Cover Page
Cover Page - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Jan. 31, 2024 | Jun. 30, 2023 | |
Cover [Abstract] | |||
Document Type | 10-K | ||
Amendment Flag | false | ||
Document Period End Date | Dec. 31, 2023 | ||
Document Fiscal Year Focus | 2023 | ||
Document Fiscal Period Focus | FY | ||
Trading Symbol | HCA | ||
Entity Registrant Name | HCA Healthcare, Inc. | ||
Entity Central Index Key | 0000860730 | ||
Current Fiscal Year End Date | --12-31 | ||
Entity Current Reporting Status | Yes | ||
Entity Filer Category | Large Accelerated Filer | ||
Entity Shell Company | false | ||
Entity Small Business | false | ||
Entity Emerging Growth Company | false | ||
Entity Common Stock, Shares Outstanding | 264,498,700 | ||
Entity Interactive Data Current | Yes | ||
Entity File Number | 1-11239 | ||
Entity Incorporation, State or Country Code | DE | ||
Entity Tax Identification Number | 27-3865930 | ||
Entity Address, Address Line One | One Park Plaza | ||
Entity Address, City or Town | Nashville | ||
Entity Address, State or Province | TN | ||
Entity Address, Postal Zip Code | 37203 | ||
City Area Code | 615 | ||
Local Phone Number | 344-9551 | ||
Document Annual Report | true | ||
Document Transition Report | false | ||
Title of 12(b) Security | Common Stock, $0.01 Par Value | ||
Security Exchange Name | NYSE | ||
Entity Voluntary Filers | No | ||
Entity Well-known Seasoned Issuer | Yes | ||
Entity Public Float | $ 61,126 | ||
ICFR Auditor Attestation Flag | true | ||
Auditor Firm ID | 42 | ||
Auditor Name | Ernst & Young LLP | ||
Auditor Location | Nashville, Tennessee, United States of America | ||
Document Financial Statement Error Correction [Flag] | false | ||
Documents Incorporated by Reference | Portions of the Registrant’s definitive proxy materials for its 2024 Annual Meeting of Stockholders are incorporated by reference into Part III hereof. |
Consolidated Income Statements
Consolidated Income Statements - USD ($) shares in Thousands, $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Income Statement [Abstract] | |||
Revenues | $ 64,968 | $ 60,233 | $ 58,752 |
Salaries and benefits | 29,487 | 27,685 | 26,779 |
Supplies | 9,902 | 9,371 | 9,481 |
Other operating expenses | 12,875 | 11,155 | 9,961 |
Equity in earnings of affiliates | (22) | (45) | (113) |
Depreciation and amortization | 3,077 | 2,969 | 2,853 |
Interest expense | 1,938 | 1,741 | 1,566 |
Losses (gains) on sales of facilities | 5 | (1,301) | (1,620) |
Losses on retirement of debt | 0 | 78 | 12 |
Total expenses including equity in earnings of affiliates | 57,262 | 51,653 | 48,919 |
Income before income taxes | 7,706 | 8,580 | 9,833 |
Provision for income taxes | 1,615 | 1,746 | 2,112 |
Net income | 6,091 | 6,834 | 7,721 |
Net income attributable to noncontrolling interests | 849 | 1,191 | 765 |
Net income attributable to HCA Healthcare, Inc. | $ 5,242 | $ 5,643 | $ 6,956 |
Per share data: | |||
Basic earnings per share | $ 19.25 | $ 19.43 | $ 21.52 |
Diluted earnings per share | $ 18.97 | $ 19.15 | $ 21.16 |
Shares used in earnings per share calculations (in millions): | |||
Basic | 272,404 | 290,348 | 323,315 |
Diluted | 276,412 | 294,666 | 328,752 |
Consolidated Comprehensive Inco
Consolidated Comprehensive Income Statements - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Statement of Comprehensive Income [Abstract] | |||
Net income | $ 6,091 | $ 6,834 | $ 7,721 |
Other comprehensive income (loss) before taxes: | |||
Foreign currency translation | 41 | (111) | (9) |
Unrealized gains (losses) on available-for-sale securities | 11 | (55) | (16) |
Losses (gains) included in other operating expenses | (1) | 1 | 0 |
Total Unrealized losses on available-for-sale securities | 10 | (54) | (16) |
Defined benefit plans | 27 | 49 | 87 |
Pension costs included in salaries and benefits | 3 | 9 | 28 |
Total defined benefit plans | 30 | 58 | 115 |
Change in fair value of derivative financial instruments | 0 | 6 | 1 |
Interest costs included in interest expense | 0 | 2 | 37 |
Total change in fair value of derivative financial instruments | 0 | 8 | 38 |
Other comprehensive income (loss) before taxes | 81 | (99) | 128 |
Income taxes (benefits) related to other comprehensive income items | 16 | (13) | 30 |
Other comprehensive income (loss) | 65 | (86) | 98 |
Comprehensive income | 6,156 | 6,748 | 7,819 |
Comprehensive income attributable to noncontrolling interests | 849 | 1,191 | 765 |
Comprehensive income attributable to HCA Healthcare, Inc. | $ 5,307 | $ 5,557 | $ 7,054 |
Consolidated Balance Sheets
Consolidated Balance Sheets - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Current assets: | ||
Cash and cash equivalents | $ 935 | $ 908 |
Accounts receivable | 9,958 | 8,891 |
Inventories | 2,021 | 2,068 |
Other | 2,013 | 1,776 |
Total current assets | 14,927 | 13,643 |
Property and equipment, at cost: | ||
Land | 3,120 | 2,799 |
Buildings | 21,560 | 20,221 |
Equipment | 31,998 | 29,981 |
Construction in progress | 1,870 | 1,756 |
Property and equipment, at cost | 58,548 | 54,757 |
Accumulated depreciation | (30,833) | (29,182) |
Property and equipment, net | 27,715 | 25,575 |
Investments of insurance subsidiaries | 477 | 381 |
Investments in and advances to affiliates | 756 | 823 |
Goodwill and other intangible assets | 9,945 | 9,653 |
Right-of-use operating lease assets | 2,207 | 2,065 |
Other | 184 | 298 |
Total assets | 56,211 | 52,438 |
Current liabilities: | ||
Accounts payable | 4,233 | 4,239 |
Accrued salaries | 2,127 | 1,712 |
Other accrued expenses | 3,871 | 3,581 |
Long-term debt due within one year | 2,424 | 370 |
Total current liabilities | 12,655 | 9,902 |
Long-term debt, less debt issuance costs and discounts of $333 and $301 | 37,169 | 37,714 |
Professional liability risks | 1,557 | 1,528 |
Right-of-use operating lease obligations | 1,903 | 1,752 |
Income taxes and other liabilities | 1,867 | 1,615 |
Stockholders' equity (deficit): | ||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 265,537,300 shares - 2023 and 277,378,300 shares - 2022 | 3 | 3 |
Accumulated other comprehensive loss | (425) | (490) |
Retained deficit | (1,352) | (2,280) |
Stockholders' deficit attributable to HCA Healthcare, Inc. | (1,774) | (2,767) |
Noncontrolling interests | 2,834 | 2,694 |
Total stockholders' equity (deficit) | 1,060 | (73) |
Total liabilities and stockholders' equity (deficit) | $ 56,211 | $ 52,438 |
Consolidated Balance Sheets (Pa
Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Statement of Financial Position [Abstract] | ||
Debt issuance costs | $ 333 | $ 301 |
Common stock, par value | $ 0.01 | $ 0.01 |
Common stock, shares authorized | 1,800,000,000 | 1,800,000,000 |
Common stock, shares outstanding | 265,537,300 | 277,378,300 |
Consolidated Statements of Stoc
Consolidated Statements of Stockholders' Equity (Deficit) - USD ($) $ in Millions | Total | Common Stock [Member] | Capital in Excess of Par Value [Member] | Accumulated Other Comprehensive Loss [Member] | Retained Earnings (Deficit) [Member] | Equity Attributable to Noncontrolling Interests [Member] |
Balance at Dec. 31, 2020 | $ 2,892 | $ 3 | $ 294 | $ (502) | $ 777 | $ 2,320 |
Balance, shares at Dec. 31, 2020 | 339,426,000 | |||||
Comprehensive income (loss) | 7,819 | 98 | 6,956 | 765 | ||
Repurchase of common stock | $ (8,215) | (578) | (7,637) | |||
Repurchase of common stock, shares | (37,812,000) | (37,812,000) | ||||
Share-based benefit plans | $ 280 | 280 | ||||
Share-based benefit plans, shares | 3,863,000 | |||||
Cash dividends declared | (628) | (628) | ||||
Distributions | (749) | (749) | ||||
Other | 90 | 4 | 86 | |||
Balance at Dec. 31, 2021 | 1,489 | $ 3 | 0 | (404) | (532) | 2,422 |
Balance, shares at Dec. 31, 2021 | 305,477,000 | |||||
Comprehensive income (loss) | 6,748 | (86) | 5,643 | 1,191 | ||
Repurchase of common stock | $ (7,000) | (264) | (6,736) | |||
Repurchase of common stock, shares | (30,747,000) | (30,747,000) | ||||
Share-based benefit plans | $ 282 | 282 | ||||
Share-based benefit plans, shares | 2,648,000 | |||||
Cash dividends declared | (655) | (655) | ||||
Distributions | (1,025) | (1,025) | ||||
Other | 88 | (18) | 106 | |||
Balance at Dec. 31, 2022 | (73) | $ 3 | 0 | (490) | (2,280) | 2,694 |
Balance, shares at Dec. 31, 2022 | 277,378,000 | |||||
Comprehensive income (loss) | 6,156 | 65 | 5,242 | 849 | ||
Repurchase of common stock | $ (3,842) | (186) | (3,656) | |||
Repurchase of common stock, shares | (14,465,000) | (14,465,000) | ||||
Share-based benefit plans | $ 172 | 172 | ||||
Share-based benefit plans, shares | 2,624,000 | |||||
Cash dividends declared | (658) | (658) | ||||
Distributions | (640) | (640) | ||||
Other | (55) | 14 | (69) | |||
Balance at Dec. 31, 2023 | $ 1,060 | $ 3 | $ 0 | $ (425) | $ (1,352) | $ 2,834 |
Balance, shares at Dec. 31, 2023 | 265,537,000 |
Consolidated Statements of St_2
Consolidated Statements of Stockholders' Equity (Deficit) (Parenthetical) - $ / shares | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Statement of Stockholders' Equity [Abstract] | |||
Cash dividends declared, per share | $ 2.4 | $ 2.24 | $ 1.92 |
Consolidated Statements of Cash
Consolidated Statements of Cash Flows - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Cash flows from operating activities: | |||
Net income | $ 6,091 | $ 6,834 | $ 7,721 |
Increase (decrease) in cash from operating assets and liabilities: | |||
Accounts receivable | (935) | (797) | (962) |
Inventories and other assets | (126) | (59) | (540) |
Accounts payable and accrued expenses | 604 | (296) | 999 |
Depreciation and amortization | 3,077 | 2,969 | 2,853 |
Income taxes | 229 | 571 | (70) |
Losses (gains) on sales of facilities | 5 | (1,301) | (1,620) |
Losses on retirement of debt | 0 | 78 | 12 |
Amortization of debt issuance costs and discounts | 35 | 29 | 27 |
Share-based compensation | 262 | 341 | 440 |
Other | 189 | 153 | 99 |
Net cash provided by operating activities | 9,431 | 8,522 | 8,959 |
Cash flows from investing activities: | |||
Purchase of property and equipment | (4,744) | (4,395) | (3,577) |
Acquisition of hospitals and health care entities | (635) | (224) | (1,105) |
Sales of hospitals and health care entities | 193 | 1,237 | 2,160 |
Change in investments | (112) | 14 | (117) |
Other | (19) | (21) | (4) |
Net cash used in investing activities | (5,317) | (3,389) | (2,643) |
Cash flows from financing activities: | |||
Issuances of long-term debt | 3,224 | 5,997 | 4,344 |
Net change in revolving credit facilities | (1,020) | 120 | 2,780 |
Repayment of long-term debt | (909) | (2,830) | (3,869) |
Distributions to noncontrolling interests | (640) | (1,025) | (749) |
Payment of debt issuance costs | (31) | (53) | (38) |
Payment of dividends | (661) | (653) | (624) |
Repurchase of common stock | (3,811) | (7,000) | (8,215) |
Other | (246) | (212) | (284) |
Net cash used in financing activities | (4,094) | (5,656) | (6,655) |
Effect of exchange rate changes on cash and cash equivalents | 7 | (20) | (3) |
Change in cash and cash equivalents | 27 | (543) | (342) |
Cash and cash equivalents at beginning of period | 908 | 1,451 | 1,793 |
Cash and cash equivalents at end of period | 935 | 908 | 1,451 |
Interest payments | 1,892 | 1,662 | 1,502 |
Income tax payments, net | $ 1,386 | $ 1,175 | $ 2,182 |
Pay vs Performance Disclosure
Pay vs Performance Disclosure - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Pay vs Performance Disclosure | |||
Net Income (Loss) | $ 5,242 | $ 5,643 | $ 6,956 |
Insider Trading Arrangements
Insider Trading Arrangements | 3 Months Ended |
Dec. 31, 2023 | |
Trading Arrangements, by Individual | |
Rule 10b5-1 Arrangement Adopted | false |
Non-Rule 10b5-1 Arrangement Adopted | false |
Rule 10b5-1 Arrangement Terminated | false |
Non-Rule 10b5-1 Arrangement Terminated | false |
Accounting Policies
Accounting Policies | 12 Months Ended |
Dec. 31, 2023 | |
Accounting Policies [Abstract] | |
Accounting Policies | NOTE 1 — ACC OUNTING POLICIES Reporting Entity HCA Healthcare, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At December 31, 2023 these affiliates owned and operated 186 hospitals, 124 freestanding surgery centers, 24 freestanding endoscopy centers and provided extensive outpatient and ancillary services. HCA Healthcare, Inc.’s facilities are located in 20 states and England. The terms “Company,” “HCA,” “we,” “our” or “us,” as used herein and unless otherwise stated or indicated by context, refer to HCA Healthcare, Inc. and its affiliates. The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA and the term “employees” refers to employees of affiliates of HCA. Basis of Presentation The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates. The consolidated financial statements include all subsidiaries and entities controlled by HCA. We generally define “control” as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which we absorb a majority of the entity’s expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of ownership, contractual or other financial interests in the entity. The accounts of acquired entities are included in our consolidated financial statements for periods subsequent to our acquisition of controlling interests. Significant intercompany transactions have been eliminated. Investments in entities we do not control, but in which we have a substantial ownership interest and can exercise significant influence, are accounted for using the equity method. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative include our corporate office costs, which were $ 315 million, $ 307 million and $ 337 million for the years ended December 31, 2023, 2022 and 2021 , respectively. Revenues Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges . Our performance obligations for outpatient services are generally satisfied over a period of less than one day . The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals. NOTE 1 — ACCOUNTING POLICIES (continued) Revenues (continued) Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured and other discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Our revenues by primary third-party payer classification and other (including uninsured patients) for the years ended December 31, are summarized in the following table (dollars in millions): Years Ended December 31, 2023 Ratio 2022 Ratio 2021 Ratio Medicare $ 10,585 16.3 % $ 10,447 17.3 % $ 10,447 17.8 % Managed Medicare 10,496 16.2 9,201 15.3 8,424 14.3 Medicaid 3,606 5.6 2,636 4.4 2,290 3.9 Managed Medicaid 3,879 6.0 3,998 6.6 3,124 5.3 Managed care and other insurers 31,819 49.0 29,120 48.3 30,295 51.6 International (managed care and other insurers) 1,509 2.3 1,317 2.2 1,336 2.3 Other 3,074 4.6 3,514 5.9 2,836 4.8 Revenues $ 64,968 100.0 % $ 60,233 100.0 % $ 58,752 100.0 % Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process). The adjustments to estimated Medicare and Medicaid reimbursement and disproportionate-share amounts, related primarily to cost reports filed during the respective year, resulted in net increases to revenues of $ 84 million, $ 56 million and $ 53 million in 2023, 2022 and 2021 , respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in net increases to revenues of $ 58 million in 2023 , $ 42 million in 2022 and $ 19 million in 2021. The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive. Patients treated at hospitals for non-elective care, who have income at or below 400 % of the federal poverty level, are eligible for charity care, and we limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. Patients treated at hospitals for non-elective care, who have income above 400 % of the federal poverty level, are eligible for certain other discounts which limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. We apply additional discounts to limit patient responsibility for certain emergency services. