate swap agreements are deferred and amortized as adjustments to interest expense over the remaining term of the debt originally associated with the terminated swap.

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.

Reclassifications

Certain prior year amounts have been reclassified to conform to the 2020 presentation.

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 stock options, 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.

Cash Traded Investments

Our cash traded investments 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.

Derivative Financial Instruments

We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments.

Interest Rate Swaps [Member]

Financial Instruments

Interest Rate Swap Agreements

We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between us and our counterparties based on common notional principal amounts and maturity dates.

Pay-fixed

interest rate swaps effectively convert variable rate obligations to fixed interest rate obligations. The interest payments under these agreements are settled on a net basis. The net interest payments, based on the notional amounts in these agreements, generally match the timing of the related liabilities for the interest rate swap agreements which have been designated as cash flow hedges. The notional amounts of the swap agreements represent amounts used to calculate the exchange of cash flows and are not our assets or liabilities. Our credit risk related to these agreements is considered low because the swap agreements are with creditworthy financial institutions.

Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2020

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,
	2020		Ratio			2019		Ratio			2018		Ratio
Medicare	$	10,420		20.2	%	$	10,798		21.0	%	$	9,831		21.1	%
Managed Medicare		6,997		13.6			6,452		12.6			5,497		11.8
Medicaid		1,965		3.8			1,572		3.1			1,358		2.9
Managed Medicaid		2,621		5.1			2,450		4.8			2,403		5.1
Managed care and other insurers		26,535		51.5			26,544		51.6			24,467		52.4
International (managed care and other insurers)		1,120		2.2			1,162		2.3			1,156		2.5
Other		1,875		3.6			2,358		4.6			1,965		4.2

Revenues	$	51,533		100.0	%	$	51,336		100.0	%	$	46,677		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):


	2020			2019			2018
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization)	$	44,271		$	44,118		$	40,035

Cost-to-charges ratio (patient care costs as percentage of gross patient charges)		12.0	%		12.0	%		12.4	%

Total uncompensated care	$	29,029		$	31,105		$	26,757
Multiply by the cost-to-charges ratio		12.0	%		12.0	%		12.4	%

Estimated cost of total uncompensated care	$	3,483		$	3,733		$	3,318

Share-Based Compensation (Tables)

12 Months Ended

Dec. 31, 2020

Disclosure of Compensation Related Costs, Share-based Payments [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.


	2020			2019			2018
Risk-free interest rate		1.44	%		2.50	%		2.62	%
Expected volatility		27	%		27	%		29	%
Expected life, in years		6.15			6.18			6.15
Expected dividend yield		1.19	%		1.16	%		1.37	%

Schedule of Stock Option Activity

Information regarding Time Stock Options and SARs and Performance Stock Options and SARs activity during 2020, 2019 and 2018 is summarized below (share amounts in thousands):


	Time Stock Options and SARs			Performance Stock Options and SARs			Total Stock Options and SARs			Weighted Average Exercise Price		Weighted Average Remaining Contractual Term		Aggregate Intrinsic Value (dollars in millions)
Options and SARs outstanding, December 31, 2017		11,156			4,586			15,742		$	43.47
Granted		2,342			—			2,342			101.96
Exercised		(3,917	)		(1,774	)		(5,691	)		27.86
Cancelled		(221	)		(145	)		(366	)		68.43

Options and SARs outstanding, December 31, 2018		9,360			2,667			12,027			61.49
Granted		1,349			—			1,349			138.31
Exercised		(1,137	)		(523	)		(1,660	)		44.45
Cancelled		(522	)		—			(522	)		93.26

Options and SARs outstanding, December 31, 2019		9,050			2,144			11,194			71.79
Granted		1,120			—			1,120			144.47
Exercised		(2,159	)		(1,325	)		(3,484	)		44.07
Cancelled		(175	)		—			(175	)		111.69

Options and SARs outstanding, December 31, 2020		7,836			819			8,655		$	91.53		6.0 years	$	631

Options and SARs exercisable, December 31, 2020		4,562			819			5,381		$	71.25		4.8 years	$	502

Schedule of Restricted Stock Units Activity

Stock Option, SAR, RSU and PSU Activity – All Plans (continued)

Information regarding Time RSUs, Performance RSUs and PSUs activity during 2020, 2019 and 2018 is summarized below (share amounts in thousands):


	Time RSUs			Performance RSUs			PSUs			Total RSUs and PSUs			Weighted Average Grant Date Fair Value
RSUs and PSUs outstanding, December 31, 2017		3,465			227			3,562			7,254		$	72.05
Granted		1,464			—			1,261			2,725			101.85
Performance adjustment		—			—			1,250			1,250			69.27
Vested		(1,487	)		(136	)		(2,500	)		(4,123	)		67.33
Cancelled		(319	)		(91	)		(151	)		(561	)		78.82

RSUs and PSUs outstanding, December 31, 2018		3,123			—			3,422			6,545			86.32
Granted		973			—			796			1,769			138.45
Performance adjustment		—			—			227			227			69.94
Vested		(1,216	)		—			(1,251	)		(2,467	)		75.97
Cancelled		(260	)		—			(159	)		(419	)		103.27

RSUs and PSUs outstanding, December 31, 2019		2,620			—			3,035			5,655			105.23
Granted		1,048			—			808			1,856			144.17
Performance adjustment		—			—			206			206			81.89
Vested		(1,030	)		—			(1,364	)		(2,394	)		88.63
Cancelled		(162	)		—			(93	)		(255	)		124.50

RSUs and PSUs outstanding, December 31, 2020		2,476			—			2,592			5,068		$	125.40

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2020

Income Tax Disclosure [Abstract]

Schedule of Provision for Income Taxes

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


	2020			2019			2018
Current:
Federal	$	1,021		$	670		$	759
State		126			134			149
Foreign		5			17			23
Deferred:
Federal		(73	)		254			9
State		(39	)		29			13
Foreign		3			(5	)		(7	)

	$	1,043		$	1,099		$	946

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:


	2020			2019			2018
Federal statutory rate		21.0	%		21.0	%		21.0	%
State income taxes, net of federal tax benefit		1.9			2.7			2.9
Change in liability for uncertain tax positions		(0.2	)		0.4			(0.1	)
Tax benefit from settlements of employee equity awards		(1.8	)		(1.3	)		(2.4	)
Impact of Tax Act on deferred tax balances		—			—			(1.6	)
Other items, net		0.8			1.1			0.2

Effective income tax rate on income attributable to HCA Healthcare, Inc.		21.7			23.9			20.0
Income attributable to noncontrolling interests from consolidated partnerships		(2.5	)		(2.9	)		(2.3	)

Effective income tax rate on income before income taxes		19.2	%		21.0	%		17.7	%

Schedule of Deferred Tax Assets and Liabilities

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


	2020				2019
	Assets		Liabilities		Assets		Liabilities
Depreciation and fixed asset basis differences	$	—	$	678	$	—	$	601
Allowances for professional liability and other risks		407		—		376		—
Accounts receivable		283		—		307		—
Compensation		487		—		292		—
Right-of-use lease assets and obligations		416		409		369		366
Other		485		606		461		538

	$	2,078	$	1,693	$	1,805	$	1,505

Schedule of Activity Related to Unrecognized Tax Benefits

The following table summarizes the activity related to our unrecognized tax benefits (dollars in millions):


