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How to Evaluate Build vs. Buy Decisions for Health AI Using a Risk Ledger

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OpenAI's July 23, 2026 announcement of a Health feature in ChatGPT has prompted product teams to reassess whether to build or purchase AI-powered health tools. A structured risk-and-economics ledger is proposed as the evaluation framework, measuring cost per safely completed user task rather than simple monthly software expenditure. The approach requires teams to clear non-negotiable gates covering user consent, clinical boundaries, data portability, and incident ownership before any scoring begins. Sample calculations illustrate that build and buy options can produce nearly identical costs, meaning small shifts in usage volume, exit effort, or unresolved risks can easily tip the decision either way. Teams that cannot adequately staff safety and compliance obligations are advised to treat doing nothing as a legitimate and preferred option.

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How to Evaluate Build vs. Buy Decisions for Health AI Using a Risk Ledger · ShortSingh