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. We may attempt to provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance, or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied. NOTE 1 — ACCOUNTING POLICIES (continued) Revenues (continued) The collection of outstanding receivables from Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the age of those accounts. Accounts are written off when all reasonable collection efforts have been performed. The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period comparisons of our revenues. At December 31, 2023 and 2022 , estimated implicit price concessions of $ 7.283 billion and $ 6.780 billion, respectively, had been recorded to adjust our revenues and accounts receivable to the estimated amounts we expect to collect. To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions): 2023 2022 2021 Patient care costs (salaries and benefits, supplies, other operating $ 55,341 $ 51,180 $ 49,074 Cost-to-charges ratio (patient care costs as percentage of gross 10.5 % 11.0 % 11.3 % Total uncompensated care $ 35,426 $ 31,734 $ 29,642 Multiply by the cost-to-charges ratio 10.5 % 11.0 % 11.3 % Estimated cost of total uncompensated care $ 3,720 $ 3,491 $ 3,350 The total uncompensated care amounts include charity care of $ 14.425 billion, $ 13.615 billion and $ 13.644 billion for the years ended December 31, 2023, 2022 and 2021 , respectively. The estimated cost of charity care was $ 1.515 billion, $ 1.498 billion and $ 1.542 billion for the years ended December 31, 2023, 2022 and 2021 , respectively. Recent Pronouncements In November 2023, the FASB issued Accounting Standards Update 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures (“ASU 2023-07”), which requires enhanced disclosures for significant segment expenses. ASU 2023-07 is effective for public business entities for annual periods beginning on January 1, 2024 and interim periods beginning on January 1, 2025. We plan to adopt ASU 2023-07 on the respective annual and interim effective dates applying a retrospective approach to all prior periods presented in the financial statements. We do not believe the adoption of this new standard will have a material effect on our disclosures. In December 2023, the FASB issued Accounting Standards Update 2023-09, Improvements to Income Tax Disclosures (“ASU 2023-09”), which requires enhanced annual disclosures for specific categories in the rate reconciliation and income taxes paid disaggregated by federal, state and foreign taxes. ASU 2023-09 is effective for public business entities for annual periods beginning on January 1, 2025. We plan to adopt ASU 2023-09 effective January 1, 2025 applying a retrospective approach to all prior periods presented in the financial statements. We do not believe the adoption of this new standard will have a material effect on our disclosures. NOTE 1 — ACCOUNTING POLICIES (continued) Cash and Cash Equivalents Cash and cash equivalents include highly liquid investments with a maturity of three months or less when purchased. Our insurance subsidiaries’ cash equivalent investments in excess of the amounts required to pay estimated professional liability claims during the next twelve months are not included in cash and cash equivalents as these funds are not available for general corporate purposes. Carrying values of cash and cash equivalents approximate fair value due to the short-term nature of these instruments. Our cash management system provides for daily investment of available balances and the funding of outstanding checks when presented for payment. Outstanding, but unpresented, checks totaling $ 600 million and $ 656 million at December 31, 2023 and 2022 , respectively, have been included in “accounts payable” in the consolidated balance sheets. Upon presentation for payment, these checks are funded through available cash balances or our credit facility. Accounts Receivable We receive payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. We recognize that revenues and receivables from government agencies are significant to our operations, but do not believe there are significant credit risks associated with these government agencies. We do not believe there are any other significant concentrations of revenues from any particular payer that would subject us to any significant credit risks in the collection of our accounts receivable. Days revenues in accounts receivable were 53 days, 53 days and 49 days at December 31, 2023, 2022 and 2021 , respectively. Changes in general economic conditions, patient accounting service center operations, payer mix, payer claim processing, or federal or state governmental health care coverage could affect our collection of accounts receivable, cash flows and results of operations. Inventories Inventories are stated at the lower of cost (first-in, first-out) or market. Property and Equipment Depreciation expense, computed using the straight-line method, was $ 3.052 billion in 2023 , $ 2.941 billion in 2022 and $ 2.826 billion in 2021 . Buildings and improvements are depreciated over estimated useful lives ranging generally from 10 to 40 years. Estimated useful lives of equipment vary generally from four to 10 years. When events, circumstances or operating results indicate the carrying values of certain property and equipment expected to be held and used might be impaired, we prepare projections of the undiscounted future cash flows expected to result from the use of the assets and their eventual disposition. If the projections indicate the recorded amounts are not expected to be recoverable, such amounts are reduced to estimated fair value. Fair value may be estimated based upon internal evaluations that include quantitative analyses of revenues and cash flows, reviews of recent sales of similar assets and independent appraisals. Property and equipment to be disposed of are reported at the lower of their carrying amounts or fair value less costs to sell or close. The estimates of fair value are usually based upon recent sales of similar assets and market responses based upon discussions with and offers received from potential buyers. NOTE 1 — ACCOUNTING POLICIES (continued) Investments of Insurance Subsidiaries At December 31, 2023 and 2022, the investment securities held by our insurance subsidiaries were classified as “available-for-sale” as defined in Accounting Standards Codification (“ASC”) No. 320, Investments — Debt Securities and are recorded at fair value. The investment securities are held for the purpose of providing a funding source to pay liability claims covered by the insurance subsidiaries. We perform quarterly assessments of individual investment securities to determine whether declines in fair value are due to credit-related or noncredit-related factors. Our investment securities evaluation process involves subjective judgments, often involves estimating the outcome of future events, and requires a significant level of professional judgment in determining whether a credit-related impairment has occurred. We evaluate, among other things, the financial position and near term prospects of the issuer, conditions in the issuer’s industry, liquidity of the investment, changes in the amount or timing of expected future cash flows from the investment, and recent downgrades of the issuer by a rating agency, to determine if, and when, a decline in the fair value of an investment below amortized cost is considered to be a credit-related impairment. The extent to which the fair value of the investment is less than amortized cost and our ability and intent to retain the investment, to allow for any anticipated recovery of the investment’s fair value, are important components of our investment securities evaluation process. Goodwill and Intangible Assets Goodwill is not amortized but is subject to annual impairment tests. In addition to the annual impairment review, impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Impairment testing for goodwill is done at the reporting unit level. Reporting units are one level below the business segment level, and our impairment testing is performed at the operating division level. We compare the fair value of the reporting unit assets to the carrying amount, on at least an annual basis, to determine if there is potential impairment. If the fair value of the reporting unit assets is less than their carrying value, an impairment loss is recognized. Fair value is estimated based upon internal evaluations of each reporting unit that include quantitative analyses of market multiples, revenues and cash flows and reviews of recent sales of similar facilities. No goodwill impairments were recognized during 2023, 2022 or 2021. During 2023 , goodwill increased by $ 362 million related to acquisitions and declined by $ 50 million related to foreign currency translation and other adjustments. During 2022 , goodwill increased by $ 262 million related to acquisitions and declined by $ 105 million related to foreign currency translation and other adjustments. During 2023 and 2022 , identifiable intangible assets declined by $ 20 million and $ 44 million, respectively, due to amortization and other adjustments. Identifiable intangible assets with finite lives are amortized over estimated lives ranging generally from three to 10 years. The gross carrying amount of amortizable identifiable intangible assets at both December 31, 2023 and 2022 was $ 274 million and accumulated amortization was $ 228 million and $ 208 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2023 and 2022 was $ 293 million. Indefinite-lived identifiable intangible assets are not amortized but are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Debt Issuance Costs and Discounts Debt issuance costs and discounts are amortized based upon the terms of the respective debt obligations. The gross carrying amounts of debt issuance costs and discounts at December 31, 2023 and 2022 were $ 559 million and $ 496 million, respectively, and accumulated amortization was $ 226 million and $ 195 million, respectively. Amortization of debt issuance costs and discounts is included in interest expense and was $ 35 million, $ 29 million and $ 27 million for 2023, 2022 and 2021 , respectively. NOTE 1 — ACCOUNTING POLICIES (continued) Professional Liability Claims Reserves for professional liability risks were $ 2.089 billion and $ 2.043 billion at December 31, 2023 and 2022 , respectively. The current portion of the reserves, $ 532 million and $ 515 million at December 31, 2023 and 2022 , respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $ 619 million, $ 517 million and $ 453 million for 2023, 2022 and 2021 , respectively, and are included in “other operating expenses” in our consolidated income statements. Provisions for losses related to professional liability risks are based upon actuarially determined estimates. We recorded an increase to the provision for professional liability risks of $ 40 million during 2023 and reductions to the provision for professional liability risks of $ 55 million and $ 87 million for 2022 and 2021, respectively, due to the receipt of updated actuarial information. Loss and loss expense reserves represent the estimated ultimate net cost of all reported and unreported losses incurred through the respective consolidated balance sheet dates. The reserves for unpaid losses and loss expenses are estimated using individual case-basis valuations and actuarial analyses. Those estimates are subject to the effects of trends in loss severity and frequency. The estimates are continually reviewed and adjustments are recorded as experience develops or new information becomes known. Adjustments to the estimated reserve amounts are included in current operating results. The reserves for professional liability risks cover approximately 2,100 and 2,000 individual claims at December 31, 2023 and 2022, respectively, and estimates for unreported potential claims. The time period required to resolve these claims can vary depending upon the jurisdiction and whether the claim is settled or litigated. During 2023 and 2022 , $ 550 million and $ 497 million, respectively, of net payments were made for professional and general liability claims. The estimation of the timing of payments beyond a year can vary significantly. Although considerable variability is inherent in professional liability reserve estimates, we believe the reserves for losses and loss expenses are adequate; however, there can be no assurance the ultimate liability will not exceed our estimates. A portion of our professional liability risks is insured through our insurance subsidiary. Subject, in most cases, to a $ 15 million per occurrence self-insured retention, our facilities are insured by our insurance subsidiary for losses up to $ 80 million per occurrence. The insurance subsidiary has obtained reinsurance for professional liability risks generally above a retention level of either $ 25 million or $ 35 million per occurrence, depending on the jurisdiction for the related claim. We also maintain professional liability insurance with unrelated commercial carriers for losses in excess of amounts insured by our insurance subsidiary. The obligations covered by reinsurance and excess insurance contracts are included in the reserves for professional liability risks, as we remain liable to the extent the reinsurers and excess insurance carriers do not meet their obligations under the reinsurance and excess insurance contracts. The amounts receivable under the reinsurance contracts were $ 34 million and $ 48 million at December 31, 2023 and 2022 , respectively, recorded in “other assets,” and $ 8 million and $ 12 million at December 31, 2023 and 2022 , respectively, recorded in “other current assets.” Financial Instruments Derivative financial instruments have been employed to manage risks, including interest rate exposures, and have not been used for trading or speculative purposes. Changes in the fair value of derivatives are recognized periodically either in earnings or in stockholders’ equity, as a component of other comprehensive income, depending on whether the derivative financial instrument qualifies for hedge accounting, and if so, whether it qualifies as a fair value hedge or a cash flow hedge. Gains and losses on derivatives designated as cash flow hedges, to the extent they are effective, are recorded in other comprehensive income, and subsequently reclassified to earnings to offset the impact of the hedged items when they occur. The net interest paid or received on interest rate swaps is recognized as interest expense. Noncontrolling Interests in Consolidated Entities The consolidated financial statements include all assets, liabilities, revenues and expenses of less than 100% owned entities that we control. Accordingly, we have recorded noncontrolling interests in the earnings and equity of such entities. |
Share-Based Compensation
Share-Based Compensation | 12 Months Ended |
Dec. 31, 2023 | |
Share-Based Payment Arrangement [Abstract] | |
Share-Based Compensation | NOTE 2 — SHARE-BASED COMPENSATION Stock Incentive Plans Our stock incentive plans are designed to promote the long-term financial interests and growth of the Company by attracting and retaining management and other personnel, motivating them to achieve long range goals and aligning their interests with those of our stockholders. Stock appreciation right (“SAR”) and restricted share unit (“RSU”) grants vest solely based upon continued employment over a specific period of time, and performance share unit (“PSU”) grants vest based upon both continued employment over a specific period of time and the achievement of predetermined financial targets over a specific period of time. At December 31, 2023 there were 11.056 million shares available for future grants. Employee Stock Purchase Plan Our employee stock purchase plan (“ESPP”) provides our participating employees an opportunity to obtain shares of our common stock at a discount (through payroll deductions over three-month periods). At December 31, 2023 , 13.784 million shares of common stock were reserved for ESPP issuances. During 2023, 2022 and 2021 , the Company recognized $ 17 million, $ 16 million and $ 15 million, respectively, of compensation expense related to the ESPP. SAR, RSU and PSU Activity The fair value of each SAR award is estimated on the grant date, using valuation models and the weighted average assumptions indicated in the following table. Awards under our stock incentive plans generally vest based on continued employment (“Time SARs” and “RSUs”) or based upon continued employment and the achievement of certain financial targets (“Performance SARs” and “PSUs”). PSUs have a three-year cumulative earnings per share target, and the number of PSUs earned can vary from zero (for actual performance of less than 90% of target) to two times the original PSU grant (for actual performance of 110% or more of target). Each grant is valued as a single award with an expected term equal to the average expected term of the component vesting tranches. The expected term of the share-based award is limited by the contractual term. We use historical exercise behavior data and other factors to estimate the expected term of the SARs. Compensation cost is recognized on the straight-line attribution method. The straight-line attribution method requires that total compensation expense recognized must at least equal the vested portion of the grant-date fair value. The expected volatility is derived using historical stock price information for our common stock and the volatility implied by the trading of options to purchase our stock on open-market exchanges. The risk-free interest rate is the approximate yield on United States Treasury Strips having a life equal to the expected share-based award life on the date of grant. The expected life is an estimate of the number of years a share-based award will be held before it is exercised. The expected dividend yield is estimated based on the assumption that the dividend yield at date of grant will be maintained over the expected life of the grant. 2023 2022 2021 Risk-free interest rate 3.69 % 1.64 % 0.68 % Expected volatility 36 % 34 % 36 % Expected life, in years 5.14 5.11 6.17 Expected dividend yield 0.95 % 0.95 % 1.10 % NOTE 2 — SHARE-BASED COMPENSATION (continued) SAR, RSU and PSU Activity (continued) Information regarding Time SAR and Performance SAR activity during 2023, 2022 and 2021 is summarized below (share amounts in thousands): Time Performance Total Weighted Weighted Aggregate SARs outstanding, December 31, 2020 7,836 819 8,655 $ 91.53 Granted 877 — 877 174.98 Exercised ( 2,443 ) ( 533 ) ( 2,976 ) 67.57 Cancelled ( 108 ) — ( 108 ) 138.32 SARs outstanding, December 31, 2021 6,162 286 6,448 113.15 Granted 570 — 570 236.00 Exercised ( 660 ) ( 159 ) ( 819 ) 90.84 Cancelled ( 112 ) — ( 112 ) 182.87 SARs outstanding, December 31, 2022 5,960 127 6,087 126.38 Granted 580 — 580 253.49 Exercised ( 1,156 ) ( 83 ) ( 1,239 ) 95.29 Cancelled ( 59 ) — ( 59 ) 202.05 SARs outstanding, December 31, 2023 5,325 44 5,369 $ 146.46 5.5 years $ 667 SARs exercisable, December 31, 2023 3,748 44 3,792 $ 118.67 4.5 years $ 576 The weighted average fair values of SARs granted during 2023, 2022 and 2021 were $ 87.47 , $ 69.55 and $ 54.57 per share, respectively. The intrinsic values of SARs exercised during 2023, 2022 and 2021 were $ 207 million, $ 115 million and $ 404 million, respectively. As of December 31, 2023 , the unrecognized compensation cost related to nonvested SARs was $ 46 million. Information regarding RSU and PSU activity during 2023, 2022 and 2021 is summarized below (share amounts in thousands): RSUs PSUs Total RSUs Weighted RSUs and PSUs outstanding, December 31, 2020 2,476 2,592 5,068 $ 125.40 Granted 899 689 1,588 174.34 Performance adjustment — 684 684 102.02 Vested ( 992 ) ( 1,772 ) ( 2,764 ) 106.62 Cancelled ( 192 ) ( 110 ) ( 302 ) 149.07 RSUs and PSUs outstanding, December 31, 2021 2,191 2,083 4,274 150.32 Granted 611 455 1,066 235.71 Performance adjustment — 699 699 138.45 Vested ( 878 ) ( 1,399 ) ( 2,277 ) 138.41 Cancelled ( 140 ) ( 123 ) ( 263 ) 183.86 RSUs and PSUs outstanding, December 31, 2022 1,784 1,715 3,499 179.18 Granted 609 479 1,088 253.85 Performance adjustment — 697 697 144.42 Vested ( 717 ) ( 1,393 ) ( 2,110 ) 152.50 Cancelled ( 125 ) ( 88 ) ( 213 ) 217.78 RSUs and PSUs outstanding, December 31, 2023 1,551 1,410 2,961 $ 214.71 NOTE 2 — SHARE-BASED COMPENSATION (continued) SAR, RSU and PSU Activity (continued) The fair values of RSUs and PSUs that vested during 2023, 2022 and 2021 were $ 550 million, $ 550 million and $ 475 million, respectively. As of December 31, 2023 , the unrecognized compensation cost related to RSUs and PSUs was $ 274 million. |
Acquisitions and Dispositions
Acquisitions and Dispositions | 12 Months Ended |
Dec. 31, 2023 | |
Business Combinations [Abstract] | |