	2020			2019
Balance at January 1	$	522		$	390
Additions (reductions) based on tax positions related to the current year		(3	)		29
Additions for tax positions of prior years		13			119
Reductions for tax positions of prior years		(30	)		(3	)
Settlements		(22	)		—
Lapse of applicable statutes of limitations		(11	)		(13	)

Balance at December 31	$	469		$	522

Earnings Per Share (Tables)

12 Months Ended

Dec. 31, 2020

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, 2020, 2019 and 2018 (dollars and shares in millions, except per share amounts):


	2020		2019		2018
Net income attributable to HCA Healthcare, Inc.	$	3,754	$	3,505	$	3,787

Weighted average common shares outstanding		338.274		341.210		347.297
Effect of dilutive incremental shares		5.331		7.016		8.006

Shares used for diluted earnings per share		343.605		348.226		355.303

Earnings per share:
Basic earnings per share	$	11.10	$	10.27	$	10.90
Diluted earnings per share	$	10.93	$	10.07	$	10.66

Investments of Insurance Subsidiaries (Tables)

12 Months Ended

Dec. 31, 2020

Investments, Debt and Equity Securities [Abstract]

Schedule of Investments

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


	2020
	Amortized Cost		Unrealized Amounts				Fair Value
	Amortized Cost		Gains		Losses		Fair Value
Debt securities	$	384	$	32	$	—	$	416
Money market funds and other		88		—		—		88

	$	472	$	32	$	—		504

Amounts classified as current assets								(116	)

Investment carrying value							$	388


	2019
	Amortized Cost		Unrealized Amounts				Fair Value
	Amortized Cost		Gains		Losses		Fair Value
Debt securities	$	359	$	18	$	—	$	377
Money market funds and other		85		—		—		85

	$	444	$	18	$	—		462

Amounts classified as current assets								(147	)

Investment carrying value							$	315

Schedule of Maturities of Investments

Scheduled maturities of investments in debt securities at December 31, 2020 were as follows (dollars in millions):


	Amortized Cost		Fair Value
Due in one year or less	$	4	$	4
Due after one year through five years		147		156
Due after five years through ten years		157		174
Due after ten years		76		82

	$	384	$	416

Financial Instruments (Tables)

12 Months Ended

Dec. 31, 2020

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges

The following table sets forth our interest rate swap agreements, which have been designated as cash flow hedges, at December 31, 2020 (dollars in millions):


	Notional Amount		Maturity Date		Fair Value
Pay-fixed interest rate swaps	$	2,000		December 2021	$	(27	)
Pay-fixed interest rate swaps		500		December 2022		(19	)

Effect of Interest Rate on Results of Operations

The following table presents the effect of our interest rate swaps on our results of operations for the year ended December 31, 2020 (dollars in millions):


Derivatives in Cash Flow Hedging Relationships	Amount of Loss Recognized in OCI on Derivatives, Net of Tax		Location of Loss Reclassified from Accumulated OCI into Operations		Amount of Loss Reclassified from Accumulated OCI into Operations
Interest rate swaps	$	51		Interest expense	$	24

Assets and Liabilities Measured at Fair Value (Tables)

12 Months Ended

Dec. 31, 2020

Fair Value Disclosures [Abstract]

Schedule of Assets Measured at Fair Value on Recurring Basis

The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of December 31, 2020 and 2019, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):


	December 31, 2020
	Fair Value			Fair Value Measurements Using
	Fair Value			Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1)			Significant Other Observable Inputs (Level 2)			Significant Unobservable Inputs (Level 3)
Assets:
Investments of insurance subsidiaries:
Debt securities	$	416		$	—		$	416		$	—
Money market funds and other		88			88			—			—

Investments of insurance subsidiaries		504			88			416			—
Less amounts classified as current assets		(116	)		(87	)		(29	)		—

	$	388			1		$	387		$	—

Liabilities:
Interest rate swaps (Income taxes and other liabilities)	$	46		$	—		$	46		$	—


	December 31, 2019
	Fair Value			Fair Value Measurements Using
	Fair Value			Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1)			Significant Other Observable Inputs (Level 2)			Significant Unobservable Inputs (Level 3)
Assets:
Investments of insurance subsidiaries:
Debt securities	$	377		$	—		$	377		$	—
Money market funds and other		85			85			—			—

Investments of insurance subsidiaries		462			85			377			—
Less amounts classified as current assets		(147	)		(83	)		(64	)		—

	$	315			2		$	313		$	—

Interest rate swaps (Other)	$	3		$	—		$	3		$	—
Liabilities:
Interest rate swaps (Income taxes and other liabilities)	$	7		$	—		$	7		$	—

Long-Term Debt (Tables)

12 Months Ended

Dec. 31, 2020

Debt Disclosure [Abstract]

Schedule of Long-Term Debt

A summary of long-term debt at December 31, including related interest rates at December 31, 2020, follows (dollars in millions):


	2020			2019
Senior secured asset-based revolving credit facility	$	—		$	2,480
Senior secured revolving credit facility		—			—
Senior secured 364-day term loan facility		—			—
Senior secured term loan facilities (effective interest rate of 2.8%)		3,671			3,725
Senior secured notes (effective interest rate of 5.1%)		13,850			13,850
Other senior secured debt (effective interest rate of 4.7%)		767			654

Senior secured debt		18,288			20,709
Senior unsecured notes (effective interest rate of 5.5%)		12,952			13,252
Net debt issuance costs		(236	)		(239	)

Total debt (average life of 8.9 years, rates averaging 5.0%)		31,004			33,722
Less amounts due within one year		209			145

	$	30,795		$	33,577

Leases (Tables)

12 Months Ended

Dec. 31, 2020

Leases [Abstract]

Schedule of lease-related assets and liabilities

The following table presents our lease-related assets and liabilities at December 31, 2020 and 2019 (dollars in millions):


	Balance Sheet Classification		2020			2019
Assets:
Operating leases		Right-of-use operating lease assets	$	2,024		$	1,834
Finance leases		Property and equipment		553			520

Total lease assets			$	2,577		$	2,354

Liabilities:
Current:
Operating leases		Other accrued expenses	$	379		$	350
Finance leases		Long-term debt due within one year		128			87
Noncurrent:
Operating leases		Right-of-use operating lease obligations		1,673			1,499
Finance leases		Long-term debt		494			470

Total lease liabilities			$	2,674		$	2,406

Weighted-average remaining term:
Operating leases				10.4 years			10.8 years
Finance leases				11.5 years			12.0 years
Weighted-average discount rate:
Operating leases				4.8	%		5.3	%
Finance leases				5.4	%		6.0	%

Schedule of lease expense for finance and operating leases

The following table presents certain information related to lease expense for finance and operating leases for the years ended December 31, 2020 and 2019 (dollars in millions):


	2020		2019
Finance lease expense:
Depreciation and amortization	$	106	$	93
Interest		31		32
Operating leases( 1 )		447		389
Short-term lease expense( 1 )		322		316
Variable lease expense( 1 )		154		150

	$	1,060	$	980

(

1

)

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, 2020 and 2019 (dollars in millions):


	2020		2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows for operating leases	$	445	$	404
Operating cash flows for finance leases		31		32
Financing cash flows for finance leases		86		79

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, 2020 and 2019 (dollars in millions):


