Type of Care

General Health Care

Mental/Substance-Use Health Care



patient privacy and confidentiality, but more-protective state statutes take precedence.




The use of electronic health records, decision support, and other information technology (IT) applications is growing.

IT is less well developed and less commonly used for clinical care support.


Only physicians and certain advanced practice nurses generally are licensed to diagnose and treat.

A more diverse workforce is licensed to diagnose and treat, including psychologists, psychiatrists, other physicians, social workers, psychiatric nurses, marriage and family therapists, addiction therapists, and a variety of counselors with different education and certification requirements.

Marketplace and insurance coverage

Private insurance and Medicare dominate purchasing.

State and local governments (including Medicaid) dominate purchasing.


Care is typically covered by insurance. Copayments are lower, and more visits/days of care are covered.

Insurance provides less coverage. Copayments are higher, and fewer visits/days of care and therapies are covered.


Non-M/SU specialty care is purchased under the same contract as primary care.

M/SU insurance coverage is purchased separately (“carved out”) from general health care.

Diagnostic Methods

Compared with general health care, relatively few laboratory, imaging, or other physical findings can be used to diagnose mental illnesses or substance dependence.1 Accurate diagnosis instead relies primarily on clinical


Substance use, but not dependence, can be detected by laboratory tests.

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