Acquisitions and Dispositions | NOTE 3 — ACQUISITIONS AND DISPOSITIONS During 2023 , we paid $ 229 million to acquire four hospital facilities in Texas and $ 406 million to acquire nonhospital health care entities. During 2022 , we paid $ 224 million to acquire nonhospital health care entities (noncontrolling interests of $ 72 million were recorded). During 2021 , we paid $ 67 million to acquire two hospital facilities, one in southern Georgia and one in Tennessee, $ 594 million to acquire a network of urgent care centers in Florida and $ 114 million to acquire other nonhospital health care entities (noncontrolling interests of $ 117 million were recorded). We also paid $ 330 million and assumed certain liabilities to acquire an 80 % interest (noncontrolling interests of $ 100 million were recorded) in a venture providing post-acute care services (home health and hospice). Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values. The purchase price paid in excess of the fair value of identifiable net assets of these acquired entities aggregated $ 362 million, $ 262 million and $ 1.002 billion in 2023, 2022 and 2021, respectively. The consolidated financial statements include the accounts and operations of the acquired entities subsequent to the respective acquisition dates. The pro forma effects of these acquired entities on our results of operations for periods prior to the respective acquisition dates were not significant. During 2023 , we received proceeds of $ 162 million for the sale of two hospital facilities in Louisiana. We also received proceeds of $ 31 million related to sales of real estate and other health care entity investments. We recognized a pretax loss of $ 5 million for these transactions. During 2022, we received proceeds of $ 326 million and recognized a pretax gain of $ 274 million ($ 200 million after tax ) related to sales of real estate and other health care entity investments. We also received proceeds of $ 911 million and recognized a pretax gain of $ 1.027 billion ($ 527 million after tax and amounts attributable to noncontrolling interests) related to the sale of a controlling interest in a subsidiary of our group purchasing organization. During 2021, we received proceeds of $ 1.502 billion and recognized a pretax gain of $ 1.226 billion ($ 920 million after tax ) related to the sales of five hospital facilities in Georgia, comprised of three facilities from our northern Georgia market and two facilities from our southern Georgia market. We also received proceeds of $ 658 million and recognized a pretax gain of $ 394 million ($ 294 million after tax ) related to sales of other health care entity investments and real estate. |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2023 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | NOTE 4 — INCOME TAXES The provision for income taxes consists of the following (dollars in millions): 2023 2022 2021 Current: Federal $ 1,118 $ 1,222 $ 1,769 State 213 206 311 Foreign 3 18 15 Deferred: Federal 241 261 24 State 21 27 ( 18 ) Foreign 19 12 11 $ 1,615 $ 1,746 $ 2,112 Our provision for income taxes for the years ended December 31, 2023, 2022 and 2021 included tax benefits of $ 93 million, $ 77 million and $ 119 million, respectively, related to the settlement of employee equity awards. Our foreign pretax income was $ 85 million, $ 66 million and $ 64 million for the years ended December 31, 2023, 2022 and 2021, respectively. NOTE 4 — INCOME TAXES (continued) A reconciliation of the federal statutory rate to the effective income tax rate follows: 2023 2022 2021 Federal statutory rate 21.0 % 21.0 % 21.0 % State income taxes, net of federal tax benefit 2.6 2.3 2.0 Change in liability for uncertain tax positions 0.4 0.7 0.7 Tax benefit from settlements of employee equity awards ( 1.2 ) ( 0.9 ) ( 1.2 ) Other items, net 0.8 0.5 0.8 Effective income tax rate on income attributable to HCA Healthcare, Inc. 23.6 23.6 23.3 Income attributable to noncontrolling interests from consolidated partnerships ( 2.6 ) ( 3.3 ) ( 1.8 ) Effective income tax rate on income before income taxes 21.0 % 20.3 % 21.5 % A summary of the items comprising our deferred tax assets and liabilities at December 31 follows (dollars in millions): 2023 2022 Assets Liabilities Assets Liabilities Depreciation and fixed asset basis differences $ — $ 1,048 $ — $ 938 Allowances for professional liability and other risks 452 — 430 — Accounts receivable 363 — 368 — Compensation 308 — 402 — Right-of-use lease assets and obligations 506 492 451 438 Other 592 860 536 698 $ 2,221 $ 2,400 $ 2,187 $ 2,074 At December 31, 2023 , federal and state net operating loss carryforwards (expiring in years 2024 through 2042 ) available to offset future taxable income approximated $ 28 million and $ 189 million, respectively. Utilization of net operating loss carryforwards in any one year may be limited. The following table summarizes the activity related to our gross unrecognized tax benefits, excluding accrued interest of $ 177 million and $ 129 million as of December 31, 2023 and 2022, respectively (dollars in millions): 2023 2022 Balance at January 1 $ 639 $ 576 Additions based on tax positions related to the current year 30 25 Additions for tax positions of prior years 4 50 Reductions for tax positions of prior years ( 10 ) ( 4 ) Settlements — ( 1 ) Lapse of applicable statutes of limitations ( 24 ) ( 7 ) Balance at December 31 $ 639 $ 639 Unrecognized tax benefits of $ 320 million as of December 31, 2023 ($ 278 million as of December 31, 2022) would affect the effective rate, if recognized. At December 31, 2023 , the Internal Revenue Service (“IRS”) was conducting examinations of the Company’s 2016, 2017 and 2018 federal income tax returns and the 2019 returns of certain affiliates. We are also subject to examination by the IRS for tax years after 2019 as well as by state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change. |
Earnings Per Share
Earnings Per Share | 12 Months Ended |
Dec. 31, 2023 | |
Earnings Per Share [Abstract] | |
Earnings Per Share | NOTE 5 — EARNINGS PER SHARE We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding plus the dilutive effect of outstanding SARs, RSUs and PSUs, computed using the treasury stock method. During 2023, 2022 and 2021, we repurchased 14.465 million shares, 30.747 million shares and 37.812 million shares, respectively, of our common stock. The following table sets forth the computations of basic and diluted earnings per share for the years ended December 31, 2023, 2022 and 2021 (dollars and shares in millions, except per share amounts): 2023 2022 2021 Net income attributable to HCA Healthcare, Inc. $ 5,242 $ 5,643 $ 6,956 Weighted average common shares outstanding 272.404 290.348 323.315 Effect of dilutive incremental shares 4.008 4.318 5.437 Shares used for diluted earnings per share 276.412 294.666 328.752 Earnings per share: Basic earnings per share $ 19.25 $ 19.43 $ 21.52 Diluted earnings per share $ 18.97 $ 19.15 $ 21.16 |
Investments of Insurance Subsid
Investments of Insurance Subsidiaries | 12 Months Ended |
Dec. 31, 2023 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments of Insurance Subsidiaries | NOTE 6 — INVESTMENTS OF INSURANCE SUBSIDIARIES A summary of the insurance subsidiaries’ investments at December 31 follows (dollars in millions): 2023 Unrealized Amortized Gains Losses Fair Debt securities $ 404 $ 1 $ ( 29 ) $ 376 Money market funds and other 188 — — 188 $ 592 $ 1 $ ( 29 ) 564 Amounts classified as current assets ( 87 ) Investment carrying value $ 477 2022 Unrealized Amortized Gains Losses Fair Debt securities $ 415 $ — $ ( 38 ) $ 377 Money market funds and other 96 — — 96 $ 511 $ — $ ( 38 ) 473 Amounts classified as current assets ( 92 ) Investment carrying value $ 381 At December 31, 2023 and 2022, the investments in debt securities of our insurance subsidiaries were classified as “available-for-sale.” Changes in unrealized gains and losses that are not credit-related are recorded as adjustments to other comprehensive income (loss). NOTE 6 — INVESTMENTS OF INSURANCE SUBSIDIARIES (continued) Scheduled maturities of investments in debt securities at December 31, 2023 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 12 $ 12 Due after one year through five years 150 144 Due after five years through ten years 165 148 Due after ten years 77 72 $ 404 $ 376 The average expected maturity of the investments in debt securities at December 31, 2023 was 5.1 years, compared to the average scheduled maturity of 8.8 years. Expected and scheduled maturities may differ because the issuers of certain securities have the right to call, prepay or otherwise redeem such obligations prior to their scheduled maturity date. |
Assets and Liabilities Measured
Assets and Liabilities Measured at Fair Value | 12 Months Ended |
Dec. 31, 2023 | |
Fair Value Disclosures [Abstract] | |
Assets and Liabilities Measured at Fair Value | NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”) emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy). Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment. The investments of our insurance subsidiaries are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. The following tables summarize the investments of our insurance subsidiaries measured at fair value on a recurring basis as of December 31, 2023 and 2022, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): 2023 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Debt securities $ 376 $ — $ 376 $ — Money market funds and other 188 188 — — Investments of insurance subsidiaries 564 188 376 — Less amounts classified as current assets ( 87 ) ( 87 ) — — $ 477 $ 101 $ 376 $ — NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued) 2022 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Debt securities $ 377 $ — $ 377 $ — Money market funds and other 96 96 — — Investments of insurance subsidiaries 473 96 377 — Less amounts classified as current assets ( 92 ) ( 92 ) — — $ 381 $ 4 $ 377 $ — The estimated fair value of our long-term debt was $ 38.253 billion and $ 35.555 billion at December 31, 2023 and 2022 , respectively, compared to carrying amounts, gross of debt issuance costs and discounts, aggregating $ 39.926 billion and $ 38.385 billion, respectively. The estimates of fair value are generally based on Level 2 inputs, including quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities. |
Long-Term Debt
Long-Term Debt | 12 Months Ended |
Dec. 31, 2023 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | NOTE 8 — LONG-TERM DEBT A summary of long-term debt at December 31, including related interest rates at December 31, 2023, follows (dollars in millions): 2023 2022 Senior secured asset-based revolving credit facility (effective interest rate of 6.7 %) $ 1,880 $ 2,900 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 6.8 %) 1,313 1,880 Other senior secured debt (effective interest rate of 4.1 %) 967 953 Senior secured debt 4,160 5,733 Senior unsecured notes (effective interest rate of 5.0 %) 35,766 32,652 Debt issuance costs and discounts ( 333 ) ( 301 ) Total debt (average life of 9.4 years, rates averaging 5.1 %) 39,593 38,084 Less amounts due within one year 2,424 370 $ 37,169 $ 37,714 During 2023, the availability under our senior secured revolving credit facility was increased by $ 1.500 billion to total $ 3.500 billion, the senior secured term loan B facility was fully retired and certain administrative updates were made to our credit agreements. We also issued $ 3.250 billion aggregate principal amount of senior notes comprised of (i) $ 1.000 billion aggregate principal amount of 5.200 % senior notes due 2028, (ii) $ 1.250 billion aggregate principal amount of 5.500 % senior notes due 2033 and (iii) $ 1.000 billion aggregate principal amount of 5.900 % senior notes due 2053 . We used the net proceeds to repay borrowings under our asset-based revolving credit facility. Senior Secured Credit Facilities And Other Senior Secured Debt We have entered into the following senior secured credit facilities: (i) a $ 4.500 billion asset-based revolving credit facility maturing on June 30, 2026 with a borrowing base of 85 % of eligible accounts receivable, subject to customary reserves and eligibility criteria ($ 1.880 billion outstanding at December 31, 2023 ) (the “ABL credit facility”); (ii) a $ 3.500 billion senior secured revolving credit facility maturing on June 30, 2026 ( no ne outstanding at December 31, 2023 without giving effect to certain outstanding letters of credit); and (iii) a $ 1.313 billion senior secured term loan facility maturing on June 30, 2026 . We refer to the facilities described under (ii) and (iii) above, collectively, as the “cash flow credit facility” and, together with the ABL credit facility, the “senior secured credit facilities.” Finance leases and other secured debt totaled $ 967 million at December 31, 2023. NOTE 8 — LONG-TERM DEBT (continued) Borrowings under the senior secured credit facilities bear interest at a rate equal to, at our option, either (a) a base rate determined by reference to the higher of (1) the federal funds rate plus 0.50 % or (2) the prime rate of Bank of America or (b) a reference rate (the Secured Overnight Financing Rate (SOFR)) for the relevant interest period, plus, in each case, an applicable margin. The applicable margin for borrowings under the senior secured credit facilities may be reduced subject to attaining certain leverage ratios. The senior secured credit facilities contain a number of covenants that restrict, subject to certain exceptions, our (and some or all of our subsidiaries’) ability to incur additional indebtedness, repay subordinated indebtedness, create liens on assets, sell assets, make investments, loans or advances, engage in certain transactions with affiliates, pay dividends and distributions, and enter into sale and leaseback transactions. In addition, we are required to satisfy and maintain a maximum total leverage ratio covenant under the cash flow credit facility and, in certain situations under the ABL credit facility, a minimum interest coverage ratio covenant. Senior Unsecured Notes Senior unsecured notes consist of (i) $ 35.041 billion aggregate principal amount of senior notes with maturities ranging from 2024 to 2053 ; (ii) an aggregate principal amount of $ 125 million medium-term notes maturing 2025; and (iii) an aggregate principal amount of $ 600 million debentures with maturities ranging from 2024 to 2095 . General Debt Information The senior secured credit facilities are fully and unconditionally guaranteed by substantially all existing and future, direct and indirect, 100% owned material domestic subsidiaries that are “Unrestricted Subsidiaries” under our Indenture (the “1993 Indenture”) dated December 16, 1993 (except for certain special purpose subsidiaries that only guarantee and pledge their assets under our ABL credit facility). All obligations under the ABL credit facility, and the guarantees of those obligations, are secured, subject to permitted liens and other exceptions, by a first-priority lien on substantially all of the receivables of the borrowers and each guarantor under such ABL credit facility (the “Receivables Collateral”). All obligations under the cash flow credit facility and the guarantees of such obligations are secured, subject to permitted liens and other exceptions, by: • a first-priority lien on the capital stock owned by HCA Inc., or by any guarantor, in each of their respective first-tier subsidiaries; • a first-priority lien on substantially all present and future assets of HCA Inc. and of each guarantor other than (i) “Principal Properties” (as defined in the 1993 Indenture), (ii) certain other real properties and (iii) deposit accounts, other bank or securities accounts, cash, leaseholds, motor-vehicles and certain other exceptions; and • a second-priority lien on certain of the Receivables Collateral. Maturities of long-term debt in years 2025 through 2028 are $ 4.672 billion, $ 5.350 billion, $ 2.408 billion and $ 2.545 billion, respectively. |
Leases
Leases | 12 Months Ended |
Dec. 31, 2023 | |
Leases [Abstract] | |
Leases | NOTE 9 — LEASES We lease property and equipment under finance and operating leases. For leases with terms greater than 12 months, we record the related assets and obligations at the present value of lease payments over the term. Many of our leases include rental escalation clauses and renewal options that are factored into our determination of lease payments, when appropriate. We do not separate lease and nonlease components of contracts. Generally, we use our estimated incremental borrowing rate to discount the lease payments, as most of our leases do not provide a readily determinable implicit interest rate. NOTE 9 — LEASES (continued) The following table presents our lease-related assets and liabilities at December 31, 2023 and 2022 (dollars in millions): Balance Sheet Classification 2023 2022 Assets: Operating leases Right-of-use operating lease assets $ 2,207 $ 2,065 Finance leases Property and equipment 556 587 Total lease assets $ 2,763 $ 2,652 Liabilities: Current: Operating leases Other accrued expenses $ 363 $ 364 Finance leases Long-term debt due within one year 166 131 Noncurrent: Operating leases Right-of-use operating lease obligations 1,903 1,752 Finance leases Long-term debt 541 579 Total lease liabilities $ 2,973 $ 2,826 Weighted-average remaining term: Operating leases 11.8 years 10.1 years Finance leases 9.0 years 9.5 years Weighted-average discount rate: Operating leases 4.9 % 4.4 % Finance leases 4.9 % 4.5 % The following table presents certain information related to expenses for finance and operating leases for the years ended December 31, 2023, 2022 and 2021 (dollars in millions): 2023 2022 2021 Finance lease expense: Depreciation and amortization $ 164 $ 163 $ 135 Interest 31 29 29 Operating leases(1) 495 484 478 Short-term lease expense(1) 337 329 354 Variable lease expense(1) 162 163 157 $ 1,189 $ 1,168 $ 1,153 (1) Expenses are included in “other operating expenses” in our consolidated income statements. The following table presents supplemental cash flow information for the years ended December 31, 2023, 2022 and 2021 (dollars in millions): 2023 2022 2021 Cash paid for amounts included in the measurement of lease Operating cash flows for operating leases $ 479 $ 473 $ 474 Operating cash flows for finance leases 31 29 29 Financing cash flows for finance leases 140 124 123 NOTE 9 — LEASES (continued) Maturities of Lease Liabilities The following table reconciles the undiscounted minimum lease payment amounts to the operating and finance lease liabilities recorded on the balance sheet at December 31, 2023 and 2022 (dollars in millions): 2023 2022 Operating Finance Operating Finance Year 1 $ 452 $ 193 $ 436 $ 156 Year 2 394 155 380 164 Year 3 340 115 320 125 Year 4 288 60 269 89 Year 5 228 45 222 39 Thereafter 1,540 356 1,122 359 Total minimum lease payments 3,242 924 2,749 932 Less: amount of lease payments representing interest ( 976 ) ( 217 ) ( 633 ) ( 222 ) Present value of future minimum lease payments 2,266 707 2,116 710 Less: current lease obligations ( 363 ) ( 166 ) ( 364 ) ( 131 ) Long-term lease obligations $ 1,903 $ 541 $ 1,752 $ 579 |