	2020						2019
	Operating Leases			Finance Leases			Operating Leases			Finance Leases
Year 1	$	431		$	155		$	411		$	110
Year 2		366			125			350			105
Year 3		307			81			285			99
Year 4		255			82			228			58
Year 5		207			51			182			60
Thereafter		1,136			353			1,074			368

Total minimum lease payments		2,702			847			2,530			800
Less: amount of lease payments representing interest		(650	)		(225	)		(681	)		(243	)

Present value of future minimum lease payments		2,052			622			1,849			557
Less: current lease obligations		(379	)		(128	)		(350	)		(87	)

Long-term lease obligations	$	1,673		$	494		$	1,499		$	470

Segment and Geographic Information (Tables)

12 Months Ended

Dec. 31, 2020

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):


	For the Years Ended December 31,
	2020			2019			2018
Revenues:
National Group	$	25,694		$	25,913		$	22,581
American Group		23,593			23,173			21,959
Corporate and other		2,246			2,250			2,137

	$	51,533		$	51,336		$	46,677

Equity in earnings of affiliates:
National Group	$	(28	)	$	(2	)	$	(4	)
American Group		(42	)		(44	)		(40	)
Corporate and other		16			3			15

	$	(54	)	$	(43	)	$	(29	)

Adjusted segment EBITDA:
National Group	$	5,532		$	5,634		$	4,980
American Group		5,333			4,904			4,593
Corporate and other		(828	)		(681	)		(624	)

	$	10,037		$	9,857		$	8,949

Depreciation and amortization:
National Group	$	1,216		$	1,161		$	946
American Group		1,164			1,117			1,027
Corporate and other		341			318			305

	$	2,721		$	2,596		$	2,278


	For the Years Ended December 31,
	2020		2019			2018
Adjusted segment EBITDA	$	10,037	$	9,857		$	8,949
Depreciation and amortization		2,721		2,596			2,278
Interest expense		1,584		1,824			1,755
Losses (gains) on sales of facilities		7		(18	)		(428	)
Losses on retirement of debt		295		211			9

Income before income taxes	$	5,430	$	5,244		$	5,335


	December 31,
	2020		2019			2018
Assets:
National Group	$	18,913	$	18,290		$	14,839
American Group		20,760		20,608			19,122
Corporate and other		7,817		6,160			5,246

	$	47,490	$	45,058		$	39,207


	National Group			American Group			Corporate and Other			Total
Goodwill and other intangible assets:
Balance at December 31, 2017	$	1,474		$	5,265		$	655		$	7,394
Acquisitions		132			504			—			636
Foreign currency translation, amortization and other		(9	)		(40	)		(28	)		(77	)

Balance at December 31, 2018		1,597			5,729			627			7,953
Acquisitions		155			39			138			332
Foreign currency translation, amortization and other		(13	)		(3	)		—			(16	)

Balance at December 31, 2019		1,739			5,765			765			8,269
Acquisitions		38			27			279			344
Foreign currency translation, amortization and other		(2	)		(17	)		(16	)		(35	)

Balance at December 31, 2020	$	1,775		$	5,775		$	1,028		$	8,578

Other Comprehensive Loss (Tables)

12 Months Ended

Dec. 31, 2020

Equity [Abstract]

Components of Accumulated Other Comprehensive Loss

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


	Unrealized Gains on Available- for-Sale Securities			Foreign Currency Translation Adjustments			Defined Benefit Plans			Change in Fair Value of Derivative Instruments			Total
Balances at December 31, 2017	$	7		$	(149	)	$	(168	)	$	32		$	(278	)
Unrealized losses on available-for-sale securities, net of $2 income tax benefit		(5	)		—			—			—			(5	)
Foreign currency translation adjustments, net of $8 income tax benefit		—			(63	)		—			—			(63	)
Defined benefit plans, net of $10 of income taxes		—			—			34			—			34
Change in fair value of derivative instruments, net of $5 of income taxes		—			—			—			18			18
Expense (income) reclassified into operations from other comprehensive income, net of $5 income tax benefit and $2 of income taxes, respectively		—			—			16			(8	)		8
Reclassification of stranded tax effects		1			(71	)		(30	)		5			(95	)

Balances at December 31, 2018		3			(283	)		(148	)		47			(381	)
Unrealized gains on available-for-sale securities, net of $4 of income taxes		11			—			—			—			11
Foreign currency translation adjustments, net of $5 of income taxes		—			—			—			—			—
Defined benefit plans, net of $14 income tax benefit		—			—			(49	)		—			(49	)
Change in fair value of derivative instruments, net of $13 income tax benefit		—			—			—			(37	)		(37	)
Expense (income) reclassified into operations from other comprehensive income, net of $3 income tax benefit and $3 of income taxes, respectively		—			—			10			(14	)		(4	)

Balances at December 31, 2019		14			(283	)		(187	)		(4	)		(460	)
Unrealized gains on available-for-sale securities, net of $3 of income taxes		11			—			—			—			11
Foreign currency translation adjustments, net of $6 of income taxes		—			12			—			—			12
Defined benefit plans, net of $16 income tax benefit		—			—			(55	)		—			(55	)
Change in fair value of derivative instruments, net of $15 income tax benefit		—			—			—			(51	)		(51	)
Expense reclassified into operations from other comprehensive income, net of $6 and $5 income tax benefits, respectively		—			—			22			19			41

Balances at December 31, 2020	$	25		$	(271	)	$	(220	)	$	(36	)	$	(502	)

Accrued Expenses (Tables)

12 Months Ended

Dec. 31, 2020

Text Block [Abstract]

Summary of Other Accrued Expenses

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


	2020		2019
Professional liability risks	$	477	$	457
Defined contribution benefit plan		547		528
Right-of-use operating lease		379		350
Taxes other than income		343		325
Interest		315		368
Government stimulus refund liability		83		—
Other		1,096		904

