Emerging shadow health systems: regulating health-focused generative AI chatbots from a European perspective

ChatGPT Health and other health-focused generative AI chatbots increasingly function as alternative first points of contact that may mediate-and in some cases substitute-engagement with regulated healthcare systems. At scale, these systems can shape care-seeking behavior, system capacity, trust in clinical expertise, and health equity. We describe this development as the emergence of shadow health systems: privately governed infrastructures that perform health-system functions without being subject to healthcare-specific safeguards. EU law currently regulates such tools based on declared medical purpose rather than their real-world effects, creating gaps in legal protection. This Policy Brief examines the public health implications and regulatory positioning of health-focused generative AI chatbots in Europe and proposes targeted reforms to address emerging governance gaps.