Contingencies
Contingencies | 12 Months Ended |
Dec. 31, 2023 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | NOTE 10 — CONTINGENCIES We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us, which may not be covered by insurance. We are also subject to claims by various taxing authorities for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations, financial position or liquidity. Government Investigations, Claims and Litigation Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam , or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our results of operations, financial position or liquidity. Texas operates a state Medicaid program pursuant to a waiver from the Centers for Medicare & Medicaid Services under Section 1115 of the Social Security Act (“Program”). The Program includes uncompensated-care pools; payments from these pools are intended to defray the uncompensated costs of services provided by our and other hospitals to Medicaid eligible or uninsured individuals. Separately, we and other hospitals provide charity care services in several communities in the state. In 2018, the Civil Division of the U.S. Department of Justice and the U.S. Attorney’s Office for the Southern District of Texas requested information about whether the Program, as operated in Harris County, complied with the laws and regulations applicable to provider related donations, and the Company cooperated with that request. On May 21, 2019, a qui tam lawsuit asserting violations of the FCA and the Texas Medicaid Fraud Prevention Act related to the Program, as operated in Harris County, was unsealed by the U.S. District Court for the Southern District of Texas. Both the federal and state governments declined to intervene in the qui tam lawsuit. The Company believes that our participation is and has been consistent with the requirements of the Program and is vigorously defending against the lawsuit being pursued by the relator. We cannot predict what effect, if any, the qui tam lawsuit could have on the Company. |
Capital Stock
Capital Stock | 12 Months Ended |
Dec. 31, 2023 | |
Federal Home Loan Banks [Abstract] | |
Capital Stock | NOTE 11 — CAPITAL STOCK The amended and restated certificate of incorporation authorizes the Company to issue up to 1,800,000,000 shares of common stock, and our amended and restated by-laws set the number of directors constituting the board of directors of the Company at not less than three members, the exact number to be determined from time to time by resolution adopted by the affirmative vote of a majority of the total number of directors then in office. Share Repurchase Transactions During January 2024, January 2023, January 2022, February 2021, January 2020 and January 2019, our Board of Directors authorized share repurchase programs for up to $ 6 billion, $ 3 billion, $ 8 billion, $ 6 billion, $ 2 billion and $ 2 billion, respectively, of the Company’s outstanding common stock. During 2023, we repurchased 14.465 million shares of our common stock at an average price of $ 263.47 per share through market purchases pursuant to the January 2022 authorization (which was completed during 2023) and the January 2023 authorization. At December 31, 2023 , we had $ 775 million of repurchase authorization available under the January 2023 authorization. During 2022, we repurchased 30.747 million shares of our common stock at an average price of $ 227.67 per share through market purchases pursuant to the February 2021 authorization (which was completed during 2022) and the January 2022 authorization. During 2021, we repurchased 37.812 million shares of our common stock at an average price of $ 217.25 per share through market purchases pursuant to the January 2019 and January 2020 authorizations (which were completed during 2021) and the February 2021 authorization. |
Employee Benefit Plans
Employee Benefit Plans | 12 Months Ended |
Dec. 31, 2023 | |
Retirement Benefits [Abstract] | |
Employee Benefit Plans | NOTE 12 — EMPLOYEE BENEFIT PLANS We maintain defined contribution benefit plans that are available to employees who meet certain minimum requirements. The plans require that we match participant contributions up to certain maximum levels (generally, 100 % of the first 3 % to 9 %, depending upon years of vesting service, of compensation deferred by participants). Benefits expense under these plans totaled $ 659 million for 2023 , $ 606 million for 2022 and $ 560 million for 2021. Our matching contributions are funded during the year following the participant contributions. We maintain the noncontributory, nonqualified Restoration Plan to provide retirement benefits for eligible employees. Eligibility for the Restoration Plan is based upon earning eligible compensation in excess of a base amount and attaining 1,000 or more hours of service during the plan year. Company credits to participants’ hypothetical account balances (the Restoration Plan is not funded) depend upon participants’ compensation, years of vesting service, hypothetical investment returns (gains or losses) and certain IRS limitations. Amounts recognized under this plan was $ 40 million expense for 2023 , a $ 27 million credit for 2022 and $ 38 million expense for 2021 . Accrued benefits liabilities under this plan totaled $ 227 million at December 31, 2023 and $ 210 million at December 31, 2022. We maintain a Supplemental Executive Retirement Plan (“SERP”) for certain executives (the SERP is not funded). The plan is designed to ensure that upon retirement the participant receives the value of a prescribed life annuity from the combination of the SERP and our other benefit plans. Benefits expense under the plan was $ 10 million for 2023 , $ 22 million for 2022 and $ 22 million for 2021 . Accrued benefits liabilities under this plan totaled $ 106 million at December 31, 2023 and $ 137 million at December 31, 2022. We maintain defined benefit pension plans which resulted from certain hospital acquisitions in prior years. Amounts recognized under these plans was $ 2 million expense for 2023 , $ 11 million credit for 2022 , and $ 4 million expense for 2021 . Accrued benefits under these plans totaled $ 43 million of assets at December 31, 2023 and $ 9 million of assets at December 31, 2022 . |
Segment and Geographic Informat
Segment and Geographic Information | 12 Months Ended |
Dec. 31, 2023 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION We operate in one line of business, which is operating hospitals and related health care entities. Effective January 1, 2023, we reorganized our operations into three geographically organized groups: the National, American and Atlantic Groups with retrospective presentation for all periods presented. At December 31, 2023, the National Group included 57 hospitals located in Alaska, California, Idaho, Indiana, Kentucky, Nevada, New Hampshire, North Carolina, Tennessee, Utah and Virginia, the American Group included 60 hospitals located in Colorado, Central Kansas, Louisiana and Texas, and the Atlantic Group included 62 hospitals located in Florida, Georgia, Northern Kansas, Missouri and South Carolina. The seven hospitals we operate in England are included in the Corporate and other group. Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses and gains on sales of facilities, losses on retirement of debt, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions) and represent the operating segments under the January 1, 2023 reorganized segment structure: For the Year Ended December 31, 2023 2022 2021 Revenues: National Group $ 18,105 $ 16,767 $ 16,329 Atlantic Group 21,167 19,324 19,098 American Group 22,318 20,858 19,636 Corporate and other 3,378 3,284 3,689 $ 64,968 $ 60,233 $ 58,752 Equity in losses (earnings) of affiliates: National Group $ ( 2 ) $ ( 1 ) $ ( 33 ) Atlantic Group ( 3 ) ( 3 ) ( 2 ) American Group ( 59 ) ( 43 ) ( 50 ) Corporate and other 42 2 ( 28 ) $ ( 22 ) $ ( 45 ) $ ( 113 ) Adjusted segment EBITDA: National Group $ 4,000 $ 3,616 $ 4,202 Atlantic Group 4,492 3,881 4,218 American Group 5,208 5,102 4,836 Corporate and other ( 974 ) ( 532 ) ( 612 ) $ 12,726 $ 12,067 $ 12,644 Depreciation and amortization: National Group $ 834 $ 801 $ 754 Atlantic Group 989 921 848 American Group 971 937 897 Corporate and other 283 310 354 $ 3,077 $ 2,969 $ 2,853 NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued) For the Year Ended December 31, 2023 2022 2021 Adjusted segment EBITDA $ 12,726 $ 12,067 $ 12,644 Depreciation and amortization 3,077 2,969 2,853 Interest expense 1,938 1,741 1,566 Losses (gains) on sales of facilities 5 ( 1,301 ) ( 1,620 ) Losses on retirement of debt — 78 12 Income before income taxes $ 7,706 $ 8,580 $ 9,833 December 31, 2023 2022 2021 Assets: National Group $ 12,487 $ 11,793 $ 11,236 Atlantic Group 16,098 15,092 13,944 American Group 19,786 17,934 17,224 Corporate and other 7,840 7,619 8,338 $ 56,211 $ 52,438 $ 50,742 National Atlantic American Corporate Total Goodwill and other intangible assets: Balance at December 31, 2020 $ 1,089 $ 1,375 $ 4,996 $ 1,118 $ 8,578 Acquisitions 126 610 66 260 1,062 Foreign currency translation, amortization and other ( 3 ) ( 15 ) — ( 82 ) ( 100 ) Balance at December 31, 2021 1,212 1,970 5,062 1,296 9,540 Acquisitions 75 90 90 7 262 Foreign currency translation, amortization and other ( 43 ) ( 3 ) — ( 103 ) ( 149 ) Balance at December 31, 2022 1,244 2,057 5,152 1,200 9,653 Acquisitions — 8 326 28 362 Foreign currency translation, amortization and other ( 3 ) ( 1 ) — ( 66 ) ( 70 ) Balance at December 31, 2023 $ 1,241 $ 2,064 $ 5,478 $ 1,162 $ 9,945 |
Other Comprehensive Loss
Other Comprehensive Loss | 12 Months Ended |
Dec. 31, 2023 | |
Equity [Abstract] | |
Other Comprehensive Loss | NOTE 14 — OTHER COMPREHENSIVE LOSS The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized Foreign Defined Change Total Balances at December 31, 2020 $ 25 $ ( 271 ) $ ( 220 ) $ ( 36 ) $ ( 502 ) Unrealized losses on available-for-sale securities, net 3 income tax benefit ( 13 ) ( 13 ) Foreign currency translation adjustments, net of $ 2 ( 7 ) ( 7 ) Defined benefit plans, net of $ 20 of income taxes 67 67 Change in fair value of derivative instruments 1 1 Expense reclassified into operations from other 7 and $ 8 income 21 29 50 Balances at December 31, 2021 12 ( 278 ) ( 132 ) ( 6 ) ( 404 ) Unrealized losses on available-for-sale securities, net 12 income tax benefit ( 43 ) ( 43 ) Foreign currency translation adjustments, net of $ 16 ( 95 ) ( 95 ) Defined benefit plans, net of $ 11 of income taxes 38 38 Change in fair value of derivative instruments, net of $ 1 5 5 Expense reclassified into operations from other 2 and $ 1 1 7 1 9 Balances at December 31, 2022 ( 30 ) ( 373 ) ( 87 ) — ( 490 ) Unrealized gains on available-for-sale securities, net 2 of income taxes 9 9 Foreign currency translation adjustments, net of $ 7 34 34 Defined benefit plans, net of $ 6 of income taxes 21 21 Expense (benefit) reclassified into operations from other no ne of income taxes 1 income tax benefit, respectively ( 1 ) 2 1 Balances at December 31, 2023 $ ( 22 ) $ ( 339 ) $ ( 64 ) $ — $ ( 425 ) |
Accrued Expenses
Accrued Expenses | 12 Months Ended |
Dec. 31, 2023 | |
Text Block [Abstract] | |
Accrued Expenses | NOTE 15 — ACCRUED EXPENSES A summary of other accrued expenses at December 31 follows (dollars in millions): 2023 2022 Professional liability risks $ 532 $ 515 Defined contribution benefit plans 668 612 Right-of-use operating leases 363 364 Taxes other than income 382 371 Interest 414 402 Employee medical benefits 199 182 Other 1,313 1,135 $ 3,871 $ 3,581 |
Accounting Policies (Policies)
Accounting Policies (Policies) | 12 Months Ended |
Dec. 31, 2023 | |
Basis of Presentation | Basis of Presentation The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates. The consolidated financial statements include all subsidiaries and entities controlled by HCA. We generally define “control” as ownership of a majority of the voting interest of an entity. The consolidated financial statements include entities in which we absorb a majority of the entity’s expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of ownership, contractual or other financial interests in the entity. The accounts of acquired entities are included in our consolidated financial statements for periods subsequent to our acquisition of controlling interests. Significant intercompany transactions have been eliminated. Investments in entities we do not control, but in which we have a substantial ownership interest and can exercise significant influence, are accounted for using the equity method. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative include our corporate office costs, which were $ 315 million, $ 307 million and $ 337 million for the years ended December 31, 2023, 2022 and 2021 , respectively. |
Revenues | Revenues Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges . Our performance obligations for outpatient services are generally satisfied over a period of less than one day . The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals. NOTE 1 — ACCOUNTING POLICIES (continued) Revenues (continued) Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured and other discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Our revenues by primary third-party payer classification and other (including uninsured patients) for the years ended December 31, are summarized in the following table (dollars in millions): Years Ended December 31, 2023 Ratio 2022 Ratio 2021 Ratio Medicare $ 10,585 16.3 % $ 10,447 17.3 % $ 10,447 17.8 % Managed Medicare 10,496 16.2 9,201 15.3 8,424 14.3 Medicaid 3,606 5.6 2,636 4.4 2,290 3.9 Managed Medicaid 3,879 6.0 3,998 6.6 3,124 5.3 Managed care and other insurers 31,819 49.0 29,120 48.3 30,295 51.6 International (managed care and other insurers) 1,509 2.3 1,317 2.2 1,336 2.3 Other 3,074 4.6 3,514 5.9 2,836 4.8 Revenues $ 64,968 100.0 % $ 60,233 100.0 % $ 58,752 100.0 % Laws and regulations governing the Medicare and Medicaid programs are complex and subject to interpretation. Estimated reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report” filing and settlement process). The adjustments to estimated Medicare and Medicaid reimbursement and disproportionate-share amounts, related primarily to cost reports filed during the respective year, resulted in net increases to revenues of $ 84 million, $ 56 million and $ 53 million in 2023, 2022 and 2021 , respectively. The adjustments to estimated reimbursement amounts related primarily to cost reports filed during previous years resulted in net increases to revenues of $ 58 million in 2023 , $ 42 million in 2022 and $ 19 million in 2021. The Emergency Medical Treatment and Labor Act (“EMTALA”) requires any hospital participating in the Medicare program to conduct an appropriate medical screening examination of every person who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition. The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. Federal and state laws and regulations require, and our commitment to providing quality patient care encourages, us to provide services to patients who are financially unable to pay for the health care services they receive. Patients treated at hospitals for non-elective care, who have income at or below 400 % of the federal poverty level, are eligible for charity care, and we limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. Patients treated at hospitals for non-elective care, who have income above 400 % of the federal poverty level, are eligible for certain other discounts which limit the patient responsibility amounts for these patients to a percentage of their annual household income, computed on a sliding scale based upon their annual income and the applicable percentage of the federal poverty level. We apply additional discounts to limit patient responsibility for certain emergency services. The federal poverty level is established by the federal government and is based on income and family size. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. We provide discounts to uninsured patients who do not qualify for Medicaid or charity care. We may attempt to provide assistance to uninsured patients to help determine whether they may qualify for Medicaid, other federal or state assistance, or charity care. If an uninsured patient does not qualify for these programs, the uninsured discount is applied. NOTE 1 — ACCOUNTING POLICIES (continued) Revenues (continued) The collection of outstanding receivables from Medicare, Medicaid, managed care payers, other third-party payers and patients is our primary source of cash and is critical to our operating performance. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance carrier has paid the amounts covered by the applicable agreement, but patient responsibility amounts (deductibles and copayments) remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients. Estimated implicit price concessions are recorded for all uninsured accounts, regardless of the age of those accounts. Accounts are written off when all reasonable collection efforts have been performed. The estimates for implicit price concessions are based upon management’s assessment of historical writeoffs and expected net collections, business and economic conditions, trends in federal, state and private employer health care coverage and other collection indicators. Management relies on the results of detailed reviews of historical writeoffs and collections at facilities that represent a majority of our revenues and accounts receivable (the “hindsight analysis”) as a primary source of information in estimating the collectability of our accounts receivable. We perform the hindsight analysis quarterly, utilizing rolling twelve-months accounts receivable collection and writeoff data. We believe our quarterly updates to the estimated implicit price concession amounts at each of our hospital facilities provide reasonable estimates of our revenues and valuations of our accounts receivable. These routine, quarterly changes in estimates have not resulted in material adjustments to the valuations of our accounts receivable or period-to-period comparisons of our revenues. At December 31, 2023 and 2022 , estimated implicit price concessions of $ 7.283 billion and $ 6.780 billion, respectively, had been recorded to adjust our revenues and accounts receivable to the estimated amounts we expect to collect. To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions): 2023 2022 2021 Patient care costs (salaries and benefits, supplies, other operating $ 55,341 $ 51,180 $ 49,074 Cost-to-charges ratio (patient care costs as percentage of gross 10.5 % 11.0 % 11.3 % Total uncompensated care $ 35,426 $ 31,734 $ 29,642 Multiply by the cost-to-charges ratio 10.5 % 11.0 % 11.3 % Estimated cost of total uncompensated care $ 3,720 $ 3,491 $ 3,350 The total uncompensated care amounts include charity care of $ 14.425 billion, $ 13.615 billion and $ 13.644 billion for the years ended December 31, 2023, 2022 and 2021 , respectively. The estimated cost of charity care was $ 1.515 billion, $ 1.498 billion and $ 1.542 billion for the years ended December 31, 2023, 2022 and 2021 , respectively. |