	$	3,240	$	2,932

Accounting Policies - Additional Information (Detail) $ in Thousands	1 Months Ended	3 Months Ended	12 Months Ended
	Nov. 30, 2017	Dec. 31, 2020 USD ($) Claim State Surgery_Center Endoscopy_Center Hospital	Dec. 31, 2020 USD ($) Claim State Surgery_Center Endoscopy_Center Hospital	Dec. 31, 2019 USD ($) Claim	Dec. 31, 2018 USD ($)
Summary Of Significant Accounting Policies [Line Items]
Number of owned and operated hospitals \| Hospital		185	185
Number of freestanding surgery centers \| Surgery_Center		121	121
Number of freestanding endoscopy centers \| Endoscopy_Center		21	21
Number of facilities locations \| State		20	20
General and administrative expense			$ 416,000	$ 370,000	$ 344,000
Adjustments to estimated reimbursement filed during respective year			70,000	51,000	29,000
Adjustments to estimated reimbursement filed during previous years			(5,000)	13,000	51,000
Estimated implicit price concessions recorded as reductions to revenues and accounts receivable			6,108,000	6,953,000
Charity care amount			13,763,000	13,260,000	8,611,000
Estimated costs of charity care			1,652	1,591	$ 1,068,000
Outstanding checks unpresented for payment		$ 495,000	$ 495,000	$ 486,000
Days revenues in accounts receivable			45 days	50 days	51 days
Depreciation expense			$ 2,693,000	$ 2,579,000	$ 2,262,000
Goodwill impairments			0	0	0
Goodwill acquired during period			279,000	332,000
Intangible assets decreased			26,000	12,000
Gross carrying amount of intangible assets			249,000	184,000
Accumulated amortization of intangible assets		149,000	149,000	123,000
Gross carrying amount of indefinite-lived intangible assets		269,000	269,000	269,000
Deferred loan costs		411,000	411,000	413,000
Deferred loan costs, accumulated amortization		175,000	175,000	174,000
Amortization of debt issuance costs			30,000	30,000	31,000
Reserves for professional liability risks		1,963,000	1,963,000	1,827,000
Current portion of professional liability risks reserves		$ 477,000	477,000	457,000
Provisions for losses related to professional liability risks			435,000	497,000	447,000
Decrease in provision for professional liability risks			$ 112,000	$ 50,000	70,000
Reserves for professional liability risks cover individual claims \| Claim		2,300	2,300	2,300
Net payments of professional and general liability claims			$ 292,000	$ 408,000
Self-insured retention amount per occurrence					15,000
Maximum amount losses per occurrence					$ 50,000
Reinsurance for professional liability risks retention minimum level of amount per occurrence			25,000
Reinsurance for professional liability risks retention level of amount per occurrence			35,000
Amounts receivable under reinsurance contracts recorded in other assets		$ 31,000	31,000	37,000
Amounts receivable under reinsurance contracts recorded in other current assets		8,000	8,000	9,000
Government stimulus refund liability		83,000	83,000
Increase decrease in accounts receivable			$ 329,000
Percentage increase in fourth quarter revenues per day			5.70%
CARES Act Provider Relief Fund [Member]
Summary Of Significant Accounting Policies [Line Items]
Accelerated Medicare payments received			$ 4,400,000
General and targeted distributions recived			1,800,000
Deferred social security taxes		688,000	688,000
Employee retention payroll tax credits			60,000
Repayments of provider relief funds		6,100,000
Government stimulus refund liability		$ 83,000	83,000
Foreign Currency Translation And Other [Member]
Summary Of Significant Accounting Policies [Line Items]
Goodwill increase (decrease)			$ 9,000	$ 4,000
Insurance Subsidiary [Member]
Summary Of Significant Accounting Policies [Line Items]
Insurance subsidiary ownership percentage				100.00%
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
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

Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 51,533	$ 51,336	$ 46,677
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	$ 10,420	$ 10,798	$ 9,831
Revenues from third party payers, Ratio	20.20%	21.00%	21.10%
Managed Medicare [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 6,997	$ 6,452	$ 5,497
Revenues from third party payers, Ratio	13.60%	12.60%	11.80%
Medicaid [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 1,965	$ 1,572	$ 1,358
Revenues from third party payers, Ratio	3.80%	3.10%	2.90%
Managed Medicaid [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 2,621	$ 2,450	$ 2,403
Revenues from third party payers, Ratio	5.10%	4.80%	5.10%
Managed Care and Other Insurers [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 26,535	$ 26,544	$ 24,467
Revenues from third party payers, Ratio	51.50%	51.60%	52.40%
International (Managed Care and Other Insurers) [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 1,120	$ 1,162	$ 1,156
Revenues from third party payers, Ratio	2.20%	2.30%	2.50%
Product and Service, Other [Member]
Revenues From Third Party Payers [Line Items]
Revenues from third party payers	$ 1,875	$ 2,358	$ 1,965
Other, Ratio	3.60%	4.60%	4.20%

Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Accounting Policies [Abstract]
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization)	$ 44,271	$ 44,118	$ 40,035
Cost-to-charges ratio (patient care costs as percentage of gross patient charges)	12.00%	12.00%	12.40%
Total uncompensated care	$ 29,029	$ 31,105	$ 26,757
Multiply by the cost-to-charges ratio	12.00%	12.00%	12.40%
Estimated cost of total uncompensated care	$ 3,483	$ 3,733	$ 3,318

Share-Based Compensation - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted Average Fair Value of Stock Options Granted	$ 35.98	$ 38.21	$ 28.90
Total Intrinsic Value of Stock Options	$ 328	$ 153	$ 456
Unrecognized Compensation Cost Related to Nonvested Awards	$ 53
Employee Stock Purchase Plan ("ESPP") [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock were reserved for issuance	5,865,000
Compensation expense	$ 13	12	10
Stock Appreciation Rights (SARs) [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares Available for Future Grants	20,274,000
Restricted Stock Units and Performance Stock Units [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
RSUs and PSUs, Vested, value	$ 349	$ 346	$ 413
Unrecognized Compensation Cost Related to Nonvested Awards	$ 330

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, 2020	Dec. 31, 2019	Dec. 31, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Risk-free interest rate	1.44%	2.50%	2.62%
Expected volatility	27.00%	27.00%	29.00%
Expected life, in years	6 years 1 month 24 days	6 years 2 months 4 days	6 years 1 month 24 days
Expected dividend yield	1.19%	1.16%	1.37%

Share-Based Compensation - Schedule of Stock Option Activity (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock Options outstanding, Weighted Average Exercise Price, Beginning Balance	$ 71.79	$ 61.49	$ 43.47
Granted, Weighted Average Exercise Price	144.47	138.31	101.96
Exercised, Weighted Average Exercise Price	44.07	44.45	27.86
Cancelled, Weighted Average Exercise Price	111.69	93.26	68.43
Stock Options outstanding, Weighted Average Exercise Price, Ending Balance	91.53	$ 71.79	$ 61.49
Options exercisable, Weighted Average Exercise Price	$ 71.25
Options outstanding, Weighted Average Remaining Contractual Term	6 years
Options exercisable, Weighted Average Remaining Contractual Term	4 years 9 months 18 days
Options outstanding, Aggregate Intrinsic Value	$ 631
Options exercisable, Aggregate Intrinsic Value	$ 502
Time Based Stock Options and SARs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock Options Outstanding, Beginning Balance	9,050	9,360	11,156
Granted, Stock Options	1,120	1,349	2,342
Exercised, Stock Options	(2,159)	(1,137)	(3,917)
Cancelled, Stock Options	(175)	(522)	(221)
Stock Options Outstanding, Ending Balance	7,836	9,050	9,360
Stock Options Exercisable, Ending Balance	4,562
Performance Stock Options and SARs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock Options Outstanding, Beginning Balance	2,144	2,667	4,586
Exercised, Stock Options	(1,325)	(523)	(1,774)
Cancelled, Stock Options			(145)
Stock Options Outstanding, Ending Balance	819	2,144	2,667
Stock Options Exercisable, Ending Balance	819
Total Stock Options and Stock SARs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock Options Outstanding, Beginning Balance	11,194	12,027	15,742
Granted, Stock Options	1,120	1,349	2,342
Exercised, Stock Options	(3,484)	(1,660)	(5,691)
Cancelled, Stock Options	(175)	(522)	(366)
Stock Options Outstanding, Ending Balance	8,655	11,194	12,027
Stock Options Exercisable, Ending Balance	5,381