Recent Pronouncements | Recent Pronouncements In November 2023, the FASB issued Accounting Standards Update 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures (“ASU 2023-07”), which requires enhanced disclosures for significant segment expenses. ASU 2023-07 is effective for public business entities for annual periods beginning on January 1, 2024 and interim periods beginning on January 1, 2025. We plan to adopt ASU 2023-07 on the respective annual and interim effective dates applying a retrospective approach to all prior periods presented in the financial statements. We do not believe the adoption of this new standard will have a material effect on our disclosures. In December 2023, the FASB issued Accounting Standards Update 2023-09, Improvements to Income Tax Disclosures (“ASU 2023-09”), which requires enhanced annual disclosures for specific categories in the rate reconciliation and income taxes paid disaggregated by federal, state and foreign taxes. ASU 2023-09 is effective for public business entities for annual periods beginning on January 1, 2025. We plan to adopt ASU 2023-09 effective January 1, 2025 applying a retrospective approach to all prior periods presented in the financial statements. We do not believe the adoption of this new standard will have a material effect on our disclosures. |
Cash and Cash Equivalents | Cash and Cash Equivalents Cash and cash equivalents include highly liquid investments with a maturity of three months or less when purchased. Our insurance subsidiaries’ cash equivalent investments in excess of the amounts required to pay estimated professional liability claims during the next twelve months are not included in cash and cash equivalents as these funds are not available for general corporate purposes. Carrying values of cash and cash equivalents approximate fair value due to the short-term nature of these instruments. Our cash management system provides for daily investment of available balances and the funding of outstanding checks when presented for payment. Outstanding, but unpresented, checks totaling $ 600 million and $ 656 million at December 31, 2023 and 2022 , respectively, have been included in “accounts payable” in the consolidated balance sheets. Upon presentation for payment, these checks are funded through available cash balances or our credit facility. |
Accounts Receivable | Accounts Receivable We receive payments for services rendered from federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, employers and patients. We recognize that revenues and receivables from government agencies are significant to our operations, but do not believe there are significant credit risks associated with these government agencies. We do not believe there are any other significant concentrations of revenues from any particular payer that would subject us to any significant credit risks in the collection of our accounts receivable. Days revenues in accounts receivable were 53 days, 53 days and 49 days at December 31, 2023, 2022 and 2021 , respectively. Changes in general economic conditions, patient accounting service center operations, payer mix, payer claim processing, or federal or state governmental health care coverage could affect our collection of accounts receivable, cash flows and results of operations. |
Inventories | Inventories Inventories are stated at the lower of cost (first-in, first-out) or market. |
Property and Equipment | Property and Equipment Depreciation expense, computed using the straight-line method, was $ 3.052 billion in 2023 , $ 2.941 billion in 2022 and $ 2.826 billion in 2021 . Buildings and improvements are depreciated over estimated useful lives ranging generally from 10 to 40 years. Estimated useful lives of equipment vary generally from four to 10 years. When events, circumstances or operating results indicate the carrying values of certain property and equipment expected to be held and used might be impaired, we prepare projections of the undiscounted future cash flows expected to result from the use of the assets and their eventual disposition. If the projections indicate the recorded amounts are not expected to be recoverable, such amounts are reduced to estimated fair value. Fair value may be estimated based upon internal evaluations that include quantitative analyses of revenues and cash flows, reviews of recent sales of similar assets and independent appraisals. Property and equipment to be disposed of are reported at the lower of their carrying amounts or fair value less costs to sell or close. The estimates of fair value are usually based upon recent sales of similar assets and market responses based upon discussions with and offers received from potential buyers. |
Investments of Insurance Subsidiaries | Investments of Insurance Subsidiaries At December 31, 2023 and 2022, the investment securities held by our insurance subsidiaries were classified as “available-for-sale” as defined in Accounting Standards Codification (“ASC”) No. 320, Investments — Debt Securities and are recorded at fair value. The investment securities are held for the purpose of providing a funding source to pay liability claims covered by the insurance subsidiaries. We perform quarterly assessments of individual investment securities to determine whether declines in fair value are due to credit-related or noncredit-related factors. Our investment securities evaluation process involves subjective judgments, often involves estimating the outcome of future events, and requires a significant level of professional judgment in determining whether a credit-related impairment has occurred. We evaluate, among other things, the financial position and near term prospects of the issuer, conditions in the issuer’s industry, liquidity of the investment, changes in the amount or timing of expected future cash flows from the investment, and recent downgrades of the issuer by a rating agency, to determine if, and when, a decline in the fair value of an investment below amortized cost is considered to be a credit-related impairment. The extent to which the fair value of the investment is less than amortized cost and our ability and intent to retain the investment, to allow for any anticipated recovery of the investment’s fair value, are important components of our investment securities evaluation process. |
Goodwill and Intangible Assets | Goodwill and Intangible Assets Goodwill is not amortized but is subject to annual impairment tests. In addition to the annual impairment review, impairment reviews are performed whenever circumstances indicate a possible impairment may exist. Impairment testing for goodwill is done at the reporting unit level. Reporting units are one level below the business segment level, and our impairment testing is performed at the operating division level. We compare the fair value of the reporting unit assets to the carrying amount, on at least an annual basis, to determine if there is potential impairment. If the fair value of the reporting unit assets is less than their carrying value, an impairment loss is recognized. Fair value is estimated based upon internal evaluations of each reporting unit that include quantitative analyses of market multiples, revenues and cash flows and reviews of recent sales of similar facilities. No goodwill impairments were recognized during 2023, 2022 or 2021. During 2023 , goodwill increased by $ 362 million related to acquisitions and declined by $ 50 million related to foreign currency translation and other adjustments. During 2022 , goodwill increased by $ 262 million related to acquisitions and declined by $ 105 million related to foreign currency translation and other adjustments. During 2023 and 2022 , identifiable intangible assets declined by $ 20 million and $ 44 million, respectively, due to amortization and other adjustments. Identifiable intangible assets with finite lives are amortized over estimated lives ranging generally from three to 10 years. The gross carrying amount of amortizable identifiable intangible assets at both December 31, 2023 and 2022 was $ 274 million and accumulated amortization was $ 228 million and $ 208 million, respectively. The gross carrying amount of indefinite-lived identifiable intangible assets at both December 31, 2023 and 2022 was $ 293 million. Indefinite-lived identifiable intangible assets are not amortized but are subject to annual impairment tests, and impairment reviews are performed whenever circumstances indicate a possible impairment may exist. |
Debt Issuance Costs and Discounts | Debt Issuance Costs and Discounts Debt issuance costs and discounts are amortized based upon the terms of the respective debt obligations. The gross carrying amounts of debt issuance costs and discounts at December 31, 2023 and 2022 were $ 559 million and $ 496 million, respectively, and accumulated amortization was $ 226 million and $ 195 million, respectively. Amortization of debt issuance costs and discounts is included in interest expense and was $ 35 million, $ 29 million and $ 27 million for 2023, 2022 and 2021 , respectively. |
Professional Liability Claims | Professional Liability Claims Reserves for professional liability risks were $ 2.089 billion and $ 2.043 billion at December 31, 2023 and 2022 , respectively. The current portion of the reserves, $ 532 million and $ 515 million at December 31, 2023 and 2022 , respectively, is included in “other accrued expenses” in the consolidated balance sheets. Provisions for losses related to professional liability risks were $ 619 million, $ 517 million and $ 453 million for 2023, 2022 and 2021 , respectively, and are included in “other operating expenses” in our consolidated income statements. Provisions for losses related to professional liability risks are based upon actuarially determined estimates. We recorded an increase to the provision for professional liability risks of $ 40 million during 2023 and reductions to the provision for professional liability risks of $ 55 million and $ 87 million for 2022 and 2021, respectively, due to the receipt of updated actuarial information. Loss and loss expense reserves represent the estimated ultimate net cost of all reported and unreported losses incurred through the respective consolidated balance sheet dates. The reserves for unpaid losses and loss expenses are estimated using individual case-basis valuations and actuarial analyses. Those estimates are subject to the effects of trends in loss severity and frequency. The estimates are continually reviewed and adjustments are recorded as experience develops or new information becomes known. Adjustments to the estimated reserve amounts are included in current operating results. The reserves for professional liability risks cover approximately 2,100 and 2,000 individual claims at December 31, 2023 and 2022, respectively, and estimates for unreported potential claims. The time period required to resolve these claims can vary depending upon the jurisdiction and whether the claim is settled or litigated. During 2023 and 2022 , $ 550 million and $ 497 million, respectively, of net payments were made for professional and general liability claims. The estimation of the timing of payments beyond a year can vary significantly. Although considerable variability is inherent in professional liability reserve estimates, we believe the reserves for losses and loss expenses are adequate; however, there can be no assurance the ultimate liability will not exceed our estimates. A portion of our professional liability risks is insured through our insurance subsidiary. Subject, in most cases, to a $ 15 million per occurrence self-insured retention, our facilities are insured by our insurance subsidiary for losses up to $ 80 million per occurrence. The insurance subsidiary has obtained reinsurance for professional liability risks generally above a retention level of either $ 25 million or $ 35 million per occurrence, depending on the jurisdiction for the related claim. We also maintain professional liability insurance with unrelated commercial carriers for losses in excess of amounts insured by our insurance subsidiary. The obligations covered by reinsurance and excess insurance contracts are included in the reserves for professional liability risks, as we remain liable to the extent the reinsurers and excess insurance carriers do not meet their obligations under the reinsurance and excess insurance contracts. The amounts receivable under the reinsurance contracts were $ 34 million and $ 48 million at December 31, 2023 and 2022 , respectively, recorded in “other assets,” and $ 8 million and $ 12 million at December 31, 2023 and 2022 , respectively, recorded in “other current assets.” |
Financial Instruments | Financial Instruments Derivative financial instruments have been employed to manage risks, including interest rate exposures, and have not been used for trading or speculative purposes. Changes in the fair value of derivatives are recognized periodically either in earnings or in stockholders’ equity, as a component of other comprehensive income, depending on whether the derivative financial instrument qualifies for hedge accounting, and if so, whether it qualifies as a fair value hedge or a cash flow hedge. Gains and losses on derivatives designated as cash flow hedges, to the extent they are effective, are recorded in other comprehensive income, and subsequently reclassified to earnings to offset the impact of the hedged items when they occur. The net interest paid or received on interest rate swaps is recognized as interest expense. |
Noncontrolling Interests in Consolidated Entities | Noncontrolling Interests in Consolidated Entities The consolidated financial statements include all assets, liabilities, revenues and expenses of less than 100% owned entities that we control. Accordingly, we have recorded noncontrolling interests in the earnings and equity of such entities. |
Earning Per Share | We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding plus the dilutive effect of outstanding SARs, RSUs and PSUs, computed using the treasury stock method. |
Fair Value Measurements and Disclosures | Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”) emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy). Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment. |
Investment Securities | The investments of our insurance subsidiaries are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. |
Accounting Policies (Tables)
Accounting Policies (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Accounting Policies [Abstract] | |
Schedule of Revenues from Third Party Payers, Uninsured and Other Payers | Our revenues by primary third-party payer classification and other (including uninsured patients) for the years ended December 31, are summarized in the following table (dollars in millions): Years Ended December 31, 2023 Ratio 2022 Ratio 2021 Ratio Medicare $ 10,585 16.3 % $ 10,447 17.3 % $ 10,447 17.8 % Managed Medicare 10,496 16.2 9,201 15.3 8,424 14.3 Medicaid 3,606 5.6 2,636 4.4 2,290 3.9 Managed Medicaid 3,879 6.0 3,998 6.6 3,124 5.3 Managed care and other insurers 31,819 49.0 29,120 48.3 30,295 51.6 International (managed care and other insurers) 1,509 2.3 1,317 2.2 1,336 2.3 Other 3,074 4.6 3,514 5.9 2,836 4.8 Revenues $ 64,968 100.0 % $ 60,233 100.0 % $ 58,752 100.0 % |
Schedule of Estimated Cost of Uncompensated Care | A summary of the estimated cost of total uncompensated care for the years ended December 31, follows (dollars in millions): 2023 2022 2021 Patient care costs (salaries and benefits, supplies, other operating $ 55,341 $ 51,180 $ 49,074 Cost-to-charges ratio (patient care costs as percentage of gross 10.5 % 11.0 % 11.3 % Total uncompensated care $ 35,426 $ 31,734 $ 29,642 Multiply by the cost-to-charges ratio 10.5 % 11.0 % 11.3 % Estimated cost of total uncompensated care $ 3,720 $ 3,491 $ 3,350 |
Share-Based Compensation (Table
Share-Based Compensation (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Share-Based Payment Arrangement [Abstract] | |
Schedule of Fair Value of Each Stock Option Award is Estimated on Grant Date, Using Option Valuation Models | The expected dividend yield is estimated based on the assumption that the dividend yield at date of grant will be maintained over the expected life of the grant. 2023 2022 2021 Risk-free interest rate 3.69 % 1.64 % 0.68 % Expected volatility 36 % 34 % 36 % Expected life, in years 5.14 5.11 6.17 Expected dividend yield 0.95 % 0.95 % 1.10 % |
Schedule of Stock Appreciation Rights Activity | Information regarding Time SAR and Performance SAR activity during 2023, 2022 and 2021 is summarized below (share amounts in thousands): Time Performance Total Weighted Weighted Aggregate SARs outstanding, December 31, 2020 7,836 819 8,655 $ 91.53 Granted 877 — 877 174.98 Exercised ( 2,443 ) ( 533 ) ( 2,976 ) 67.57 Cancelled ( 108 ) — ( 108 ) 138.32 SARs outstanding, December 31, 2021 6,162 286 6,448 113.15 Granted 570 — 570 236.00 Exercised ( 660 ) ( 159 ) ( 819 ) 90.84 Cancelled ( 112 ) — ( 112 ) 182.87 SARs outstanding, December 31, 2022 5,960 127 6,087 126.38 Granted 580 — 580 253.49 Exercised ( 1,156 ) ( 83 ) ( 1,239 ) 95.29 Cancelled ( 59 ) — ( 59 ) 202.05 SARs outstanding, December 31, 2023 5,325 44 5,369 $ 146.46 5.5 years $ 667 SARs exercisable, December 31, 2023 3,748 44 3,792 $ 118.67 4.5 years $ 576 |