Share-Based Compensation - Schedule of Restricted Stock Units Activity (Detail) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
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	5,655	6,545	7,254
RSUs and PSUs, Granted	1,856	1,769	2,725
Performance adjustment	206	227	1,250
RSUs and PSUs, Vested	(2,394)	(2,467)	(4,123)
RSUs and PSUs, Cancelled	(255)	(419)	(561)
RSUs and PSUs Outstanding, Ending Balance	5,068	5,655	6,545
Weighted Average Grant Date Fair Value, RSUs and PSUs, Beginning balance	$ 105.23	$ 86.32	$ 72.05
Weighted Average Grant Date Fair Value, RSUs and PSUs, Granted	144.17	138.45	101.85
Performance adjustment	81.89	69.94	69.27
Weighted Average Grant Date Fair Value, RSUs and PSUs, Vested	88.63	75.97	67.33
Weighted Average Grant Date Fair Value, RSUs and PSUs, Cancelled	124.50	103.27	78.82
Weighted Average Grant Date Fair Value, RSUs and PSUs, Ending balance	$ 125.40	$ 105.23	$ 86.32
Restricted Stock Units and Performance Stock Units [Member] \| Time Based Stock Options and SARs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
RSUs and PSUs Outstanding, Beginning Balance	2,620	3,123	3,465
RSUs and PSUs, Granted	1,048	973	1,464
RSUs and PSUs, Vested	(1,030)	(1,216)	(1,487)
RSUs and PSUs, Cancelled	(162)	(260)	(319)
RSUs and PSUs Outstanding, Ending Balance	2,476	2,620	3,123
Restricted Stock Units and Performance Stock Units [Member] \| Performance Based Stock Options and RSUs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
RSUs and PSUs Outstanding, Beginning Balance			227
RSUs and PSUs, Vested			(136)
RSUs and PSUs, Cancelled			(91)
Performance Shares PSUs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
RSUs and PSUs Outstanding, Beginning Balance	3,035	3,422	3,562
RSUs and PSUs, Granted	808	796	1,261
Performance adjustment	206	227	1,250
RSUs and PSUs, Vested	(1,364)	(1,251)	(2,500)
RSUs and PSUs, Cancelled	(93)	(159)	(151)
RSUs and PSUs Outstanding, Ending Balance	2,592	3,035	3,422

Acquisitions and Dispositions - Additional Information (Detail) $ in Millions	12 Months Ended
	Dec. 31, 2020 USD ($) Hospital	Dec. 31, 2019 USD ($) Hospital	Dec. 31, 2018 USD ($) Hospital
Business Acquisition [Line Items]
Number of hospitals purchased \| Hospital	1	7	2
Proceeds from sale of business	$ 68	$ 61	$ 808
Real Estate and Other Investments [Member]
Business Acquisition [Line Items]
Pretax gain (loss) before tax			75
Pretax gain (loss) after tax			59
Proceeds from sale of business			50
Discontinued Operations, Disposed of by Sale [Member] \| Oklahoma [Member]
Business Acquisition [Line Items]
Pretax gain (loss) before tax			353
Pretax gain (loss) after tax			265
Proceeds from sale of business			$ 758
Number of hospitals sold \| Hospital			2
Discontinued Operations, Disposed of by Sale [Member] \| Louisiana [Member]
Business Acquisition [Line Items]
Pretax gain (loss) before tax		18
Pretax gain (loss) after tax		13
Proceeds from sale of business		$ 61
Number of hospitals sold \| Hospital		1
Discontinued Operations, Disposed of by Sale [Member] \| Mississippi [Member]
Business Acquisition [Line Items]
Pretax gain (loss) before tax	(7)
Pretax gain (loss) after tax	(9)
Proceeds from sale of business	$ 68
Number of hospitals sold \| Hospital	1
Hospitals [Member]
Business Acquisition [Line Items]
Aggregate purchase price		$ 1,384	$ 792
Nonhospital Health Care [Member]
Business Acquisition [Line Items]
Aggregate purchase price		298	461
Other [Member]
Business Acquisition [Line Items]
Goodwill	$ 279	$ 332	$ 636
Hospital and other nonhospital health care entities [Member]
Business Acquisition [Line Items]
Aggregate purchase price	$ 568

Income Taxes - Schedule of Provision for Income Taxes (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Current, Federal	$ 1,021	$ 670	$ 759
Current, State	126	134	149
Current, Foreign	5	17	23
Deferred, Federal	(73)	254	9
Deferred, State	(39)	29	13
Deferred, Foreign	3	(5)	(7)
Provision for income taxes	$ 1,043	$ 1,099	$ 946

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Income Taxes - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax Contingency [Line Items]
Provisional amount related to remeasurement of deferred tax assets and liabilities, recorded as a component of provision for income taxes			$ 67
Effective tax rate	21.00%	21.00%	21.00%	35.00%
Reduction to provision for income taxes for tax credits			$ (28)
Provision for tax benefits related to settlement of employee awards	$ 92	$ 65	124
Foreign pretax income	9	50	$ 86
State net operating loss carryforwards	56
Federal net operating loss carryforwards	127
Liability for unrecognized tax benefits	508	550
Unrecognized tax benefits, accrued interest	73	62
Unrecognized tax benefits that would impact effective tax rate	157	160
Deferred tax assets, reductions	$ 34	$ 34
State and Local Jurisdiction [Member] \| Minimum [Member]
Income Tax Contingency [Line Items]
Net operating loss carryforwards, expiration date	2023
State and Local Jurisdiction [Member] \| Maximum [Member]
Income Tax Contingency [Line Items]
Net operating loss carryforwards, expiration date	2039

Income Taxes - Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate (Detail)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Federal statutory rate	21.00%	21.00%	21.00%	35.00%
State income taxes, net of federal tax benefit	1.90%	2.70%	2.90%
Change in liability for uncertain tax positions	(0.20%)	0.40%	(0.10%)
Tax benefit from settlements of employee equity awards	(1.80%)	(1.30%)	(2.40%)
Impact of Tax Act on deferred tax balances			(1.60%)
Other items, net	0.80%	1.10%	0.20%
Effective income tax rate on income attributable to HCA Healthcare, Inc.	21.70%	23.90%	20.00%
Income attributable to noncontrolling interests from consolidated partnerships	(2.50%)	(2.90%)	(2.30%)
Effective income tax rate on income before income taxes	19.20%	21.00%	17.70%

Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Millions	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Depreciation and fixed asset basis differences, Assets	$ 0	$ 0
Allowances for professional liability and other risks, Assets	407	376
Accounts receivable, Assets	283	307
Compensation, Assets	487	292
Right-of-use lease obligations	416	369
Other, Assets	485	461
Deferred tax assets	2,078	1,805
Depreciation and fixed asset basis differences, Liabilities	678	601
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	409	366
Other, Liabilities	606	538
Deferred tax liabilities	$ 1,693	$ 1,505

Income Taxes - Schedule of Activity Related to Unrecognized Tax Benefits (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Beginning Balance	$ 522	$ 390
Additions (reductions) based on tax positions related to the current year	(3)	29
Additions for tax positions of prior years	13	119
Reductions for tax positions of prior years	(30)	(3)
Settlements	(22)	0
Lapse of applicable statutes of limitations	(11)	(13)
Ending Balance	$ 469	$ 522

Earnings Per Share - Additional information (Detail) - shares	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Earnings Per Share [Abstract]
Common stock repurchased	3,287,000	7,949,000	14,070,000.000

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, 2020	Dec. 31, 2019	Dec. 31, 2018
Earnings Per Share [Abstract]
Net income attributable to HCA Healthcare, Inc.	$ 3,754	$ 3,505	$ 3,787
Weighted average common shares outstanding	338,274	341,210	347,297
Effect of dilutive incremental shares	5,331	7,016	8,006
Shares used for diluted earnings per share	343,605	348,226	355,303
Basic earnings per share	$ 11.10	$ 10.27	$ 10.90
Diluted earnings per share	$ 10.93	$ 10.07	$ 10.66