Schedule of Restricted Stock Units Activity | Information regarding RSU and PSU activity during 2023, 2022 and 2021 is summarized below (share amounts in thousands): RSUs PSUs Total RSUs Weighted RSUs and PSUs outstanding, December 31, 2020 2,476 2,592 5,068 $ 125.40 Granted 899 689 1,588 174.34 Performance adjustment — 684 684 102.02 Vested ( 992 ) ( 1,772 ) ( 2,764 ) 106.62 Cancelled ( 192 ) ( 110 ) ( 302 ) 149.07 RSUs and PSUs outstanding, December 31, 2021 2,191 2,083 4,274 150.32 Granted 611 455 1,066 235.71 Performance adjustment — 699 699 138.45 Vested ( 878 ) ( 1,399 ) ( 2,277 ) 138.41 Cancelled ( 140 ) ( 123 ) ( 263 ) 183.86 RSUs and PSUs outstanding, December 31, 2022 1,784 1,715 3,499 179.18 Granted 609 479 1,088 253.85 Performance adjustment — 697 697 144.42 Vested ( 717 ) ( 1,393 ) ( 2,110 ) 152.50 Cancelled ( 125 ) ( 88 ) ( 213 ) 217.78 RSUs and PSUs outstanding, December 31, 2023 1,551 1,410 2,961 $ 214.71 |
Income Taxes (Tables)
Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Income Tax Disclosure [Abstract] | |
Schedule of Provision for Income Taxes | The provision for income taxes consists of the following (dollars in millions): 2023 2022 2021 Current: Federal $ 1,118 $ 1,222 $ 1,769 State 213 206 311 Foreign 3 18 15 Deferred: Federal 241 261 24 State 21 27 ( 18 ) Foreign 19 12 11 $ 1,615 $ 1,746 $ 2,112 |
Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate | A reconciliation of the federal statutory rate to the effective income tax rate follows: 2023 2022 2021 Federal statutory rate 21.0 % 21.0 % 21.0 % State income taxes, net of federal tax benefit 2.6 2.3 2.0 Change in liability for uncertain tax positions 0.4 0.7 0.7 Tax benefit from settlements of employee equity awards ( 1.2 ) ( 0.9 ) ( 1.2 ) Other items, net 0.8 0.5 0.8 Effective income tax rate on income attributable to HCA Healthcare, Inc. 23.6 23.6 23.3 Income attributable to noncontrolling interests from consolidated partnerships ( 2.6 ) ( 3.3 ) ( 1.8 ) Effective income tax rate on income before income taxes 21.0 % 20.3 % 21.5 % |
Schedule of Deferred Tax Assets and Liabilities | A summary of the items comprising our deferred tax assets and liabilities at December 31 follows (dollars in millions): 2023 2022 Assets Liabilities Assets Liabilities Depreciation and fixed asset basis differences $ — $ 1,048 $ — $ 938 Allowances for professional liability and other risks 452 — 430 — Accounts receivable 363 — 368 — Compensation 308 — 402 — Right-of-use lease assets and obligations 506 492 451 438 Other 592 860 536 698 $ 2,221 $ 2,400 $ 2,187 $ 2,074 |
Schedule of Activity Related to our Gross Unrecognized Tax Benefits | The following table summarizes the activity related to our gross unrecognized tax benefits, excluding accrued interest of $ 177 million and $ 129 million as of December 31, 2023 and 2022, respectively (dollars in millions): 2023 2022 Balance at January 1 $ 639 $ 576 Additions based on tax positions related to the current year 30 25 Additions for tax positions of prior years 4 50 Reductions for tax positions of prior years ( 10 ) ( 4 ) Settlements — ( 1 ) Lapse of applicable statutes of limitations ( 24 ) ( 7 ) Balance at December 31 $ 639 $ 639 |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Earnings Per Share [Abstract] | |
Schedule of Computations of Basic and Diluted Earnings Per Share | The following table sets forth the computations of basic and diluted earnings per share for the years ended December 31, 2023, 2022 and 2021 (dollars and shares in millions, except per share amounts): 2023 2022 2021 Net income attributable to HCA Healthcare, Inc. $ 5,242 $ 5,643 $ 6,956 Weighted average common shares outstanding 272.404 290.348 323.315 Effect of dilutive incremental shares 4.008 4.318 5.437 Shares used for diluted earnings per share 276.412 294.666 328.752 Earnings per share: Basic earnings per share $ 19.25 $ 19.43 $ 21.52 Diluted earnings per share $ 18.97 $ 19.15 $ 21.16 |
Investments of Insurance Subs_2
Investments of Insurance Subsidiaries (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | A summary of the insurance subsidiaries’ investments at December 31 follows (dollars in millions): 2023 Unrealized Amortized Gains Losses Fair Debt securities $ 404 $ 1 $ ( 29 ) $ 376 Money market funds and other 188 — — 188 $ 592 $ 1 $ ( 29 ) 564 Amounts classified as current assets ( 87 ) Investment carrying value $ 477 2022 Unrealized Amortized Gains Losses Fair Debt securities $ 415 $ — $ ( 38 ) $ 377 Money market funds and other 96 — — 96 $ 511 $ — $ ( 38 ) 473 Amounts classified as current assets ( 92 ) Investment carrying value $ 381 |
Schedule of Maturities of Investments | Scheduled maturities of investments in debt securities at December 31, 2023 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 12 $ 12 Due after one year through five years 150 144 Due after five years through ten years 165 148 Due after ten years 77 72 $ 404 $ 376 |
Assets and Liabilities Measur_2
Assets and Liabilities Measured at Fair Value (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Fair Value Disclosures [Abstract] | |
Summary of Investments of Insurance Subsidiaries Measured at Fair Value on Recurring Basis | The following tables summarize the investments of our insurance subsidiaries measured at fair value on a recurring basis as of December 31, 2023 and 2022, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): 2023 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Debt securities $ 376 $ — $ 376 $ — Money market funds and other 188 188 — — Investments of insurance subsidiaries 564 188 376 — Less amounts classified as current assets ( 87 ) ( 87 ) — — $ 477 $ 101 $ 376 $ — NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued) 2022 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Debt securities $ 377 $ — $ 377 $ — Money market funds and other 96 96 — — Investments of insurance subsidiaries 473 96 377 — Less amounts classified as current assets ( 92 ) ( 92 ) — — $ 381 $ 4 $ 377 $ — |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | A summary of long-term debt at December 31, including related interest rates at December 31, 2023, follows (dollars in millions): 2023 2022 Senior secured asset-based revolving credit facility (effective interest rate of 6.7 %) $ 1,880 $ 2,900 Senior secured revolving credit facility — — Senior secured term loan facilities (effective interest rate of 6.8 %) 1,313 1,880 Other senior secured debt (effective interest rate of 4.1 %) 967 953 Senior secured debt 4,160 5,733 Senior unsecured notes (effective interest rate of 5.0 %) 35,766 32,652 Debt issuance costs and discounts ( 333 ) ( 301 ) Total debt (average life of 9.4 years, rates averaging 5.1 %) 39,593 38,084 Less amounts due within one year 2,424 370 $ 37,169 $ 37,714 |
Leases (Tables)
Leases (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Leases [Abstract] | |
Schedule of lease-related assets and liabilities | The following table presents our lease-related assets and liabilities at December 31, 2023 and 2022 (dollars in millions): Balance Sheet Classification 2023 2022 Assets: Operating leases Right-of-use operating lease assets $ 2,207 $ 2,065 Finance leases Property and equipment 556 587 Total lease assets $ 2,763 $ 2,652 Liabilities: Current: Operating leases Other accrued expenses $ 363 $ 364 Finance leases Long-term debt due within one year 166 131 Noncurrent: Operating leases Right-of-use operating lease obligations 1,903 1,752 Finance leases Long-term debt 541 579 Total lease liabilities $ 2,973 $ 2,826 Weighted-average remaining term: Operating leases 11.8 years 10.1 years Finance leases 9.0 years 9.5 years Weighted-average discount rate: Operating leases 4.9 % 4.4 % Finance leases 4.9 % 4.5 % |
Schedule of lease expense for finance and operating leases | 2023 2022 2021 Finance lease expense: Depreciation and amortization $ 164 $ 163 $ 135 Interest 31 29 29 Operating leases(1) 495 484 478 Short-term lease expense(1) 337 329 354 Variable lease expense(1) 162 163 157 $ 1,189 $ 1,168 $ 1,153 Expenses are included in “other operating expenses” in our consolidated income statements. |
Schedule of supplemental cash flow information | The following table presents supplemental cash flow information for the years ended December 31, 2023, 2022 and 2021 (dollars in millions): 2023 2022 2021 Cash paid for amounts included in the measurement of lease Operating cash flows for operating leases $ 479 $ 473 $ 474 Operating cash flows for finance leases 31 29 29 Financing cash flows for finance leases 140 124 123 NOTE 9 — LEASES (continued) |
Schedule of undiscounted cash flows to the finance lease liabilities and operating lease liabilities recorded on balance sheet | The following table reconciles the undiscounted minimum lease payment amounts to the operating and finance lease liabilities recorded on the balance sheet at December 31, 2023 and 2022 (dollars in millions): 2023 2022 Operating Finance Operating Finance Year 1 $ 452 $ 193 $ 436 $ 156 Year 2 394 155 380 164 Year 3 340 115 320 125 Year 4 288 60 269 89 Year 5 228 45 222 39 Thereafter 1,540 356 1,122 359 Total minimum lease payments 3,242 924 2,749 932 Less: amount of lease payments representing interest ( 976 ) ( 217 ) ( 633 ) ( 222 ) Present value of future minimum lease payments 2,266 707 2,116 710 Less: current lease obligations ( 363 ) ( 166 ) ( 364 ) ( 131 ) Long-term lease obligations $ 1,903 $ 541 $ 1,752 $ 579 |
Segment and Geographic Inform_2
Segment and Geographic Information (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Segment Reporting [Abstract] | |
Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization, Assets and Goodwill and Other Intangible Assets | The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions) and represent the operating segments under the January 1, 2023 reorganized segment structure: For the Year Ended December 31, 2023 2022 2021 Revenues: National Group $ 18,105 $ 16,767 $ 16,329 Atlantic Group 21,167 19,324 19,098 American Group 22,318 20,858 19,636 Corporate and other 3,378 3,284 3,689 $ 64,968 $ 60,233 $ 58,752 Equity in losses (earnings) of affiliates: National Group $ ( 2 ) $ ( 1 ) $ ( 33 ) Atlantic Group ( 3 ) ( 3 ) ( 2 ) American Group ( 59 ) ( 43 ) ( 50 ) Corporate and other 42 2 ( 28 ) $ ( 22 ) $ ( 45 ) $ ( 113 ) Adjusted segment EBITDA: National Group $ 4,000 $ 3,616 $ 4,202 Atlantic Group 4,492 3,881 4,218 American Group 5,208 5,102 4,836 Corporate and other ( 974 ) ( 532 ) ( 612 ) $ 12,726 $ 12,067 $ 12,644 Depreciation and amortization: National Group $ 834 $ 801 $ 754 Atlantic Group 989 921 848 American Group 971 937 897 Corporate and other 283 310 354 $ 3,077 $ 2,969 $ 2,853 NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION (continued) For the Year Ended December 31, 2023 2022 2021 Adjusted segment EBITDA $ 12,726 $ 12,067 $ 12,644 Depreciation and amortization 3,077 2,969 2,853 Interest expense 1,938 1,741 1,566 Losses (gains) on sales of facilities 5 ( 1,301 ) ( 1,620 ) Losses on retirement of debt — 78 12 Income before income taxes $ 7,706 $ 8,580 $ 9,833 December 31, 2023 2022 2021 Assets: National Group $ 12,487 $ 11,793 $ 11,236 Atlantic Group 16,098 15,092 13,944 American Group 19,786 17,934 17,224 Corporate and other 7,840 7,619 8,338 $ 56,211 $ 52,438 $ 50,742 National Atlantic American Corporate Total Goodwill and other intangible assets: Balance at December 31, 2020 $ 1,089 $ 1,375 $ 4,996 $ 1,118 $ 8,578 Acquisitions 126 610 66 260 1,062 Foreign currency translation, amortization and other ( 3 ) ( 15 ) — ( 82 ) ( 100 ) Balance at December 31, 2021 1,212 1,970 5,062 1,296 9,540 Acquisitions 75 90 90 7 262 Foreign currency translation, amortization and other ( 43 ) ( 3 ) — ( 103 ) ( 149 ) Balance at December 31, 2022 1,244 2,057 5,152 1,200 9,653 Acquisitions — 8 326 28 362 Foreign currency translation, amortization and other ( 3 ) ( 1 ) — ( 66 ) ( 70 ) Balance at December 31, 2023 $ 1,241 $ 2,064 $ 5,478 $ 1,162 $ 9,945 |
Other Comprehensive Loss (Table
Other Comprehensive Loss (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Equity [Abstract] | |
Components of Accumulated Other Comprehensive Loss | The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized Foreign Defined Change Total Balances at December 31, 2020 $ 25 $ ( 271 ) $ ( 220 ) $ ( 36 ) $ ( 502 ) Unrealized losses on available-for-sale securities, net 3 income tax benefit ( 13 ) ( 13 ) Foreign currency translation adjustments, net of $ 2 ( 7 ) ( 7 ) Defined benefit plans, net of $ 20 of income taxes 67 67 Change in fair value of derivative instruments 1 1 Expense reclassified into operations from other 7 and $ 8 income 21 29 50 Balances at December 31, 2021 12 ( 278 ) ( 132 ) ( 6 ) ( 404 ) Unrealized losses on available-for-sale securities, net 12 income tax benefit ( 43 ) ( 43 ) Foreign currency translation adjustments, net of $ 16 ( 95 ) ( 95 ) Defined benefit plans, net of $ 11 of income taxes 38 38 Change in fair value of derivative instruments, net of $ 1 5 5 Expense reclassified into operations from other 2 and $ 1 1 7 1 9 Balances at December 31, 2022 ( 30 ) ( 373 ) ( 87 ) — ( 490 ) Unrealized gains on available-for-sale securities, net 2 of income taxes 9 9 Foreign currency translation adjustments, net of $ 7 34 34 Defined benefit plans, net of $ 6 of income taxes 21 21 Expense (benefit) reclassified into operations from other no ne of income taxes 1 income tax benefit, respectively ( 1 ) 2 1 Balances at December 31, 2023 $ ( 22 ) $ ( 339 ) $ ( 64 ) $ — $ ( 425 ) |
Accrued Expenses (Tables)
Accrued Expenses (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Text Block [Abstract] | |
Summary of Other Accrued Expenses | A summary of other accrued expenses at December 31 follows (dollars in millions): 2023 2022 Professional liability risks $ 532 $ 515 Defined contribution benefit plans 668 612 Right-of-use operating leases 363 364 Taxes other than income 382 371 Interest 414 402 Employee medical benefits 199 182 Other 1,313 1,135 $ 3,871 $ 3,581 |
Accounting Policies - Additiona
Accounting Policies - Additional Information (Detail) | 1 Months Ended | 12 Months Ended | ||
Nov. 30, 2017 | Dec. 31, 2023 USD ($) Hospital EndoscopyCenter SurgeryCenter Claim State | Dec. 31, 2022 USD ($) Claim | Dec. 31, 2021 USD ($) | |
Summary Of Significant Accounting Policies [Line Items] | ||||
Number of owned and operated hospitals | Hospital | 186 | |||
Number of freestanding surgery centers | SurgeryCenter | 124 | |||
Number of freestanding endoscopy centers | EndoscopyCenter | 24 | |||
Number of facilities locations | State | 20 | |||
General and administrative expense | $ 315,000,000 | $ 307,000,000 | $ 337,000,000 | |
Adjustments to estimated reimbursement filed during respective year | 84,000,000 | 56,000,000 | 53,000,000 | |
Adjustments to estimated reimbursement filed during previous years | 58,000,000 | 42,000,000 | 19,000,000 | |
Estimated implicit price concessions recorded as reductions to revenues and accounts receivable | 7,283,000,000 | 6,780,000,000 | ||
Charity care amount | 14,425,000,000 | 13,615,000,000 | 13,644,000,000 | |
Estimated costs of charity care | 1,515,000,000 | 1,498,000,000 | $ 1,542,000,000 | |
Outstanding checks unpresented for payment | $ 600,000,000 | $ 656,000,000 | ||
Days revenues in accounts receivable | 53 days | 53 days | 49 days | |
Depreciation expense | $ 3,052,000,000 | $ 2,941,000,000 | $ 2,826,000,000 | |
Goodwill impairments | 0 | 0 | 0 | |
Goodwill acquired during period | 362,000,000 | 262,000,000 | ||
Intangible assets decreased due to amortization and other adjustments | 20,000,000 | 44,000,000 | ||
Gross carrying amount of intangible assets | 274,000,000 | 274,000,000 | ||
Accumulated amortization of intangible assets | 228,000,000 | 208,000,000 | ||
Gross carrying amount of indefinite-lived intangible assets | 293,000,000 | 293,000,000 | ||
Deferred loan costs | 559,000,000 | 496,000,000 | ||
Deferred loan costs, accumulated amortization | 226,000,000 | 195,000,000 | ||
Amortization of debt issuance costs | 35,000,000 | 29,000,000 | 27,000,000 | |
Reserves for professional liability risks | 2,089,000,000 | 2,043,000,000 | ||
Current portion of professional liability risks reserves | 532,000,000 | 515,000,000 | ||
Provisions for losses related to professional liability risks | 619,000,000 | 517,000,000 | 453,000,000 | |
Increase (decrease) in provisions for professional liability risks | $ 40,000,000 | $ (55,000,000) | $ (87,000,000) | |
Reserves for professional liability risks cover individual claims | Claim | 2,100 | 2,000 | ||
Net payments of professional and general liability claims | $ 550,000,000 | $ 497,000,000 | ||
Self-insured retention amount per occurrence | 15,000,000 | |||
Maximum amount losses per occurrence | 80,000,000 | |||
Reinsurance for professional liability risks retention minimum level of amount per occurrence | 25,000,000 | |||
Reinsurance for professional liability risks retention level of amount per occurrence | 35,000,000 | |||
Amounts receivable under reinsurance contracts recorded in other assets | 34,000,000 | 48,000,000 | ||
Amounts receivable under reinsurance contracts recorded in other current assets | 8,000,000 | 12,000,000 | ||
Foreign Currency Translation And Other [Member] | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Goodwill increase (decrease) | $ 50,000,000 | $ 105,000,000 | ||
Inpatient Services [Member] | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Performance obligations for inpatient/ outpatient services satisfied period | Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges | |||
Maximum [Member] | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Percentage of income of federal poverty level eligible for charity care | 400% | |||
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
Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Revenues From Third Party Payers [Line Items] | |||
Revenues | $ 64,968 | $ 60,233 | $ 58,752 |
Revenues ratio from third party payers | 100% | 100% | 100% |
Medicare [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 10,585 | $ 10,447 | $ 10,447 |
Revenues from third party payers, Ratio | 16.30% | 17.30% | 17.80% |
Managed Medicare [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 10,496 | $ 9,201 | $ 8,424 |
Revenues from third party payers, Ratio | 16.20% | 15.30% | 14.30% |
Medicaid [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 3,606 | $ 2,636 | $ 2,290 |
Revenues from third party payers, Ratio | 5.60% | 4.40% | 3.90% |
Managed Medicaid [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 3,879 | $ 3,998 | $ 3,124 |
Revenues from third party payers, Ratio | 6% | 6.60% | 5.30% |
Managed Care and Other Insurers [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 31,819 | $ 29,120 | $ 30,295 |
Revenues from third party payers, Ratio | 49% | 48.30% | 51.60% |
International (Managed Care and Other Insurers) [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues from third party payers | $ 1,509 | $ 1,317 | $ 1,336 |
Revenues from third party payers, Ratio | 2.30% | 2.20% | 2.30% |
Other [Member] | |||
Revenues From Third Party Payers [Line Items] | |||
Revenues | $ 3,074 | $ 3,514 | $ 2,836 |
Other, Ratio | 4.60% | 5.90% | 4.80% |
Accounting Policies - Schedul_2
Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Accounting Policies [Abstract] | |||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | $ 55,341 | $ 51,180 | $ 49,074 |
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) | 10.50% | 11% | 11.30% |
Total uncompensated care | $ 35,426 | $ 31,734 | $ 29,642 |
Multiply by the cost-to-charges ratio | 10.50% | 11% | 11.30% |
Estimated cost of total uncompensated care | $ 3,720 | $ 3,491 | $ 3,350 |
Share-Based Compensation - Addi
Share-Based Compensation - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Employee Stock Purchase Plan ("ESPP") [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Common stock were reserved for issuance | 13,784,000 | ||
Compensation expense | $ 17 | $ 16 | $ 15 |
Stock Appreciation Rights (SARs) | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Shares Available for Future Grants | 11,056,000 | ||
Weighted Average Fair Value of SARs Options Granted | $ 87.47 | $ 69.55 | $ 54.57 |
Total Intrinsic Value of SARs | $ 207 | $ 115 | $ 404 |
Unrecognized Compensation Cost Related to Nonvested Awards | 46 | ||
Restricted Stock Units and Performance Stock Units [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs, Vested, value | 550 | $ 550 | $ 475 |
Unrecognized Compensation Cost Related to Nonvested Awards | $ 274 |
Share-Based Compensation - Sche
Share-Based Compensation - Schedule of Fair Value of Each Stock Option Award is Estimated on Grant Date, Using Option Valuation Models (Detail) | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Share-Based Payment Arrangement [Abstract] | |||
Risk-free interest rate | 3.69% | 1.64% | 0.68% |
Expected volatility | 36% | 34% | 36% |
Expected life, in years | 5 years 1 month 20 days | 5 years 1 month 9 days | 6 years 2 months 1 day |
Expected dividend yield | 0.95% | 0.95% | 1.10% |
Share-Based Compensation - Sc_2
Share-Based Compensation - Schedule of Stock Appreciation Rights Activity (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
SARs Options outstanding, Weighted Average Exercise Price, Beginning Balance | $ 126.38 | $ 113.15 | $ 91.53 |
Granted, Weighted Average Exercise Price | 253.49 | 236 | 174.98 |
Exercised, Weighted Average Exercise Price | 95.29 | 90.84 | 67.57 |
Cancelled, Weighted Average Exercise Price | 202.05 | 182.87 | 138.32 |
SARs Options outstanding, Weighted Average Exercise Price, Ending Balance | 146.46 | $ 126.38 | $ 113.15 |
SARs Options exercisable, Weighted Average Exercise Price | $ 118.67 | ||
SARs Options outstanding, Weighted Average Remaining Contractual Term | 5 years 6 months | ||
SARs Options exercisable, Weighted Average Remaining Contractual Term | 4 years 6 months | ||
SARs Options outstanding, Aggregate Intrinsic Value | $ 667 | ||
SARs Options exercisable, Aggregate Intrinsic Value | $ 576 | ||
Time SARs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
SARs Options Outstanding, Beginning Balance | 5,960 | 6,162 | 7,836 |
Granted, SARs Options | 580 | 570 | 877 |
Exercised, SARs Options | (1,156) | (660) | (2,443) |
Cancelled, SARs Options | (59) | (112) | (108) |
SARs Options Outstanding, Ending Balance | 5,325 | 5,960 | 6,162 |
SARs Options Exercisable, Ending Balance | 3,748 | ||
Performance SARs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
SARs Options Outstanding, Beginning Balance | 127 | 286 | 819 |
Granted, SARs Options | 0 | 0 | 0 |
Exercised, SARs Options | (83) | (159) | (533) |
Cancelled, SARs Options | 0 | 0 | 0 |
SARs Options Outstanding, Ending Balance | 44 | 127 | 286 |
SARs Options Exercisable, Ending Balance | 44 | ||
Total SARs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
SARs Options Outstanding, Beginning Balance | 6,087 | 6,448 | 8,655 |
Granted, SARs Options | 580 | 570 | 877 |
Exercised, SARs Options | (1,239) | (819) | (2,976) |
Cancelled, SARs Options | (59) | (112) | (108) |
SARs Options Outstanding, Ending Balance | 5,369 | 6,087 | 6,448 |
SARs Options Exercisable, Ending Balance | 3,792 |
Share-Based Compensation - Sc_3
Share-Based Compensation - Schedule of Restricted Stock Units Activity (Detail) - $ / shares shares in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Restricted Stock Units (RSUs) [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs Outstanding, Beginning Balance | 1,784 | 2,191 | 2,476 |
RSUs and PSUs, Granted | 609 | 611 | 899 |
Performance adjustment | 0 | 0 | 0 |
RSUs and PSUs, Vested | (717) | (878) | (992) |
RSUs and PSUs, Cancelled | (125) | (140) | (192) |
RSUs and PSUs Outstanding, Ending Balance | 1,551 | 1,784 | 2,191 |
Performance Shares PSUs [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs Outstanding, Beginning Balance | 1,715 | 2,083 | 2,592 |
RSUs and PSUs, Granted | 479 | 455 | 689 |
Performance adjustment | 697 | 699 | 684 |
RSUs and PSUs, Vested | (1,393) | (1,399) | (1,772) |
RSUs and PSUs, Cancelled | (88) | (123) | (110) |
RSUs and PSUs Outstanding, Ending Balance | 1,410 | 1,715 | 2,083 |
Restricted Stock Units and Performance Stock Units [Member] | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
RSUs and PSUs Outstanding, Beginning Balance | 3,499 | 4,274 | 5,068 |
RSUs and PSUs, Granted | 1,088 | 1,066 | 1,588 |
Performance adjustment | 697 | 699 | 684 |
RSUs and PSUs, Vested | (2,110) | (2,277) | (2,764) |
RSUs and PSUs, Cancelled | (213) | (263) | (302) |
RSUs and PSUs Outstanding, Ending Balance | 2,961 | 3,499 | 4,274 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Beginning balance | $ 179.18 | $ 150.32 | $ 125.4 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Granted | 253.85 | 235.71 | 174.34 |
Performance adjustment | 144.42 | 138.45 | 102.02 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Vested | 152.5 | 138.41 | 106.62 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Cancelled | 217.78 | 183.86 | 149.07 |
Weighted Average Grant Date Fair Value, RSUs and PSUs, Ending balance | $ 214.71 | $ 179.18 | $ 150.32 |
Acquisitions and Dispositions -
Acquisitions and Dispositions - Additional Information (Detail) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 USD ($) Hospital | Dec. 31, 2022 USD ($) | Dec. 31, 2021 USD ($) Hospital | |
Business Acquisition [Line Items] | |||
Pretax gain (loss) before tax | $ (5) | ||
Proceeds from sale of business | 193 | $ 1,237 | $ 2,160 |
Real Estate and Other Investments [Member] | |||
Business Acquisition [Line Items] | |||
Pretax gain (loss) before tax | 274 | 394 | |
Pretax gain (loss) after tax | $ 200 | $ 294 | |
Discontinued Operation, Gain (Loss) on Disposal, Statement of Income or Comprehensive Income [Extensible Enumeration] | Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property | Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property | |
Proceeds from sale of business | 31 | $ 326 | $ 658 |
Discontinued Operations, Disposed of by Sale [Member] | |||
Business Acquisition [Line Items] | |||
Pretax gain (loss) before tax | 1,027 | ||
Pretax gain (loss) after tax | $ 527 | ||
Discontinued Operation, Gain (Loss) on Disposal, Statement of Income or Comprehensive Income [Extensible Enumeration] | Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property | ||
Proceeds from sale of business | $ 911 | ||
Hospital Facility [Member] | |||
Business Acquisition [Line Items] | |||
Aggregate purchase price | $ 229 | $ 67 | |
Number of hospitals purchased | Hospital | 4 | 2 | |
Proceeds from sale of business | $ 162 | ||
Number of hospitals sold | Hospital | 2 | ||
Hospital Facility [Member] | Southern Georgia [Member] | |||
Business Acquisition [Line Items] | |||
Number of hospitals purchased | Hospital | 1 | ||
Hospital Facility [Member] | TENNESSEE | |||
Business Acquisition [Line Items] | |||
Number of hospitals purchased | Hospital | 1 | ||
Hospital Facility [Member] | Discontinued Operations, Disposed of by Sale [Member] | Southern Georgia [Member] | |||
Business Acquisition [Line Items] | |||
Number of hospitals sold | Hospital | 2 | ||
Hospital Facility [Member] | Discontinued Operations, Disposed of by Sale [Member] | GEORGIA | |||
Business Acquisition [Line Items] | |||
Pretax gain (loss) before tax | $ 1,226 | ||
Pretax gain (loss) after tax | $ 920 | ||
Discontinued Operation, Gain (Loss) on Disposal, Statement of Income or Comprehensive Income [Extensible Enumeration] | Gain (Loss) on Disposition of Property Plant Equipment, Excluding Oil and Gas Property and Timber Property | ||
Proceeds from sale of business | $ 1,502 | ||
Number of hospitals sold | Hospital | 5 | ||
Hospital Facility [Member] | Discontinued Operations, Disposed of by Sale [Member] | Northern Georgia [Member] | |||
Business Acquisition [Line Items] | |||
Number of hospitals sold | Hospital | 3 | ||
Nonhospital Health Care [Member] | |||
Business Acquisition [Line Items] | |||
Aggregate purchase price | $ 406 | 224 | $ 114 |
Fair value of the noncontrolling interest in the acquiree at the acquisition date | 72 | 117 | |
Other [Member] | |||
Business Acquisition [Line Items] | |||
Goodwill | $ 362 | $ 262 | 1,002 |
Urgent Care Centers [Member] | |||
Business Acquisition [Line Items] | |||
Aggregate purchase price | 594 | ||
Home Health and Hospice [Member] | |||
Business Acquisition [Line Items] | |||
Fair value of the noncontrolling interest in the acquiree at the acquisition date | 100 | ||
Payment to acquire venture providing post acute care services | $ 330 | ||
Business acquisition percentage of voting interests acquired | 80% |
Income Taxes - Schedule of Prov
Income Taxes - Schedule of Provision for Income Taxes (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Income Tax Disclosure [Abstract] | |||
Current, Federal | $ 1,118 | $ 1,222 | $ 1,769 |
Current, State | 213 | 206 | 311 |
Current, Foreign | 3 | 18 | 15 |
Deferred, Federal | 241 | 261 | 24 |
Deferred, State | 21 | 27 | (18) |
Deferred, Foreign | 19 | 12 | 11 |
Provision for income taxes | $ 1,615 | $ 1,746 | $ 2,112 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Income Tax Contingency [Line Items] | |||
Provision for tax benefits related to settlement of employee awards | $ 93 | $ 77 | $ 119 |
Foreign pretax income | 85 | 66 | $ 64 |
State net operating loss carryforwards | 28 | ||
Federal net operating loss carryforwards | 189 | ||
Unrecognized tax benefits, accrued interest | 177 | 129 | |
Unrecognized tax benefits that would impact effective tax rate | $ 320 | $ 278 | |
State and Local Jurisdiction [Member] | Minimum [Member] | |||
Income Tax Contingency [Line Items] | |||
Net operating loss carryforwards, expiration date | 2024 | ||
State and Local Jurisdiction [Member] | Maximum [Member] | |||
Income Tax Contingency [Line Items] | |||
Net operating loss carryforwards, expiration date | 2042 |
Income Taxes - Schedule of Reco
Income Taxes - Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate (Detail) | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Income Tax Disclosure [Abstract] | |||
Federal statutory rate | 21% | 21% | 21% |
State income taxes, net of federal tax benefit | 2.60% | 2.30% | 2% |
Change in liability for uncertain tax positions | 0.40% | 0.70% | 0.70% |
Tax benefit from settlements of employee equity awards | (1.20%) | (0.90%) | (1.20%) |
Other items, net | 0.80% | 0.50% | 0.80% |
Effective income tax rate on income attributable to HCA Healthcare, Inc. | 23.60% | 23.60% | 23.30% |
Income attributable to noncontrolling interests from consolidated partnerships | (2.60%) | (3.30%) | (1.80%) |
Effective income tax rate on income before income taxes | 21% | 20.30% | 21.50% |
Income Taxes - Schedule of Defe
Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Income Tax Disclosure [Abstract] | ||
Depreciation and fixed asset basis differences, Assets | $ 0 | $ 0 |
Allowances for professional liability and other risks, Assets | 452 | 430 |
Accounts receivable, Assets | 363 | 368 |
Compensation, Assets | 308 | 402 |
Right-of-use lease obligations | 506 | 451 |
Other, Assets | 592 | 536 |
Deferred tax assets | 2,221 | 2,187 |
Depreciation and fixed asset basis differences, Liabilities | 1,048 | 938 |
Allowances for professional liability and other risks, Liabilities | 0 | 0 |
Accounts receivable, Liabilities | 0 | 0 |
Compensation, Liabilities | 0 | 0 |
Right-of-use lease assets and obligations | 492 | 438 |
Other, Liabilities | 860 | 698 |
Deferred tax liabilities | $ 2,400 | $ 2,074 |
Income Taxes - Schedule of Acti
Income Taxes - Schedule of Activity Related to Unrecognized Tax Benefits (Detail) - USD ($) $ in Millions | 12 Months Ended | |
Dec. 31, 2023 | Dec. 31, 2022 | |
Income Tax Disclosure [Abstract] | ||
Beginning Balance | $ 639 | $ 576 |
Additions based on tax positions related to the current year | 30 | 25 |
Additions for tax positions of prior years | 4 | 50 |
Reductions for tax positions of prior years | (10) | (4) |
Settlements | 0 | (1) |
Lapse of applicable statutes of limitations | (24) | (7) |
Ending Balance | $ 639 | $ 639 |
Earnings Per Share - Additional
Earnings Per Share - Additional information (Detail) - shares | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Earnings Per Share [Abstract] | |||
Repurchase of common stock, shares | 14,465,000 | 30,747,000 | 37,812,000 |
Earnings Per Share - Schedule o
Earnings Per Share - Schedule of Computations of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Earnings Per Share [Abstract] | |||
Net income attributable to HCA Healthcare, Inc. | $ 5,242 | $ 5,643 | $ 6,956 |
Weighted average common shares outstanding | 272,404 | 290,348 | 323,315 |
Effect of dilutive incremental shares | 4,008 | 4,318 | 5,437 |
Shares used for diluted earnings per share | 276,412 | 294,666 | 328,752 |
Basic earnings per share | $ 19.25 | $ 19.43 | $ 21.52 |
Diluted earnings per share | $ 18.97 | $ 19.15 | $ 21.16 |
Investments of Insurance Subs_3
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Debt Securities, Available-for-sale [Line Items] | ||
Amounts classified as current assets | $ (87) | $ (92) |
Investment carrying value | 477 | 381 |
Money market funds and other, Amortized Cost | 188 | 96 |
Money market funds and other, Unrealized Gains | 0 | 0 |
Money market funds and other, Unrealized Losses | 0 | 0 |
Money market funds and other, Fair Value | 188 | 96 |
Investment Owned, at Cost, Total | 592 | 511 |
Investment Gains | 1 | 0 |
Investment Losses | 29 | 38 |
Investment Fiar Value | 564 | 473 |
Debt Securities [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 404 | 415 |
Unrealized Amounts, Gains | 1 | 0 |
Unrealized Amounts, Losses | (29) | (38) |
Fair Value | $ 376 | $ 377 |
Investments of Insurance Subs_4
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions | Dec. 31, 2023 USD ($) |
Investments, Debt and Equity Securities [Abstract] | |
Due in one year or less, Amortized Cost | $ 12 |
Due after one year through five years, Amortized Cost | 150 |
Due after five years through ten years, Amortized Cost | 165 |
Due after ten years, Amortized Cost | 77 |
Amortized Cost, Total | 404 |
Due in one year or less, Fair Value | 12 |
Due after one year through five years, Fair Value | 144 |
Due after five years through ten years, Fair Value | 148 |
Due after ten years, Fair Value | 72 |
Fair Value, Total | $ 376 |
Investments of Insurance Subs_5
Investments of Insurance Subsidiaries - Additional Information (Detail) | 12 Months Ended |
Dec. 31, 2023 | |
Investments, Debt and Equity Securities [Abstract] | |
Available for sale securities expected maturity of debt securities | 5 years 1 month 6 days |
Available for sale securities average scheduled maturity | 8 years 9 months 18 days |
Financial Instruments - Effect
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Derivative Instruments, Gain (Loss) [Line Items] | |||
Amount of Loss Recognized in OCI on Derivatives, Net of Tax | $ 0 | $ (6) | $ (1) |
Assets and Liabilities Measur_3
Assets and Liabilities Measured at Fair Value - Summary of Investments of Insurance Subsidiaries Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Money market funds and other | $ 188 | $ 96 |
Investments of insurance subsidiaries | 564 | 473 |
Less amounts classified as current assets | (87) | (92) |
Asset fair value | 477 | 381 |
Quoted Prices in Active Markets for Identical Assets (Level 1) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Money market funds and other | 188 | 96 |
Investments of insurance subsidiaries | 188 | 96 |
Less amounts classified as current assets | (87) | (92) |
Asset fair value | 101 | 4 |
Significant Other Observable Inputs (Level 2) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Investments of insurance subsidiaries | 376 | 377 |
Asset fair value | 376 | 377 |
Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt securities | 376 | 377 |
Debt Securities [Member] | Significant Other Observable Inputs (Level 2) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt securities | $ 376 | $ 377 |
Assets and Liabilities Measur_4
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Fair Value Disclosures [Abstract] | ||
Estimated fair value of long-term debt | $ 38,253 | $ 35,555 |
Carrying amounts of debt | $ 39,926 | $ 38,385 |
Long-Term Debt - Schedule of Lo
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Debt Instrument [Line Items] | ||
Senior secured debt | $ 4,160 | $ 5,733 |
Debt issuance costs and discounts | (333) | (301) |
Total debt (average life of 9.4 years, rates averaging 5.1%) | 39,593 | 38,084 |
Less amounts due within one year | 2,424 | 370 |
Long-term debt | 37,169 | 37,714 |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 1,880 | 2,900 |
Senior Secured Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 0 | 0 |
Senior Secured Term Loan Facilities [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 1,313 | 1,880 |