- Definition

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

+ References

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+ Details

- Definition

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

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- Definition

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

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+ Details

Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions	Dec. 31, 2020	Dec. 31, 2019
Debt Securities, Available-for-sale [Line Items]
Amounts classified as current assets	$ (116)	$ (147)
Investment carrying value	388	315
Amortized Cost	472	444
Unrealized Amounts, Gains	32	18
Fair Value	504	462
Money Market Funds and Other [Member]
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	88	85
Fair Value	88	85
Debt Securities [Member] \| States and Municipalities [Member]
Debt Securities, Available-for-sale [Line Items]
Amortized Cost	384	359
Unrealized Amounts, Gains	32	18
Fair Value	$ 416	$ 377

Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions	Dec. 31, 2020 USD ($)
Investments, Debt and Equity Securities [Abstract]
Due in one year or less, Amortized Cost	$ 4
Due after one year through five years, Amortized Cost	147
Due after five years through ten years, Amortized Cost	157
Due after ten years, Amortized Cost	76
Amortized Cost, Total	384
Due in one year or less, Fair Value	4
Due after one year through five years, Fair Value	156
Due after five years through ten years, Fair Value	174
Due after ten years, Fair Value	82
Fair Value, Total	$ 416

Investments of Insurance Subsidiaries - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2020
Investments, Debt and Equity Securities [Abstract]
Available for sale securities expected maturity of debt securities	5 years 2 months 12 days
Available for sale securities average scheduled maturity	9 years 4 months 24 days

Financial Instruments - Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges (Detail) - Pay-Fixed Interest Rate Swaps [Member] $ in Millions	12 Months Ended
	Dec. 31, 2020 USD ($)
Maturity Date, 2021 [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Notional Amount	$ 2,000
Fair Value	$ (27)
Maturity Date	2021-12
Maturity Date, 2022 [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Notional Amount	$ 500
Fair Value	$ (19)
Maturity Date	2022-12

Financial Instruments - Additional Information (Detail) $ in Millions	12 Months Ended
	Dec. 31, 2020 USD ($)
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Estimated amount reclassified from other comprehensive income and reduce interest expense	$ 37
Estimated termination value	$ 46

Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Loss Recognized in OCI on Derivatives, Net of Tax	$ 51	$ 37	$ (18)
Interest Rate Swaps [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Loss Recognized in OCI on Derivatives, Net of Tax	51
Interest Rate Swaps [Member] \| Reclassification out of Accumulated Other Comprehensive Income [Member]
Derivative Instruments, Gain (Loss) [Line Items]
Interest rate swaps	$ 24

Assets and Liabilities Measured at Fair Value - Schedule of Assets Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Millions	Dec. 31, 2020	Dec. 31, 2019
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Assets, Fair Value Disclosure	$ 504	$ 462
Less amounts classified as current assets	(116)	(147)
Investments of insurance subsidiaries, noncurrent	388	315
Interest Rate Swaps [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Derivative Asset		3
Derivative Liability	46	7
Money Market Funds and Other [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Assets, Fair Value Disclosure	88	85
Debt Securities [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt Securities, Available-for-sale Securities	416	377
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Assets, Fair Value Disclosure	88	85
Less amounts classified as current assets	(87)	(83)
Investments of insurance subsidiaries, noncurrent	1	2
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] \| Money Market Funds and Other [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Assets, Fair Value Disclosure	88	85
Significant Other Observable Inputs (Level 2) [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Assets, Fair Value Disclosure	416	377
Less amounts classified as current assets	(29)	(64)
Investments of insurance subsidiaries, noncurrent	387	313
Significant Other Observable Inputs (Level 2) [Member] \| Interest Rate Swaps [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Derivative Asset		3
Derivative Liability	46	7
Significant Other Observable Inputs (Level 2) [Member] \| Debt Securities [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt Securities, Available-for-sale Securities	$ 416	$ 377

Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions	Dec. 31, 2020	Dec. 31, 2019
Fair Value Disclosures [Abstract]
Estimated fair value of long-term debt	$ 35,814	$ 37,026
Carrying amounts of long-term debt	$ 31,240	$ 33,961

Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($) $ in Millions	Dec. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Senior secured debt	$ 18,288	$ 20,709
Net debt issuance costs	(236)	(239)
Total debt (average life of 8.9 years, rates averaging 5.0%)	31,004	33,722
Less amounts due within one year	209	145
Long-term debt	30,795	33,577
Senior Secured Asset-Based Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Long-term line of credit		2,480
Senior Secured Term Loan Facilities [Member]
Debt Instrument [Line Items]
Senior secured debt	3,671	3,725
Senior Secured Notes [Member]
Debt Instrument [Line Items]
Senior secured debt	13,850	13,850
Other Senior Secured Debt [Member]
Debt Instrument [Line Items]
Other senior secured debt	767	654
Senior Unsecured Notes [Member]
Debt Instrument [Line Items]
Senior unsecured notes	$ 12,952	$ 13,252

Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail)	12 Months Ended
	Dec. 31, 2020
Debt Instrument [Line Items]
Total debt average term	8 years 10 months 24 days
Total debt average rate	5.00%
Senior Secured Term Loan Facilities [Member]
Debt Instrument [Line Items]
Effective interest rate	2.80%
Senior Secured Notes [Member]
Debt Instrument [Line Items]
Effective interest rate	5.10%
Other Senior Secured Debt [Member]
Debt Instrument [Line Items]
Effective interest rate	4.70%
Senior Unsecured Notes [Member]
Debt Instrument [Line Items]
Effective interest rate	5.50%

Long-Term Debt - Additional Information (Detail) - USD ($)	1 Months Ended	12 Months Ended
	Mar. 31, 2020	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Feb. 29, 2020
Debt Instrument [Line Items]
Pretax loss on retirement of debt		$ 295,000,000	$ 211,000,000	$ 9,000,000
Capital leases and other secured debt		767,000,000
Maturity of long-term debt in 2022		233,000,000
Maturity of long-term debt in 2023		2,799,000,000
Maturity of long-term debt in 2024		3,163,000,000
Maturity of long-term debt in 2025		$ 5,872,000,000
Minimum [Member]
Debt Instrument [Line Items]
Debt instrument, maturities range		2022
Maximum [Member]
Debt Instrument [Line Items]
Debt instrument, maturities range		2025
Interest Rate Swaps [Member]
Debt Instrument [Line Items]
Notional amount, total		$ 2,500,000,000
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		$ 3,750,000,000
Debt instrument maturity date		Jun. 28, 2022
Percentage of senior secured credit facility over eligible accounts receivable		85.00%
Line of credit outstanding		$ 0
Senior Secured Revolving Credit Facility Maturing On June 28, 2022 [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity		$ 2,000,000,000.000
Debt instrument maturity date		Jun. 28, 2022
Line of credit outstanding		$ 0
Senior Secured Term Loan A-6 Facility Maturing On July 16, 2024 [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity		$ 1,078,000,000.000
Debt instrument maturity date		Jul. 16, 2024
Senior Secured Term Loan B-12 Facility Maturing On March 13, 2025 [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity		$ 1,459,000,000
Debt instrument maturity date		Mar. 13, 2025
Senior Secured Term Loan B-13 Facility Maturing On March 18, 2026 [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity		$ 1,134,000,000
Debt instrument maturity date		Mar. 18, 2026
Senior Secured Revolving Credit Facility Maturing On March 19, 2021
Debt Instrument [Line Items]
Maximum borrowing capacity		$ 2,000,000,000.000
Debt instrument maturity date		Mar. 18, 2021
Line of credit outstanding		$ 0
Senior Unsecured Note Maturities Ranging 2021 to 2033 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount		$ 12,091,000,000.000
Senior Unsecured Note Maturities Ranging 2021 to 2033 [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Debt instrument, maturities range		2023
Senior Unsecured Note Maturities Ranging 2021 to 2033 [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Debt instrument, maturities range		2033
Senior Unsecured Note Maturity Year 2025 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount		$ 125,000,000
Senior Unsecured Note Maturities Ranging 2023 to 2095 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount		$ 736,000,000
Senior Unsecured Note Maturities Ranging 2023 to 2095 [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Debt instrument, maturities range		2023
Senior Unsecured Note Maturities Ranging 2023 to 2095 [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Debt instrument, maturities range		2095
Secured Debt [Member]
Debt Instrument [Line Items]
Pretax loss on retirement of debt		$ 295,000,000
6.25% Senior Notes Due 2021 [Member]
Debt Instrument [Line Items]
Early Repayment of Senior Debt	$ 1,000,000,000.000
Debt Instrument, Redemption Price, Percentage	6.25%
7.50% Senior Notes Due 2022 [Member]
Debt Instrument [Line Items]
Early Repayment of Senior Debt	$ 2,000,000,000.000
Debt Instrument, Redemption Price, Percentage	7.50%
Senior Notes [Member] \| Senior Secured Notes Due 2023 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount		$ 1,250,000,000
Debt instrument, stated interest		4.75%
Senior Notes [Member] \| Senior Secured Notes Due 2024 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount		$ 2,000,000,000.000
Debt instrument, stated interest		5.00%
Senior Notes [Member] \| Senior Secured Notes Due 2025 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount		$ 1,400,000,000
Debt instrument, stated interest		5.25%
Senior Notes [Member] \| Senior Secured Notes Due 2026 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount		$ 1,500,000,000
Debt instrument, stated interest		5.25%
Senior Notes [Member] \| Senior Secured Notes Due 2027 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount		$ 1,200,000,000
Debt instrument, stated interest		4.50%
Senior Notes [Member] \| Senior Secured Notes Due 2029 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount		$ 2,000,000,000.000
Debt instrument, stated interest		4.125%
Senior Notes [Member] \| Senior Secured Notes Due 2047 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount		$ 1,500,000,000
Debt instrument, stated interest		5.50%
Senior Notes [Member] \| Senior Secured Notes Due 2049 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount		$ 2,000,000,000.000
Debt instrument, stated interest		5.25%
Senior Notes [Member] \| 5.13% Senior Notes Due 2039 [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount		$ 1,000,000,000.000
Senior Unsecured Notes [Member]
Debt Instrument [Line Items]
Debt instrument, principal amount					$ 2,700,000,000
Debt instrument, stated interest					3.50%
Senior Secured Three Six Four Day Term Loan Facility [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity		$ 2,000,000,000.000

Leases - Schedule Of Lease-Related Assets And Liabilities (Detail) - USD ($) $ in Millions	Dec. 31, 2020	Dec. 31, 2019
Assets:
Operating leases	$ 2,024	$ 1,834
Finance leases	553	520
Total lease assets	2,577	2,354
Liabilities
Operating leases	379	350
Finance leases	128	87
Operating leases	1,673	1,499
Finance leases	494	470
Total lease liabilities	$ 2,674	$ 2,406
Weighted-average remaining term:
Operating leases	10 years 4 months 24 days	10 years 9 months 18 days
Finance leases	11 years 6 months	12 years
Weighted-average discount rate:
Operating leases	4.80%	5.30%
Finance leases	5.40%	6.00%

Leases - Schedule Of Lease Expense For Finance And Operating Leases (Detail) - USD ($)
$ in Millions

12 Months Ended

Dec. 31, 2020

Dec. 31, 2019

Finance lease expense:

Depreciation and amortization

$ 106

$ 93

Interest

31

32

Operating leases

^[1]

447

389

Short-term lease expense

^[1]

322

316

Variable lease expense

^[1]

154

150

Total lease expense

$ 1,060

$ 980

[1]	Expenses are included in “other operating expenses” in our consolidated income statements.

Leases - Schedule Of Supplemental Cash Flow Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Cash Paid For Amounts Included In Measurement Of Lease Liabilities [Abstract]
Operating cash flows for operating leases	$ 445	$ 404
Operating cash flows for finance leases	31	32
Financing cash flows for finance leases	$ 86	$ 79

Leases - Schedule of undiscounted cash flows to the finance lease liabilities and operating lease liabilities (Detail) - USD ($) $ in Millions	Dec. 31, 2020	Dec. 31, 2019
Operating Lease Liabilities, Payments Due [Abstract]
Year 1	$ 431	$ 411
Year 2	366	350
Year 3	307	285
Year 4	255	228
Year 5	207	182
Thereafter	1,136	1,074
Total minimum lease payments	2,702	2,530
Less: amount of lease payments representing interest	(650)	(681)
Present value of future minimum lease payments	2,052	1,849
Less: current obligations under leases	(379)	(350)
Long-term lease obligations	1,673	1,499
Finance Lease Liabilities, Payments, Due [Abstract]
Year 1	155	110
Year 2	125	105
Year 3	81	99
Year 4	82	58
Year 5	51	60
Thereafter	353	368
Total minimum lease payments	847	800
Less: amount of lease payments representing interest	(225)	(243)
Present value of future minimum lease payments	622	557
Less: current obligations under leases	(128)	(87)
Long-term lease obligations	$ 494	$ 470

Capital Stock - Additional Information (Detail)	12 Months Ended
Capital Stock - Additional Information (Detail)	Dec. 31, 2020 USD ($) $ / shares Directors shares	Dec. 31, 2019 $ / shares shares	Dec. 31, 2018 $ / shares shares	Feb. 01, 2021 USD ($)	Jan. 31, 2020 USD ($)	Jan. 31, 2019 USD ($)	Oct. 31, 2017 USD ($)
Capital Structure [Line Items]
Common stock, shares authorized \| shares	1,800,000,000	1,800,000,000
Repurchase of common stock, shares \| shares	3,287,000	7,949,000	14,070,000.000
Repurchase price of common stock, per share \| $ / shares	$ 134.18	$ 129.71	$ 108.74
Share repurchase program authorized amount					$ 6,000,000,000	$ 6,000,000,000	$ 6,000,000,000
Share repurchase program, remaining authorized repurchase amount	$ 2,800,000,000				$ 2,000,000,000	$ 2,000,000,000	$ 2,000,000,000
Subsequent Event [Member]
Capital Structure [Line Items]
Share repurchase program authorized amount				$ 8,800,000,000
Share repurchase program, remaining authorized repurchase amount				2,800,000,000
Stock repurchase program additional authorized amount				$ 6,000,000,000
Minimum [Member]
Capital Structure [Line Items]
Number of directors as per the amended and restated by-laws \| Directors	3