Other Senior Secured Debt [Member] | ||
Debt Instrument [Line Items] | ||
Other senior secured debt | 967 | 953 |
Senior Unsecured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior unsecured notes | $ 35,766 | $ 32,652 |
Long-Term Debt - Schedule of _2
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) | 12 Months Ended |
Dec. 31, 2023 | |
Debt Instrument [Line Items] | |
Total debt average term | 9 years 4 months 24 days |
Total debt average rate | 5.10% |
Senior Secured Asset-Based Revolving Credit Facility [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 6.70% |
Senior Secured Term Loan Facilities [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 6.80% |
Other Senior Secured Debt [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 4.10% |
Senior Unsecured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 5% |
Long-Term Debt - Additional Inf
Long-Term Debt - Additional Information (Detail) | 12 Months Ended |
Dec. 31, 2023 USD ($) | |
Debt Instrument [Line Items] | |
Maturity of long-term debt in 2025 | $ 4,672,000,000 |
Maturity of long-term debt in 2026 | 5,350,000,000 |
Maturity of long-term debt in 2027 | 2,408,000,000 |
Maturity of long-term debt in 2028 | $ 2,545,000,000 |
Minimum [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, maturities range | 2025 |
Maximum [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, maturities range | 2028 |
Federal Fund Rate [Member] | |
Debt Instrument [Line Items] | |
Debt instrument basis spread | 0.50% |
Asset-Based Revolving Credit Facility Maturing on June 28, 2022 [Member] | |
Debt Instrument [Line Items] | |
Maximum borrowing capacity | $ 4,500,000,000 |
Percentage of senior secured credit facility over eligible accounts receivable | 85% |
Senior Secured Revolving Credit Facility Maturing On June 28, 2022 [Member] | |
Debt Instrument [Line Items] | |
Maximum borrowing capacity | $ 3,500,000,000 |
Asset Based Revolving Credit Facility Maturing On June Thirty Two Thousand Twenty Six [Member] | |
Debt Instrument [Line Items] | |
Debt instrument maturity date | Jun. 30, 2026 |
Line of credit outstanding | $ 1,880,000,000 |
Senior Secured Revolving Credit Facility Maturing On June Thirty Two Thousand Twenty Six [Member] | |
Debt Instrument [Line Items] | |
Debt instrument maturity date | Jun. 30, 2026 |
Line of credit facility | $ 3,500,000,000 |
Line of credit outstanding | 0 |
Asset Based Revolving Credit Facility Maturing On June Thirty Two Thousand Twenty Six One [Member] | |
Debt Instrument [Line Items] | |
Maximum borrowing capacity | $ 1,313,000,000 |
Debt instrument maturity date | Jun. 30, 2026 |
Senior Secured Term Loan B Facility [Member] | |
Debt Instrument [Line Items] | |
Increase in revolving credit facility | $ 1,500,000,000 |
Senior Unsecured Note Maturities Ranging 2024 to 2053 [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, principal amount | $ 35,041,000,000 |
Senior Unsecured Note Maturities Ranging 2024 to 2053 [Member] | Minimum [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, maturities range | 2024 |
Senior Unsecured Note Maturities Ranging 2024 to 2053 [Member] | Maximum [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, maturities range | 2053 |
Medium-term Notes Maturity Year 2025 [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, principal amount | $ 125,000,000 |
Debentures Maturities Ranging 2024 to 2095 [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, principal amount | $ 600,000,000 |
Debentures Maturities Ranging 2024 to 2095 [Member] | Minimum [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, maturities range | 2024 |
Debentures Maturities Ranging 2024 to 2095 [Member] | Maximum [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, maturities range | 2095 |
Senior Notes [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, principal amount | $ 3,250,000,000 |
Senior Notes [Member] | Senior Notes Due 2028 [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, principal amount | $ 1,000,000,000 |
Debt instrument, stated interest | 5.20% |
Senior Notes [Member] | Senior Notes Due 2033 [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, principal amount | $ 1,250,000,000 |
Debt instrument, stated interest | 5.50% |
Senior Notes [Member] | Senior Notes Due 2053 [Member] | |
Debt Instrument [Line Items] | |
Debt instrument, principal amount | $ 1,000,000,000 |
Debt instrument, stated interest | 5.90% |
Other Senior Secured Debt [Member] | |
Debt Instrument [Line Items] | |
Finance leases and other secured debt | $ 967,000,000 |
Leases - Schedule Of Lease-Rela
Leases - Schedule Of Lease-Related Assets And Liabilities (Detail) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Assets: | ||
Operating leases | $ 2,207 | $ 2,065 |
Finance leases | 556 | 587 |
Total lease assets | $ 2,763 | $ 2,652 |
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration] | Property, Plant and Equipment, Net | Property, Plant and Equipment, Net |
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration] | Operating leases | Operating leases |
Liabilities | ||
Operating leases | $ 363 | $ 364 |
Finance leases | 166 | 131 |
Right-of-use operating lease obligations | 1,903 | 1,752 |
Finance leases | 541 | 579 |
Total lease liabilities | $ 2,973 | $ 2,826 |
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration] | Less amounts due within one year | Less amounts due within one year |
Operating Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration] | Other Accrued Liabilities, Current | Other Accrued Liabilities, Current |
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration] | Long-Term Debt, Excluding Current Maturities | Long-Term Debt, Excluding Current Maturities |
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration] | Right-of-use operating lease obligations | Right-of-use operating lease obligations |
Weighted-average remaining term: | ||
Operating leases | 11 years 9 months 18 days | 10 years 1 month 6 days |
Finance leases | 9 years | 9 years 6 months |
Weighted-average discount rate: | ||
Operating leases | 4.90% | 4.40% |
Finance leases | 4.90% | 4.50% |
Leases - Schedule Of Lease Expe
Leases - Schedule Of Lease Expense For Finance And Operating Leases (Detail) - USD ($) $ in Millions | 12 Months Ended | |||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | ||
Finance lease expense: | ||||
Depreciation and amortization | $ 164 | $ 163 | $ 135 | |
Interest | 31 | 29 | 29 | |
Operating leases | [1] | 495 | 484 | 478 |
Short-term lease expense | [1] | 337 | 329 | 354 |
Variable lease expense | [1] | 162 | 163 | 157 |
Total lease expense | $ 1,189 | $ 1,168 | $ 1,153 | |
[1] Expenses are included in “other operating expenses” in our consolidated income statements. |
Leases - Schedule Of Supplement
Leases - Schedule Of Supplemental Cash Flow Information (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Cash Paid For Amounts Included In Measurement Of Lease Liabilities [Abstract] | |||
Operating cash flows for operating leases | $ 479 | $ 473 | $ 474 |
Operating cash flows for finance leases | 31 | 29 | 29 |
Financing cash flows for finance leases | $ 140 | $ 124 | $ 123 |
Leases - Schedule of undiscount
Leases - Schedule of undiscounted cash flows to the finance lease liabilities and operating lease liabilities (Detail) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Operating Lease Liabilities, Payments Due [Abstract] | ||
Year 1 | $ 452 | $ 436 |
Year 2 | 394 | 380 |
Year 3 | 340 | 320 |
Year 4 | 288 | 269 |
Year 5 | 228 | 222 |
Thereafter | 1,540 | 1,122 |
Total minimum lease payments | 3,242 | 2,749 |
Less: amount of lease payments representing interest | (976) | (633) |
Present value of future minimum lease payments | 2,266 | 2,116 |
Less: current obligations under leases | (363) | (364) |
Long-term lease obligations | 1,903 | 1,752 |
Finance Lease Liabilities, Payments, Due [Abstract] | ||
Year 1 | 193 | 156 |
Year 2 | 155 | 164 |
Year 3 | 115 | 125 |
Year 4 | 60 | 89 |
Year 5 | 45 | 39 |
Thereafter | 356 | 359 |
Total minimum lease payments | 924 | 932 |
Less: amount of lease payments representing interest | (217) | (222) |
Present value of future minimum lease payments | 707 | 710 |
Less: current obligations under leases | (166) | (131) |
Long-term lease obligations | $ 541 | $ 579 |
Capital Stock - Additional Info
Capital Stock - Additional Information (Detail) $ / shares in Units, $ in Millions | 12 Months Ended | ||||||||
Dec. 31, 2023 USD ($) $ / shares Directors shares | Dec. 31, 2022 $ / shares shares | Dec. 31, 2021 $ / shares shares | Jan. 31, 2024 USD ($) | Jan. 31, 2023 USD ($) | Jan. 31, 2022 USD ($) | Feb. 28, 2021 USD ($) | Jan. 31, 2020 USD ($) | Jan. 31, 2019 USD ($) | |
Capital Structure [Line Items] | |||||||||
Common stock, shares authorized | shares | 1,800,000,000 | 1,800,000,000 | |||||||
Repurchase of common stock, shares | shares | 14,465,000 | 30,747,000 | 37,812,000 | ||||||
Repurchase price of common stock, per share | $ / shares | $ 263.47 | $ 227.67 | $ 217.25 | ||||||
Board of Directors Chairman [Member] | |||||||||
Capital Structure [Line Items] | |||||||||
Share repurchase program authorized amount | $ | $ 775 | $ 3,000 | $ 8,000 | $ 6,000 | $ 2,000 | $ 2,000 | |||
Subsequent Event [Member] | Board of Directors Chairman [Member] | |||||||||
Capital Structure [Line Items] | |||||||||
Share repurchase program authorized amount | $ | $ 6,000 | ||||||||
Minimum [Member] | |||||||||
Capital Structure [Line Items] | |||||||||
Number of directors as per the amended and restated by-laws | Directors | 3 |
Employee Benefit Plans - Additi
Employee Benefit Plans - Additional Information (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Defined Contribution Benefit Plans [Member] | |||
Pension Plans, Postretirement and Other Employee Benefits [Line Items] | |||
Percentage of employer contribution to match participant contribution in defined contribution plan, net | 100% | ||
Benefits expense of defined benefit plans | $ 659 | $ 606 | $ 560 |
Defined benefit plan cost (credit) | 2 | (11) | 4 |
Defined benefit plan, assets | $ 43 | 9 | |
Defined Contribution Benefit Plans [Member] | Minimum [Member] | |||
Pension Plans, Postretirement and Other Employee Benefits [Line Items] | |||
Percentage of employer contribution to match participant contribution in defined contribution plan | 3% | ||
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% | ||
Restoration Plan [Member] | |||
Pension Plans, Postretirement and Other Employee Benefits [Line Items] | |||
Number of hours of service required to qualify for the plan | 1,000 or more | ||
Noncontributory and nonqualified plan, benefit expense | $ 40 | (27) | 38 |
Noncontributory and nonqualified plan, accrued benefits liabilities | 227 | 210 | |
Supplemental Executive Retirement Plan [Member] | |||
Pension Plans, Postretirement and Other Employee Benefits [Line Items] | |||
Defined benefit plan cost (credit) | 10 | 22 | $ 22 |
Defined benefit plan obligation | $ 106 | $ 137 |
Segment and Geographic Inform_3
Segment and Geographic Information - Additional Information (Detail) | Dec. 31, 2023 Hospital |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 186 |
Reorganization Group [Member] | National Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 57 |
Reorganization Group [Member] | American Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 60 |
Reorganization Group [Member] | Atlantic Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 62 |
Reorganization Group [Member] | Corporate and Other [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 7 |
Segment and Geographic Inform_4
Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization, Assets and Goodwill and Other Intangible Assets (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Segment Reporting Information [Line Items] | |||
Revenues | $ 64,968 | $ 60,233 | $ 58,752 |
Equity in losses (earnings) of affiliates | (22) | (45) | (113) |
Adjusted segment EBITDA | 12,726 | 12,067 | 12,644 |
Depreciation and amortization | 3,077 | 2,969 | 2,853 |
Interest expense | 1,938 | 1,741 | 1,566 |
Losses (gains) on sales of facilities | 5 | (1,301) | (1,620) |
Losses on retirement of debt | 0 | 78 | 12 |
Income before income taxes | 7,706 | 8,580 | 9,833 |
Assets | 56,211 | 52,438 | 50,742 |
Goodwill and other intangible assets, Beginning Balance | 9,653 | 9,540 | 8,578 |
Goodwill and other intangible assets, Acquisitions | 362 | 262 | 1,062 |
Foreign Currency Translation Amortization And Other | (70) | (149) | (100) |
Goodwill and other intangible assets, Ending Balance | 9,945 | 9,653 | 9,540 |
National Group [Member] | |||
Segment Reporting Information [Line Items] | |||
Revenues | 18,105 | 16,767 | 16,329 |
Equity in losses (earnings) of affiliates | (2) | (1) | (33) |
Adjusted segment EBITDA | 4,000 | 3,616 | 4,202 |
Depreciation and amortization | 834 | 801 | 754 |
Assets | 12,487 | 11,793 | 11,236 |
Goodwill and other intangible assets, Beginning Balance | 1,244 | 1,212 | 1,089 |
Goodwill and other intangible assets, Acquisitions | 0 | 75 | 126 |
Foreign Currency Translation Amortization And Other | (3) | (43) | (3) |
Goodwill and other intangible assets, Ending Balance | 1,241 | 1,244 | 1,212 |
Atlantic Group [Member] | |||
Segment Reporting Information [Line Items] | |||
Revenues | 21,167 | 19,324 | 19,098 |
Equity in losses (earnings) of affiliates | (3) | (3) | (2) |
Adjusted segment EBITDA | 4,492 | 3,881 | 4,218 |
Depreciation and amortization | 989 | 921 | 848 |
Assets | 16,098 | 15,092 | 13,944 |
Goodwill and other intangible assets, Beginning Balance | 2,057 | 1,970 | 1,375 |
Goodwill and other intangible assets, Acquisitions | 8 | 90 | 610 |
Foreign Currency Translation Amortization And Other | (1) | (3) | (15) |
Goodwill and other intangible assets, Ending Balance | 2,064 | 2,057 | 1,970 |
American Group [Member] | |||
Segment Reporting Information [Line Items] | |||
Revenues | 22,318 | 20,858 | 19,636 |
Equity in losses (earnings) of affiliates | (59) | (43) | (50) |
Adjusted segment EBITDA | 5,208 | 5,102 | 4,836 |
Depreciation and amortization | 971 | 937 | 897 |
Assets | 19,786 | 17,934 | 17,224 |
Goodwill and other intangible assets, Beginning Balance | 5,152 | 5,062 | 4,996 |
Goodwill and other intangible assets, Acquisitions | 326 | 90 | 66 |
Foreign Currency Translation Amortization And Other | 0 | 0 | 0 |
Goodwill and other intangible assets, Ending Balance | 5,478 | 5,152 | 5,062 |
Corporate and Other [Member] | |||
Segment Reporting Information [Line Items] | |||
Revenues | 3,378 | 3,284 | 3,689 |
Equity in losses (earnings) of affiliates | 42 | 2 | (28) |
Adjusted segment EBITDA | (974) | (532) | (612) |
Depreciation and amortization | 283 | 310 | 354 |
Assets | 7,840 | 7,619 | 8,338 |
Goodwill and other intangible assets, Beginning Balance | 1,200 | 1,296 | 1,118 |
Goodwill and other intangible assets, Acquisitions | 28 | 7 | 260 |
Foreign Currency Translation Amortization And Other | (66) | (103) | (82) |
Goodwill and other intangible assets, Ending Balance | $ 1,162 | $ 1,200 | $ 1,296 |
Other Comprehensive Loss - Comp
Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Equity [Abstract] | |||
Unrealized gains (losses) on available-for-sale securities, beginning balances | $ (30) | $ 12 | $ 25 |
Unrealized gains (losses) on available-for-sale securities, net of income taxes | 9 | (43) | (13) |
Unrealized gains (losses) on available-for-sale securities, expense (benefit) reclassified into operations from other comprehensive income, net of income tax benefit | (1) | 1 | |
Unrealized gains (losses) on available-for-sale securities, ending balances | (22) | (30) | 12 |
Foreign currency translation adjustments, beginning balances | (373) | (278) | (271) |
Foreign currency translation adjustments, net of income tax benefit | 34 | (95) | (7) |
Foreign currency translation adjustments, ending balances | (339) | (373) | (278) |
Defined benefit plans, beginning balances | (87) | (132) | (220) |
Defined benefit plans, net of income taxes | 21 | 38 | 67 |
Defined benefit plans, expense (benefit) reclassified into operations from other comprehensive income | 2 | 7 | 21 |
Defined benefit plans, ending balances | (64) | (87) | (132) |
Change in fair value of derivative instruments, beginning balances | 0 | (6) | (36) |
Change in fair value of derivative instruments, net of income taxes | 5 | 1 | |
Change in fair value of derivatives instruments, (income) expense (benefit) reclassified into operations from other comprehensive income | 1 | 29 | |
Change in fair value of derivative instruments, ending balances | 0 | 0 | (6) |
Accumulated other comprehensive loss, net of tax, beginning balances | (490) | (404) | (502) |
Unrealized gains (losses) on available-for-sale securities, net of income taxes | 9 | (43) | (13) |
Foreign currency translation adjustments, net of income tax benefit | 34 | (95) | (7) |
Change in fair value of derivative instruments, net of income tax benefit | 5 | 1 | |
Defined benefit plans, net of income tax benefit | 21 | 38 | 67 |
Expense (benefit) reclassified into operations from other comprehensive income, Total | 1 | 9 | 50 |
Accumulated other comprehensive loss, net of tax, ending balances | $ (425) | $ (490) | $ (404) |
Other Comprehensive Loss - Co_2
Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Equity [Abstract] | |||
Unrealized gains (losses) on available-for-sale securities, tax benefit | $ 12 | $ 3 | |
Unrealized gains (losses) on available-for-sale securities, tax expense | $ 2 | ||
Foreign currency translation adjustments, income tax benefit | 16 | 2 | |
Foreign currency translation adjustments, income tax expense | 7 | ||
Defined benefit plans, income tax expense | 6 | 11 | 20 |
Change in fair value of derivative instruments, income tax expense | 1 | ||
Defined benefit plans, benefit reclassified into operations from other comprehensive income | 0 | 2 | 7 |
Interest expense on derivative instruments, benefit reclassified into operations from other comprehensive income | $ 1 | $ 1 | $ 8 |
Accrued Expenses - Summary of O
Accrued Expenses - Summary of Other Accrued Expenses (Detail) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Payables and Accruals [Abstract] | ||
Professional liability risks | $ 532 | $ 515 |
Defined contribution benefit plans | 668 | 612 |
Right-of-use operating leases | 363 | 364 |
Taxes other than income | 382 | 371 |
Interest | 414 | 402 |
Employee medical benefits | 199 | 182 |
Other | 1,313 | 1,135 |
Other accrued expenses | $ 3,871 | $ 3,581 |