Employee Benefit Plans - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
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%
Cost of defined benefit plans	$ 552	$ 532	$ 499
Defined benefit plan cost	8	11	9
Defined benefit plan obligation	$ 96	63
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 hours
Noncontributory and nonqualified plan, benefit expense	$ 35	44	22
Noncontributory and nonqualified plan, accrued benefits liabilities	242	227
Supplemental Executive Retirement Plan [Member]
Pension Plans, Postretirement and Other Employee Benefits [Line Items]
Defined benefit plan cost	24	19	$ 26
Defined benefit plan obligation	$ 204	$ 192

Segment and Geographic Information - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2020 Hospital
Segment Reporting Information [Line Items]
Number of geographically organized groups	2
Number of owned and operated hospitals	185
Reorganization Group [Member] \| National Group [Member]
Segment Reporting Information [Line Items]
Number of owned and operated hospitals	96
Reorganization Group [Member] \| American Group [Member]
Segment Reporting Information [Line Items]
Number of owned and operated hospitals	82
Reorganization Group [Member] \| Corporate and Other [Member]
Segment Reporting Information [Line Items]
Number of owned and operated hospitals	7

Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization and Assets (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Segment Reporting Information [Line Items]
Revenues	$ 51,533	$ 51,336	$ 46,677
Equity in earnings of affiliates	(54)	(43)	(29)
Adjusted segment EBITDA	10,037	9,857	8,949
Depreciation and amortization	2,721	2,596	2,278
Interest expense	1,584	1,824	1,755
Losses (gains) on sales of facilities	7	(18)	(428)
Losses on retirement of debt	295	211	9
Income before income taxes	5,430	5,244	5,335
Assets	47,490	45,058	39,207
Goodwill and other intangible assets, Beginning Balance	8,269	7,953	7,394
Goodwill and other intangible assets, Acquisitions	344	332	636
Goodwill and other intangible assets, Foreign currency translation and other		(16)	(77)
Goodwill and other intangible assets, Foreign currency translation, amortization and other	(35)
Goodwill and other intangible assets, Ending Balance	8,578	8,269	7,953
National Group [Member]
Segment Reporting Information [Line Items]
Revenues	25,694	25,913	22,581
Equity in earnings of affiliates	(28)	(2)	(4)
Adjusted segment EBITDA	5,532	5,634	4,980
Depreciation and amortization	1,216	1,161	946
Assets	18,913	18,290	14,839
Goodwill and other intangible assets, Beginning Balance	1,739	1,597	1,474
Goodwill and other intangible assets, Acquisitions	38	155	132
Goodwill and other intangible assets, Foreign currency translation and other		(13)	(9)
Goodwill and other intangible assets, Foreign currency translation, amortization and other	(2)
Goodwill and other intangible assets, Ending Balance	1,775	1,739	1,597
American Group [Member]
Segment Reporting Information [Line Items]
Revenues	23,593	23,173	21,959
Equity in earnings of affiliates	(42)	(44)	(40)
Adjusted segment EBITDA	5,333	4,904	4,593
Depreciation and amortization	1,164	1,117	1,027
Assets	20,760	20,608	19,122
Goodwill and other intangible assets, Beginning Balance	5,765	5,729	5,265
Goodwill and other intangible assets, Acquisitions	27	39	504
Goodwill and other intangible assets, Foreign currency translation and other		(3)	(40)
Goodwill and other intangible assets, Foreign currency translation, amortization and other	(17)
Goodwill and other intangible assets, Ending Balance	5,775	5,765	5,729
Corporate and Other [Member]
Segment Reporting Information [Line Items]
Revenues	2,246	2,250	2,137
Equity in earnings of affiliates	16	3	15
Adjusted segment EBITDA	(828)	(681)	(624)
Depreciation and amortization	341	318	305
Assets	7,817	6,160	5,246
Goodwill and other intangible assets, Beginning Balance	765	627	655
Goodwill and other intangible assets, Acquisitions	279	138
Goodwill and other intangible assets, Foreign currency translation and other			(28)
Goodwill and other intangible assets, Foreign currency translation, amortization and other	(16)
Goodwill and other intangible assets, Ending Balance	$ 1,028	$ 765	$ 627

Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Equity [Abstract]
Unrealized gains on available-for-sale securities, beginning balances	$ 14	$ 3	$ 7
Unrealized gains (losses) on available-for-sale securities	11	11	(5)
Reclassification of stranded tax effects, unrealized gains (losses) on available-for-sale securities			1
Unrealized gains on available-for-sale securities, ending balances	25	14	3
Foreign currency translation adjustments, beginning balances	(283)	(283)	(149)
Foreign currency translation adjustments	12		(63)
Reclassification of stranded tax effects, foreign currency translation adjustments			(71)
Foreign currency translation adjustments, ending balances	(271)	(283)	(283)
Defined benefit plans, beginning balances	(187)	(148)	(168)
Defined benefit plans	(55)	(49)	34
Defined benefit plans, (income) expense reclassified into operations from other comprehensive income	22	10	16
Reclassification of stranded tax effects, defined benefit plans			(30)
Defined benefit plans, ending balances	(220)	(187)	(148)
Change in fair value of derivative instruments, beginning balances	(4)	47	32
Change in fair value of derivative instruments	(51)	(37)	18
Change in fair value of derivatives instruments, (income) expense reclassified into operations from other comprehensive income	19	(14)	(8)
Reclassification of stranded tax effects, change in fair value of derivative instruments			5
Change in fair value of derivative instruments, ending balances	(36)	(4)	47
Accumulated other comprehensive income (loss), net of tax, beginning balances	(460)	(381)	(278)
Unrealized gains (losses) on available-for-sale securities, net of income taxes	11	11	(5)
Foreign currency translation adjustments	12		(63)
Defined benefit plans	(55)	(49)	34
Change in fair value of derivative instruments, net of income tax benefit	(51)	(37)	18
Expense (income) reclassified into operations from other comprehensive income, Total	41	(4)	8
Reclassification of stranded tax effects, total			(95)
Accumulated other comprehensive income (loss), net of tax, ending balances	$ (502)	$ (460)	$ (381)

Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Equity [Abstract]
Unrealized gains (losses) on available-for-sale securities, tax benefit			$ 2
Unrealized gains (losses) on available-for-sale securities, tax expense	$ 3	$ 4
Foreign currency translation adjustments, income tax benefit			8
Foreign currency translation adjustments, income tax expense	6	5
Defined benefit plans, income tax benefit	16	14
Defined benefit plans, income tax expense			10
Change in fair value of derivative instruments, income tax benefit	15	13
Change in fair value of derivative instruments, income tax expense			5
Defined benefit plans, benefit reclassified into operations from other comprehensive income	6	3	5
Interest expense on derivative instruments, benefit reclassified into operations from other comprehensive income	$ 5
Interest benefit on derivative instruments, expense reclassified into operations from other comprehensive income		$ 3	$ 2

Accrued Expenses - Summary of Other Accrued Expenses (Detail) - USD ($) $ in Millions	Dec. 31, 2020	Dec. 31, 2019
Payables and Accruals [Abstract]
Professional liability risks	$ 477	$ 457
Defined contribution benefit plan	547	528
Right-of-use operating lease	379	350
Taxes other than income	343	325
Interest	315	368
Government stimulus refund liability	83
Other	1,096	904
Other accrued expenses	$ 3,240	$ 2,932